Help Optimizing!

[dneal12]

Some background on me:
5'6" 240lb male

My first sleep study was an at home study.  I had an AHI of 4.8.  They said on my sides, I was a-ok, but on my back my AHI shot up to 25ish.  I set up a second test for an in-clinic test.  In the meantime I bought a Snoogle (maternity pillow) to keep me off my back.  It worked wonderfully (I felt amazing) until I had to wash it, then it lost a bit of shape and was useless after that.  I then bought a SlumberBump, but I still felt daytime sleepiness and woke up a few times with my body twisted so I was still sort of on my back

Second sleep study (in-clinic, no-xpap).  I had an AHI of 6.8 so I got to test out a resmed airsense 10 for a week.  That week was amazing, I had no daytime sleepiness and I felt like a "morning person" (something I've never even been close to as described).  I had to return the loaner airsense 10 and I ordered one of my very own.  When it came I had high expectations but it hasn't been as smooth as it was with the loaner.  I've had less daytime sleepiness but still have fallen asleep at work a few times (but not as much as I used to).  I'm hoping some of the gurus here can look at my sleepyhead data (I've attached 2 days of screenshots) and make some recommendations to help optimize my therapy.  Thank you for any input anyone might have!

[mesenteria]

You'll note that you have coincidental snoring if you do a quick series of eye-flicks up and down your charts between the incidents at top and down to the bottom where your snoring timeline is shown.  The spacing of these events tells me that you are experiencing positional episodes, almost certainly supine or nearly so.

Have you tried a cervical collar?  If you are going to end up essentially on your back no matter what...at times...then a cervical collar may make a difference.  You need to keep your chin from tucking.

[sheepless]

other folks will help you make sure you're getting the best from your machine. I'm here to say you might be one of the few people for which weight loss might actually result in complete or near complete relief from apnea. you listed your height and weight, which as you know are out of whack. you're not alone in that by any means but your untreated ahi is so low (4.8, 6.8) and apparently all obstructive, that one wonders if you could avoid cpap altogether if you got closer to your ideal weight. easier said than done, I know. many or most of us of us would seriously benefit from weight loss but they say most of us will never be 'cured' of apnea by it. I just wonder if you might be an exception.

[dneal12]

Re: Cervical collar

I haven't tried that yet.... maybe it might be worth a go. Is there a popular one(s) that people on the board tend to prefer or is it best to just poke around Amazon. Also am I correct in assuming that I should use the collar in addition to the Auto CPAP rather than instead of?

Re: Weight loss

I have no doubt that weight loss will improve my sleep, health, and all together well being. I am really trying to make it a priority in my life. I'm not sure that it will completely cure it since I had sleep troubles back when I was an athlete and in great shape (only 7 years ago..... :'( ) But in the meantime, I think if I had better sleep, lots of things would improve (one of those things being my weight loss efforts). So in short, I totally agree with you, but I don't want to wait until I get into shape to get sleep. I want to attack both things at the same time.


Thank you both for taking the time to help!

[Sleeprider]

Welcome to Apnea Board. You are using your Autoset at default pressures of 4-20 cm range and you are using EPR at 3. I think you need to increase the minimum pressure to give your machine a head start on obstructive events, and I agree with the suggestion of a soft cervical collar. Before getting into details, your respiratory statistics are nearly ideal with completely normal respiration rate, tidal volume, minute vent and inspiratory/expiratory times. Your AHI is acceptable, and leak rate is good. You appear to be well adapted to CPAP and are doing pretty good with a machine that is at default settings and not optimized. Once we resolve the problems contributing to your positional apnea, I think you should be very comfortable and perhaps feel like a morning person again.

You are using ramp with a minimum pressure of 4.0 and 20 minutes of time. I'm not a big fan of ramp and will suggest you turn it off. You have been using CPAP long enough that I doubt ramp is a big factor in your comfort, or that you don't tolerate higher starting pressures. I think your minimum pressure should be increased to 8.0 cm. This will give you a starting pressure of 8.0/5.0 with your EPR 3 and I'd be very surprised if that is not comfortable to you. This puts you much closer to your current median pressure, so a secondary advantage is that you will experience less pressure variation, and your mask will be adjusted to prevent leaks before pressure rises. I think starting with ramp off and a higher starting pressure is a good first step. We can discuss a soft cervical collar if the big increases in pressure continue to occur, but you really don't have a big positional problem, just room for improvement.

Here are some wiki articles we have written on the positional apnea and flow limitation problems. Worth looking at pending a trial of higher starting pressure.
http://www.apneaboard.com/wiki/index.php...onal_Apnea
http://www.apneaboard.com/wiki/index.php...Limitation

[ajack]

I would agree with sleeprider. It will be better.

[dneal12]

Thank you for your help and advice!!!  I can't tell you how grateful I am.

Last night I increased my min pressure to 8.0 and turned ramp time to 'off'.  I had a pretty comfortable night.  I will let this change sit for a week or two and then check the data to see where I am at.  Just to clarify, I should hold off on the collar and just see how this change affects things, correct?

Thank you again for you advice!

[Dormeo]

There can be an advantage to making just one change at a time, so you might want to try the new pressure settings the experts have recommended before adding the additional change of using a collar. Too many changes at once and it can be hard to know which change produced which benefit.

[sheepless]

very true. no harm in waiting. unless you're impatient like me. your guides haven't responded yet and they may have a preference. however, the counterpoint in this case might be that there's potential for improvement with a collar and little to no chance it'll will make things worse. for just $20 at the local big box drug store, why not try something known to help (not all but) many? I don't see much harm one way or the other and you'll learn something either way. in the end how we apply what we read and learn here is up to each of us.

[dneal12]

So I've tried the adjustments for the past couple of weeks.  I don't think it has improved the sleepiness much.  Here are a couple of datapoints from the last week.  Should I add a collar or up the min pressure again.  Any advice is appreciated, thanks!