Guide me to a better CPAP life

[kinghuzi]

Hi Forum members,

I have been diagnosed with Severe obstructive sleep apnea with 84 AHI and min 02 52. I have started CPAP for the last 10 days and have been using it religiously.

I have a Autosense 10 Auto.

Pressure currently: 9-20
Ramp: off
ERP: 2
Heated tubing and humidifier
Resmed N30i

I started with 6-16 and increased the lower and upper. I am hoping to get some guidance on how I can improve my AHI. Last few days of data.

[staceyburke]

On the 24 and again on the 26 it looks like you have positional problems, maybe chin tuck. When ever you get into a position where it blocks breathing the machine is not of much use. The machine can correct the throat closing from different problems but not you cutting off your oxygen. Many people have this problem and it shows up with "clusters of events" - 3 or more right next to each other. One of the best ways to combat this is changing your sleep position - from back to side. If that does not work a http://www.apneaboard.com/wiki/index.php...cal_Collar is used. Cut and past this into your browser and you can read about collars. Also you can search for cervical collar.

Notice after 5:45 on the 26th you basically have no more events...

[mesenteria]

In your second chart, if you sweep your eyes from each blip/event in light blue in the top 'Flow Rates' chart (obstructive events) down to the flow limitations, you'll see that in almost every case they are commensurate.  So, you are having flow limitations which cause the machine to note, and to depict in the charts, events it says are obstructive in nature, and not just hypopneas or central apneas.

It isn't clear from this chart what is going on, but the other two, as staceyburke says above, suggest that there might be some chin-tucking going on.  This is very common.  When we see this, it's an indication that you are probably migrating from one stage of sleep to another, perhaps even relaxing more, and your body sags to the point where your head is propped up more in orientation and your chin is forced toward your chest.  This happens much more in the supine position than it does on one's side, but it does also happen on one's side, particularly with hard/large pillows.

The remedy is to either learn to sleep differently (stay off your back to the extent possible), or use a lower/softer pillow, or use a soft foam cervical collar that can be had for between $8-20, depending on brand and features.  Plus shipping, probably.

This is just our best guess.  We can't be there, using sophisticated detection devices, to monitor what happens to you as the sleeping hours progress.

There is also some substantial leaking going on, and twice you removed your mask at or at the end of such leaks.  Was the machine recording you lifting your mask, or did you cause a leak at which you became sufficiently alert and removed your mask in annoyance or to go to the John?  We dunno.

[Sleeprider]

Good suggestions above. Your minimum pressure is 9.0, but your median pressure is over 12.0, so I think we may need to increase the minimum pressure. I'd also like to increase EPR (exhale pressure relief) to 3 which will help with the flow limits. You clearly have what we refer to as positional apnea. There are two wikis I want you to read that include examples of other members and how they solved the problem.
Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar http://www.apneaboard.com/wiki/index.php...cal_Collar

Try a minimum pressure of 10 or 11 and move EPR to 3.

[kinghuzi]

Really appreciate all the feedback. Am still going through the answers but the theme seems to be positional apnea/chin tuck. 

Before I go down the path of collar, I would like to try a better pillow. 

Currently I am using the below pillow:

Therapillo Cooling Gel Top Premium Memory Foam Medium Profile PillowsizeMedium

I am 5'9 and 124KG and shave my head. 

What would be a recommended CPAP pillow that would work best in my situation.

[staceyburke]

Question- did you say your oxygen was at 52?

[kinghuzi]

Yes I'm Aquaman

[staceyburke]

I have been on oxygen with CPAP for over 10 years and my average has never been that low. My Dr set 88% as my minimum. If it dropped for a couple minutes that is ok but it needs to get back up quickly. You need a nighttime O2 study. Not a big thing, they just check out a Oximeter for you to wear at home and bring it back to them. With numbers like that, you really need it checked out!!  If you need O2 at night insurance takes care of the cost.

There are also inexpensive Oximeter you can get from eBay or Amazon for less than100. And keep track of it yourself. Cms 50f is what I have and it works well.

[kinghuzi]

This was a pharmacy home study and I'm skeptical if it was very accurate. I do have a full sleep study planned in a month's time which should shed more light.

[Sleeprider]

Really appreciate all the feedback. Am still going through the answers but the theme seems to be positional apnea/chin tuck. 

Before I go down the path of collar, I would like to try a better pillow. 

Currently I am using the below pillow:

Therapillo Cooling Gel Top Premium Memory Foam Medium Profile PillowsizeMedium

I am 5'9 and 124KG and shave my head. 

What would be a recommended CPAP pillow that would work best in my situation.

Pillows are certainly a matter of personal preference. I am your weight, a little taller, and shave parts of my face.  

I use a good quality goose down pillow from Pacific Coast Feather Co.  It's a medium fill and of course it compresses under my head and I can pull it over my shoulder, under my jaw and I don't get chin-tuck.  Just sayin'.  I think memory foam is the devil's spawn.