[CPAP] CPAP 6 weeks AHI 10's lots of CA's and hypopneas

[Nehemiah776]

6 week APAP user. OSA's under control, but what appears to be treatment-induced central apneas and hypopneas have proliferated. So my AHI's generally around 10. Only 2 below 5, a handful at 5. Waking up about 5-7x per night. 


My stats:

• Diagnosed in Jan (home sleep study) with moderate sleep apnea 15 AHI's. Mostly in supine position. There were NO central apneas nor hypopneas.
  
• New CPAP user (Mar 28). It's been pretty rough. 
  
• Initially APAP set 5-20, which was terrible. Then I tried adjusting after first couple of days. 
  
• Full face mask (Resmed F20) works best for me. I have tried the Resmed P30i and F30, with little success. I breath too much through my mouth.
  
• Due to numerous CA's and Hypop's sleep doctor ordered an in-lab titration study on 4/26. I wore my F20. Surprisingly, they had everything controlled with just 5.0 CPAP. The sleep doc then prescribed 5.0 CPAP, which is pretty much what I have been doing. Some nights things are better (around 5-7, others worse 10, rare below 5).
  

I've attached screenshots of OSCAR from last night. Note that I also have the Wellue SleepU pulse oximeter, so you will see oximetry data. There is an overall, a more closeup and closeup screen shots.

Any help to tell me what's really going on would be MUCH appreciated.

Thank you!

           

[Gideon]

Welcome to the forum.

You have the classic symptom of clustered obstructive events. This is typically indicative of a form of positional apnea specifically your cervical alignment. You are tucking your chin and by doing so "kinking" the "hose" throat resulting in a restricted airway. It is extremely unlikely that any amount of pressure produced by your CPAP will correct this. Two things to try, a pillow modification 1 vs. 2 pillows, or a less firm, flatter pillow. A buckwheat pillow with its reshapable filler could be a good idea. The ultimate fix has been a correctly sized soft cervical collar to keep your neck straight. Note that VERY FEW doctors are familiar with this. See the cervical collar link in my signature.

[Nehemiah776]

Thank you, Gideon! Who would have thought... I have one of those collars on hand, I'll try that. 

To clarify: these are not obstructive, but mostly clear airways and hypop. Typically, I have a very low number of obstructives. So do you think the collar will help the centrals and hypop's? Or do you think OSCAR is incorrectly tagging them as such, when they are really obstructives?

Many thanks,
Mark

[Gideon]

I believe that many of the CA events, not all, are related to arousal resulting from the obstructive clusters.
Either way, one step at a time and the first step needs to be the elimination of those obstructive clusters. And yes, other that those clusters you look to be in fairly good shape. Try the collar and then take it from there.

[Nehemiah776]

Gideon, you are a genius!

The last 4 nights have been fantastic (see the attached OSCAR screenshot). AHI's FINALLY getting at 5 or below after weeks of up and down starting CPAP therapy. Instead of getting up 7-8 times each night, I only got up once. I purchased a Releaf collar, which is just perfect... soft enough to sleep with, yet just enough support to keep the chin up (I have this forum and wiki to thank for that). And that, sir, DID it! The 

You and this forum did what my sleep doctor could not do, nor my DME, nor even YouTube videos by experts. YOU did it. One look at my graphs and you knew EXACTLY what was going on. I am confident that I am finally on a good path with my therapy!

My recent titration study was vital to know where my pressure should be (5, I'm grateful). But no more see-saw nights, thanks to you and this forum.

I see that you are the project manager for OSCAR. A huge thank you to you and your team for your fabulous life-improving and saving (no exaggeration) work! I am feeling so much better.... I thank God for the therapy, for OSCAR, for this board and for you, Gideon.

I will be donating to this very good cause and will do all I can to help others.


A world of thanks,
Mark

   

[multicast]

(Please switch off the calendar as well as the pie chart on your next screenshot.)

First of all you have to reduce the leakage. From 3:15 you've been using your device as a leaf blower, hence both the therapy and the collected data are worthless. Furthermore we see a constant leak of about 15: impoverished the poor mask fit at first.

Mike