Getting below 5 AHI

[AGNineOne]

Hey all! Info bomardment incoming but I'm hoping it's useful to you.

I've been on CPAP treatment now for around 3-4 months and still struggling to get below 5 AHI. My initial sleep study diagnosis was mild obstructive sleep apnea with an AHI of 18.5.

I've tried numerous masks and somewhat settled on 2 that I have the most comfort with; the F30i and N30i.

My preferece would be the N30i but I dislike mouth taping due to the residue and pain of tearing off the 3m micropore tape in the morning, so I've been using the F30i.

I've tried wedge pillows (I just keep sliding off the pillow and putting myself in a bad position), soft cervical collars (didn't help and tend to make my neck stiff in the morning for some reason) and "CPAP pillows" all to no avail.

I would say I'm primarily a back sleeper but have been making a concious effort to sleep on my side most recently. I suffer from pretty bad aeraphagia when my pressure reaches 11, so I've been trying to start low and ease my way up. I had a couple of nights back to back which were below 5 AHI but I had an insane leak rate and can't seem to mimic it without the leaks. My leak rate looks pretty bad on my most recent chart but I'm still experimenting on perfecting it. It's dropped a lot since.

I've used APAP in the past with an 8-15 pressure range and the 99.5% pressure number is 12.5.

Anyhow, please see my most recent chart below and any input would be greatly appreciated.

   

[staceyburke]

You are having positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[CPAPfriend]

Those apneas may not necessarily be due to positional apnea, so it's certainly possible it's contributing. It would help to post screenshots of up-close sections so that the CAs and OAs can be reviewed with greater deal. For example, it's possible those CAs are just post-arousal CAs, and therefore not suggesting a CO2 issue.

[Phaleronic]

Welcome to the forum AGNineOne,

The first half of that chart looks fantastic, you're doing well.

The other half and your sleep chart were the issues cropped up, but it's not a trend so we will need more charts please. You're on the correct path sidesleeping as best you can and using flat pillows.

I wanted to zoom in on the sections where the CAs and OAs overlap to see what is really happening but for now since you're using EPR at 3 fulltime and 9cm of static you please need to turn pressure up to 13cm or turn off EPR and set to 10cm, EPR off will help with the CAs and the OAs.

[AGNineOne]

You are having positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

Thank you for the feedback. I haven't changed my sleeping positions besides attempting to sleep on my side more often than my back and I've used a lot of pillows but for the past few weeks, it's only been the same two. Bear in mind, the results from this chart are generally where I sit 90% of the time. I purchased a collar a couple of days ago and used it but it didn't seem to help at all (was at 8+ AHI) but I'm assuming it'll take some getting used to.

Those apneas may not necessarily be due to positional apnea, so it's certainly possible it's contributing. It would help to post screenshots of up-close sections so that the CAs and OAs can be reviewed with greater deal. For example, it's possible those CAs are just post-arousal CAs, and therefore not suggesting a CO2 issue.

Thank you for the feedback. I've took the same chart and had a zoom in on a couple of areas. If this isn't what you meant, please let me know so I can post it.


   

   

Welcome to the forum AGNineOne,

The first half of that chart looks fantastic, you're doing well.

The other half and your sleep chart were the issues cropped up, but it's not a trend so we will need more charts please.  You're on the correct path sidesleeping as best you can and using flat pillows.

I wanted to zoom in on the sections where the CAs and OAs overlap to see what is really happening but for now since you're using EPR at 3 fulltime and 9cm of static you please need to turn pressure up to 13cm or turn off EPR and set to 10cm, EPR off will help with the CAs and the OAs.

Thank you for the feedback. I'll post charts from a couple of nights previous to the above. Regarding turning the pressure up, I get slight aerophagia even on 9cm static and going above 11cm on EPR 3 gives me insane aches in the morning, so unless there's a solution to that problem, I'm unfortunately not willing to go up to 13cm as it's unbearable.

---

As above, charts from a couple of nights earlier.

Overall night:

   


The larger cluster towards end of night:

   

[Deborah K.]

It may be that the cervical collar you bought is not the right size for you.  It needs to be high enough to hold your chin up, and not very snug, as it would need to be for a neck injury, but snug enough to keep your chin up.  That is what's needed to correct positional apnea.