Higher AHI since concussion, HELP

[KCFLY]

Hello!

I've been using BiPAP for almost 2 years after using CPAP for a couple years prior.  I was switched to BiPAP when I started getting more and more centrals.

Anyway, back on Sept 8th, I was a passenger in a car accident and got a pretty good consussion out of the deal.  Since then, my AHI has been much higher.  ( I was averaging about 3 before the accident, average of about 7-8 the last couple weeks )

Im going to try and attach last nights data for anyone to give me some suggestions.

Seems like after I get a bunch of OSA events and the pressure maxes out, it triggers some CSA events and cycles back and forth.  How do I get relief here?  

I had a great sleep doc who just recently retired and I'm still on the hunt for a new doc.  

Thanks in advance,

[Gideon]

See the clusters of obstructive events?  They are an indicator of a form of positional apnea that is typically caused by tucking your chin toward your chest.  The first try at fixing is to try a simple pillow modification.  Flatter, less firm, a feather pillow vs foam, a buckwheat pillow, or simply using 1 vs 2 pillows.  If this doesn't work a soft cervical collar usually does.  Read the Collar wiki article linked in my signature.  BTW increasing pressure does not resolve this.

If you can provide a 10 minute zoomed image of your chart It will help us with the nature of the Centrals that you are having.

[SarcasticDave94]

The Obstructive Apnea tend to appear in clusters as in Positional Apnea. Do you sleep with a high stack of pillows after the accident? Either that, or somehow your chin is pointing towards your chest. Either will kink your airway like a garden hose.

The CA are another story. Maybe the PS is causing higher CO2 flushing. Did you raise pressures to combat the Obstructive events?

[KCFLY]

Thanks for the quick response.

I currently just use one fairly flat foam pillow.  I'll see if I can try a feather pillow tonight.

Here is a zoom from the chart I posted previously

I know pressure won't fix this, part of the problem.  Raising pressure would only lead to more centrals, etc.

Anyway, thanks again

[KCFLY]

The Hypopnea tend to appear in clusters as in Positional Apnea. Do you sleep with a high stack of pillows after the accident? Either that, or somehow your chin is pointing towards your chest. Either will kink your airway like a garden hose. Since it's Hypopnea and not Obstructive Apnea, it's likely only a partial kinking.

The CA are another story. Maybe the PS is causing higher CO2 flushing. Did you raise pressures to combat Hypopnea?

Just one farily flat pillow.  That hasn't changed.

These pressure settings are what I have been using since Feb of this year when I saw my sleep doc.

[SarcasticDave94]

OK, is it possible your accident injuries are making you sleep in a different position, one that's increasing likelihood of chin tuck?

[KCFLY]

Sleep position changes could be a issue. 

Most of my physical injuries are pretty much healed up, its the concussion symptoms that remain at this point.

I typically change positions through the night.

I have looked at the collar wiki, maybe that is the solution.  (Not something I would look forward to, LOL)

[SarcasticDave94]

Yep I copy. Adding 10 or so sleep accessories isn't very appealing.

[Gideon]

 (Not something I would look forward to, LOL)

Thus the bit about the pillow, I don't like to recommend a collar, Who wants something new to attach to their alien gear?