Is this Positional Apnea?

[charlie*M]

First, I'd like to say thanks for this great wiki and forum resource, it's been tremendously helpful as I start my CPAP journey!

65 y/o male, BMI 29.5, 18" neck circumference.  Finally gave in to family prodding, and a split sleep study diagnosed severe OSA, 77 events/hour.  Prescribed APAP at 5-12 cmH2O, and I've been on it for about a month now.

Initially I had pretty good results, AHI below one for multiple nights, but then I started having more events, some leakage, and mild-ish aerophagia.  AHI some nights was over 6, with over 45 events. Events seemed to be clustered, and typically would happen when pressure was maxed out at 12 cmH2O.  So far I have not tried to change any pressures (too soon I think, and I don't want more aerophagia or leakage).  But the issue is not constant: after a night of 45 events I might have a night of 1-3 events.

From reading the excellent wiki, I think this looks like positional apnea, jaw dropping.  Before CPAP, I had been using Xylimelts to help with dry mouth, and a few nights with an F-10 mask I woke up with my lower lip below the mask.  I'm currently using the F-40 mask.  I've ordered a couple soft cervical collars, and will follow up on how they work for me.

In the mean time, can an expert(s) comment on these two screen shots?  One is a 'good' night and the other is a 'bad' night.

Thanks in advance!

   

   

[staceyburke]

May 8 had a huge amount of 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.

I also would suggest you change the min to 7 so your EPR has room to work.

[charlie*M]

Thanks for the confirmation!

No changes in a pillow or sleeping position (side) for a few years.  I'll try some other pillows.  I've read the wiki articles you referred to, and a couple of Corflex collars are already on the way.

Not sure I understand EPR needing 'room to work'; is there something in my graphs that tells you that?  Or is it just a good practice?

[SarcasticDave94]

EPR needing 7 to work inquiry is based on how EPR works. It actually reduces exhale pressure from your minimum.

Min pressure 5 EPR 1 can work fully
Min pressure 6 EPR 2 can work fully
Min pressure 7 EPR 3 can work fully

This is due to the AutoSet hard lower limit of 4.

[charlie*M]

This is due to the AutoSet hard lower limit of 4.

Thanks, makes sense now.  I didn't realize the lower limit was actually 4, rather than oscar scaling the pressure graph that way.

Last night saw 39 OAs in 3 clusters.  I tried to use a cpap pillow (not sure of the brand, but it has divots on each end), but found it put too much pressure on my jugular area.  I was hoping the bottom part of the divot would help keep my chin from dropping.  I'll try some different pillows and then the SCC when it arrives.

[G. Szabo]

I tried to use a cpap pillow (not sure of the brand, but it has divots on each end), but found it put too much pressure on my jugular area.

You might turn on your back unconsciously from time to time and have a cluster. There are devices on Amazon that prevent back sleeping.