APAP to VAuto not going well

[snapperzz]

I have used an autopap machine for 17 years. I have been very compliant and would say I have loved my apap (Remstar Auto System One). It averaged a 16 pressure.  I recently had a new sleep study showing I had 78% hypoapenas, the rest obstructive, no central. AHI of 46 in the study. They put me on a bipap. I ended up sleeping on my stomach for some of the study which is not my normal sleeping position and now I wonder if it impacted it negatively.

I bought an Aircurve 10, but it is not going well. I am not getting restful sleep. I wake up more frequently. I am waking up with a sweaty neck like before I used CPAP. I am falling asleep during the day.  It has been awful.  I was started on 13/17 set pressure.  I have adjusted it to see if I can get better results with a higher upper range, increased sensitivity, etc. but it is still not helping.  Instead of being excited to sleep, I am dreading it now.  I would love any tips. Attached are two Oscar screenshots. One is on the initial setting and one is on the most recent setting.   Any ideas what I should try? I am on the verge of going back to the old machine to get some sleep.   

I really appreciate your help.  I need some restful sleep.

[Sleeprider]

Both graphs are the same and show positional apnea. These clusters of OA may respond to higher pressure, but you should make sure you do what you can to prevent airway obstruction by avoiding tall or firm pillows or an inclined sleeping position. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

It would help to know more about your CPAP therapy. You say you used 16 pressure, and were you using EPR? Anyway, let's change your settings a bit:
Mode: Vauto (provides automatic pressure adjustment to help with obstruction)
EPAP min: 13
Max IPAP pressure: 20.0
PS: 4.0

These settings put your device in Vauto mode rather than fixed pressure, with the same minimum EPAP and pressure support as you currently have (17/13), and can increase pressure up to a maximum 20/16 pressure. This gets you on par with the higher CPAP settings you had before and should help with the apnea.

[snapperzz]

I am sorry that I uploaded the wrong second screen shot. Here it is. I had made similar changes that you recommended and am still not getting good results.  So do you think it is positional and I should try to address that?

[SarcasticDave94]

Novice guy Dave thinks that looks like a Positional Apnea pattern of clustered flags. This Positional Apnea means you're probably chin tucking.

[UnicornRider]

Definitely a pattern appearing that is suggestive of Positional Apnea very possibly Chin Tuck. The link provided in post #2 by Sleeeprider is a valid starting point. After you have viewed that link, try this on SCC.   https://www.apneaboard.com/wiki/index.ph...cal_Collar 


 If you have any questions post back.

[Phaleronic]

I had a rough time moving over to an autobipap, eventually I went back to cpap and sleep is good, if you need a break from the vauto I'd go back to the original machine for a bit.

[Sleeprider]

I have to ask whether you have used a lower pressure range in the past. In some rare cases, obstructive apnea can become worse when pressure is too high. Our normal response to OA events is to increase pressure and try to better stent the airway. You are using EPAP min 14.0 with PS 4 which results in a maximum pressure of 20/16 with your settings. I'm just looking for some history to decide the way forward. I continue to see your issue as positional based on the clustered events.