[Health] RESMED APAP tuning

[sleeper2460]

[attachment=60310][attachment=60310][attachment=60310][attachment=60310]     Attached is OSCAR data from 2-27-24, I would appreciate an evaluation  with any tips to improve my therapy. Currently stuck in the AHI 6 range and can't figure out how to get better. Sleep doctor is not much help.

     Resmed Autosense 11 Autoset
     Pressure 8-19 cmh20 
     EPR 3

[gainerfull]

It looks like you're experiencing positional apnea and your base pressure minus EPR is not offering you great support.

Recommendations:

1. Try using a thinner & softer pillow so you don't kink your neck

2. If that doesn't work, consider wearing a soft cervical collar to prevent your chin from dropping. I like this one: https://www.amazon.com/Velpeau-Brace-Foa...69WFJ?th=1

[sleeper2460]

Thanks for the input. I do sleep on my right side, but had not considered the pillow issue. I'll try a straighter neck with a softer pillow and let you know in a few days.

[sleeper2460]

Wanted to wait to get a few days data, but last nights was so dramatic I think it might be worth looking at. The only intentional change I made was to use a flat pillow and use a soft collar. AHI went from 6.98 to 12.89. Lots of hyponeas and obstructives. Any thoughts?

[sleeper2460]

Attached are my results from the last few days. I started using a flatter pillow, a soft collar and staying on my right side. The results are not very good. Any tips on how to do better?

[TechieHippie]

That's discouraging, but don't give up. It's still looking positional, or like you are unable to breathe in that position (or aren't breathing with the high pressure). Is your left side any better than the right? Any idea what position you were in after 3am on the night of March 1st?

Make sure your collar isn't tight. Maybe try it so loose you are pretty sure it won't do much. Also...Positional isn't always about your neck; the jaw and tongue contribute as well. I've had good luck with a pillow that has a thicker edge up against my shoulder to support my jaw. For me it's not just about thickness but really tucking it up against me so my jaw doesn't sag. Mouth tape helps me a lot too, but that's usually with a nasal mask. I have used under a full-face mask but it seems to impact the seal.

I don't know why your EPR isn't showing on the pressure graph. I do notice though that your pressure jumps up right away when ramp is done. You could try a higher minimum pressure so that you start off with the support you need.

Have you ever tried a nasal mask? It is better for a lot of people, if you don't have to breathe through your mouth.

Hopefully others have more ideas.

Lisa

[G. Szabo]

I also used an FF mask and slept on my side with a collar. Nevertheless, the AHI was better when I decided to tape my mouth because taping controls your tongue. Use a simple medical tape about 1/2" wide vertically from the base of your nose down under your chin. Its objective is not to seal your mouth but to prevent jaw-dropping.   
Also, higher moisture settings helped. Now, I am on level 6.
Left-side sleep is considered better. 
Ask someone to check your neck and spine position when you are on your side. The pillow should ensure no break in your spine. It would be best if you avoided both thick and thin pillows.

[sleeper2460]

Attached are my reports for the last 3 days. I stopped using the soft collar and the results are much better. I guess that says my collar didn't fit well. Still using a flatter pillow and staying on my right side. Today's report shows clusters of events. Based on previous evaluations I think that means a positional issue. If I could get consistently under 5, that would probably be a good goal. 
     Thanks for the responses. Any additional comments????

[BoxcarPete]

Your EPR is still ramp only. Try enabling it full-time at 3cm H2O, the pressure support provided may help clean up your flow limits, which have been a significant, if not major, problem for you in all your charts so far.

[sleeper2460]

Got it. Thanks. I'll give that a try-3, full time EPR