[CPAP] Am I Doing it Right?

[huebarkeepdolt]

I'll up the minimum pressure but as has been pointed out, most events seem to happen when I'm already at higher pressure but hopefully this will restore the feeling I've gotten used to.

I think last night was one of the first times I've felt my sleep being disturbed (I'm usually dead to the world within a few minutes of putting my head down) but I imagine that's because the EPR 'feels' different.  There have been other nights recently where my AHI has been as high (example posted below) and it does appear that 'clustering' is a feature on those high days.

I avoided going all out and buying special pillows and other gadgets when I got my CPAP as I wanted to see how I got on.  I like to sleep on my side but occasionally move to my back to relieve pressure points.  I've always used two pillows, a 'hard' one to give me elevation and a softer one on top.  It took me quite a while to get my headgear settings 'dialled in' to stop the mask pulling away and blowing into my eyes.  Any suggestions?  Can certainly look at collars if they actually help.

Also, what is the difference between a 'hypopnea' and an 'obstructive' event?

Finally, is there a way to switch the 'Profile: <name>' off in the title bar of OSCAR, I've used my name so would rather not edit it out each time I post an image.

[upsman]

Your events are mainly obstructive and seem to be caused in part by your sleeping positions. Raising the minimum pressure to 7 should alleviate most of these events. 
Obstructive apneas are where the airway is completely closed due to the collapse of the soft palate on the airway. PAP splints the airway open eliminating arousal. 
Hypopneas, on the other hand, is when your airway is only partially blocked but you don't stop breathing. 

Using two pillows may be the cause of some of your positional apneas. The flatter your head is, the less likely your airway would be "kinked" or obstructed. Some people find special CPAP pillows work for them, but my personal experience has been that they are way too firm for my liking and they are fairly expensive. A soft cervical collar would definitely help with the positioning of your neck and chin. 

Is your full name appearing on your OSCAR charts? If this is your issue, you can edit your profile within OSCAR to just show your first name, or whatever name you want. I can't see any security or privacy issues here, though.

Here's some good info that may help you get a better mask fit.
http://www.apneaboard.com/wiki/index.php/Mask_Primer

[Crimson Nape]

. . . what is the difference between a 'hypopnea' and an 'obstructive' event?

Apnea: 80% to 100% reduction in airflow for >= 10 seconds
Hypopnea: 50% to 80% reduction in airflow for >= 10 seconds
Flow Limitation: <50% reduction in airflow for >= 10 seconds

Also, this Wiki article will go into more detail: http://www.apneaboard.com/wiki/index.php...Rate_graph

[CorruptAlligator]

You don't need to buy a special pillow. You want your head to not tilt forward due to thick pillows. Cheapest pillows out there are the thinnest, and they keep your head and neck aligned to prevent in head tilting that can kink the neck to cause obstructions.

If you are using thick pillows that may cause head tilting (chin-tuck) that in the middle of the night (you may not think you tilt your head, but you never know what actually goes on when you are asleep), try something lower profile or use one pillow if using two.

The more guaranteed method would be getting a soft cervical collar.

Also, body position can cause this as well. If you are sleeping on your back, try sleeping on your side. This is what I mean by 'circumstantial.' One night, you may have been sleeping on your side, and another on your back at the start. Or you tucked your chin due to the pillow. Those are things that can happen.

CPAP helps to some degree, but there are external factors that CPAP cannot overcome.

3 things to try.

1. Try sleeping on the side
2. Use a shallower pillow (for supine), little more thickness is better for side sleeping. The issue is if you go on supine sometimes in the middle of the night, so you have to choose the right compromise.
3. try a soft cervical collar

I recommend trying a shallow enough pillow that works well for both side and supine if you tend to go on supine in the middle of the night. And combine that with a soft cervical collar. Soft cervical collar can help reduce flow limitations. And I'm pretty sure sleeping on the side will reduce flow limitations as well.

[huebarkeepdolt]

You may have had a bad nights sleep BUT not because of changing the EPR

EPR is exhale pressure relief meaning it lowers the exhale pressure nothing more. You have the min at 4 and 4 is the absolute lowest it can be set so… min 4 - EPR 3 still = 4.  You would HAVE TO raise the min above 4 to make ANY difference in pressure settings.

That is why we suggested min 7. Min 7 - EPR 3 =4. The same exhale pressure you have now.

Re-vamping this thread.

So, following this message I set my minimum pressure to 7.  I have decided to review my results after six months because I am convinced I have not been sleeping as well.  I loaded all of my data into OSCAR and there is a distinct jump in AHI immediately after changing my settings.  In particular the number of H and OA events has gone up.  Take a look at the picture... You can see it quite clearly from 26 June when I changed the settings.

Is this something to do with EPR?  I've attached a few nights as well.

Have I made a mistake here and set the wrong thing!

[huebarkeepdolt]

Just adding another screen shot to the above.  A jump of AHI from 1.85 to 2.82 when I changed EPR from Ramp Only 1 to Full Time 3 and increased min pressure to 7.

I haven't yet got a collar.  I wanted some of the ones recommended on here but they all seem to be permanently out of stock in the UK.  I find sleeping with a single pillow extremely uncomfortable but will give it a go!

I'm more curious why the setting change has caused a jump in AHI.  I would have expected AHI to stay the same if position is my issue?

EDIT: Does http://www.apneaboard.com/forums/Thread-...9#pid63409 explain what I am seeing?