DanEm [Therapy Thread]

[DanEm]

I have been struggling since February to improve my therapy results.
I got a significant improvement in June when I started using a MAD (mandibular advancement device).

But I still have inconsistent results.

You can see what I mean on the last 7 days screenshots I am including.

Because the file is to heavy for here, you can safely download it at the following address:
https://fromsmash.com/2eVxf8r9OW-it

The conditions for the 7 days are all the same:

1. Pressure settings 10/20. I did try before a CPAP pressure setting of 5/15 and the results were way off.
   
2. Same mask.
   
3. Use of MAD.
   
4. Wearing a rigid cervical collar (my head cannot tilt forward).
   
5. Always go to sleep on my left side.
   
6. Always wake up on my back.
   
7. Very little movements during night (the sheets are never messed up in the morning).
   

As for my medical condition, these are the major points worth knowing:

1. About 30 years ago I got an operation to eliminate/reduce my snoring. My tonsils and uvula were removed and they remove part of my soft palate.
   
2. For more than 30 years have been taking medication for pressure, cholesterol, nervousness and anxiety. 
   
3. I am a smoker recently trying to quit. (I have reduced my consumption from +25/day to now ~15/day.)
   
4. I weight 230 lbs. and measure 5' 8"
   

Following discussions here I am now trying to get a by-level machine.
It is required I have a medical prescription and have sent a formal request to my lung specialist.
I did talk to her a while back about such a change of machine, but she was not very receptive.
I am waiting for a reply to my last request.

I do not understand why I get those inconsistent results when conditions do not change.
Maybe I am wrong but I doubt positional apnea is the culprit (rigid collar).

I will very gladly receive comments and/or suggestions.

[Crimson Nape]

You already have a therapy thread started. I am merging this into that one. I have also dropped the last portion of its title, so it now is, DanEm [therapy thread]. This will be more inclusive.

[Gideon]

I am not convinced your positional issue is resolved. I evaluated your weeks of data and that was my conclusion, along with the need for a VAuto without having reviewed your history until after. So I don't think your rigid cervical collar is doing the job. Where is the collar pressing? and do try another collar.

[DanEm]

Thanks Gideon.

Maybe you are right about the collar not doing the job.

The collar I am referring to can be seen on Amazon at this address:

https://www.amazon.ca/gp/product/B0187EV...=UTF8&th=1

The rigid part circles the neck and is resting on my collar bone (I think it's the name).
There is a V dip on the side up where my chin rests.
I really cannot bend my head forward when I wear it and it is comfortable to keep for the entire night.

If I would try to get another, I really don't know what kind I should be looking for.
There are bigger ones but reading about them does not confirm they can be worn for sleep.

I have checked the forum for evaluations of such devices without finding something I could use.

Which collar could keep my head straight, not bending, to better serve the purpose of limiting positional apnea than the one I have? 
Do I have to keep buying them until I find the right one?  This could be a very long process.

The VAuto comes from comments of Sleeprider.

I'm impressed with the improvement from earlier threads I saw. It seems you still have some positional related flow limitation that drives your pressures higher and in this case increased events at the onset. Your pressure remains high for the remainder of the night. Looks good, and I don't know that you could do more without transitioning to an Aircurve Vauto.

I am trying to get one.

If it would be useful, I can zip my data and post a link to download the file.

[Gideon]

I see too possibilities.

It is too tight and as such is impinging on the neck restricting your airway, or
It is not tall enough.

FYI I wouldn't classify that as a rigid cervical collar, they use a fiberglass shell with a much thinner pad for comfort.

[DanEm]

As I tried to explain, I tighten the collar enough but not to be uncomfortable.
When I breath with the collar on, I don't feel any restriction. The air gets in and out as normal.

For the height, I bought the one that fits my neck's circumference (X-large).

When I say my head cannot tilt forward, there is really no space or slack.  If I force my head forward, the chin is immediately blocked by the collar resting on my collar-bone.

The collar could not be any taller than what it is. It would push my chin up.

I used the word rigid because the plate inside is quite tough. Pliable to follow the neck circumference but not vertically.

I don't know of any other model that would do the job.
If you have info about a better type, please send it.

BTW, it's not me on the photo 

[DanEm]

Hi all 

I did get many comments on this subject and recommendations to change my CPAP for a bi-level machine.

In short, unless I get a prescription, I can not get such machine.
I started trying to convince my lung specialist to issue the prescription.
It appears it will be an uphill battle that I am not certain I can win.
I could not find a supplier in Canada or the US that do not require such prescription.
I even searched eBay without success.

So, one more time, I have gathered samples of my Oscar results for August trying to show the good and bad ones.

I would really appreciate you would go through the attached files and confirm that the only way I can improve my sleep is with a bi-level machine.

Any comments will be greatly appreciated.