Help dialing in

[Stillglade]

I would love help dialing in my treatment.

I had a sleep study on Nov 9 2023 and the main results were:

Study Overview:

The study began (Lights Out) at 9:40:22 PM. The study ended (Lights On) at 6:26:04 AM. The patient was monitored for a
total of 525.7 minutes.

Respiratory Data:

A total of 301 apnea events occurred for an apnea index of 34.4/hour. 38 hypopnea events occurred for a hypopnea index of
4.3/hour. 339 apnea and hypopnea events were observed during the analysis period as follows, 301 obstructive apneas, 0
central apneas, O mixed apneas, and 38 hypopneas for an apnea/hypopnea index of 38.7/hour. The AHI while supine was
38.9/hour.
There were 165 oxygen desaturations that occurred during the study. Desaturations were based on 4% or greater drop from
baseline. The lowest Sp02 was 82% with an average of 93%. Last, the minimum Sp02 value associated with a respiratory
event was 82%. The amount of time with S 02 <90% was 13.2 minutes (2.5%).

I have now been using a ResMed AirSense 11 with almost out of the box settings (ramp turned off, min pressure set to 5) for about a month. I started with nasal pillow style but switched to full face mask and that has helped.

While my AHI is no longer 38.7, it is still often in the 3 - 7 range.

I use a SleepNumber bed which basically tracks movement and I wear an Apple Watch Series 8 which tracks breathing and heart rate and have included those charts from last night. I have also included the OSCAR chart from last night. Any suggestions on how to get my AHI down would be welcome.

Ben

[Sleeprider]

Stillglade, with a pressure range of 5-20, EPR 3, you will need a higher minimum pressure to capture the OA events we see in the chart. I'm going to suggest you turn off ramp and set minimum pressure to 7.0. This will make the minimum pressure with EPR 7.0/4.0 which will make the machine more responsive when responding to obstruction. We have to control OA events with a higher EPAP and the way your Autoset is setup, the EPAP will not rise until you reach 7+ cm of pressure. This may be the reason you re missing so many obstructive events. The clusters of apnea suggest there may also be a positional issue discussed in our wiki here https://www.apneaboard.com/wiki/index.ph...onal_Apnea Be sure to check for pillows too tall or firm and avoid sleeping position that cause chin-tucking or a bend in the head neck position.

[Stillglade]

Ok, I made the setting you suggested and things have improved over the last few nights.

I also noticed I was getting a bit too warm at night and made some changes. First, I swapped my sheets for 100% cotton sheets. Also, I changed the climate setting from Auto to Manual and adjusted the humidity down one step from 4 to 3. This also helped so that my cheeks on the inside of the mask didn't get damp causing the mask to slide.

As for the chin tucking, I was conscious of keeping my head back on the pillow.

My SleepNumber result was the best I have ever seen (a 97 score showing only 30 mins total of restlessness and 7h 52m restful sleep) and my Apple Health showed only 1 min total awake. Attached is the OSCAR chart from last night.

AHI 1.66 is about the lowest I have seen in a very long time. Does it get better?

Thanks for the help!!!!
Ben

[Sleeprider]

Events are still clustered, but your AHI is more than acceptable. When it comes to positional apnea, the use of a soft cervical collar is a trade-off of fewer events for more crap and possible discomfort, so I'm all in on your decision to continue without it. Your results look great. I use a medium fill down pillow, and if I feel like I'm getting out of position, the pillow is very adjustable, and I can pull a corner between my shoulder and jaw to act similarly to a collar. Anyway, your changes have made the machine more responsive and is seems you are sleeping better and are more comfortable. That is always a good outcome.