New APAP User

[SleepyCrow]

Hello.  It feels like I'm introducing myself at an AA meeting, but here goes...  I'm newly diagnosed and picked up my ResMed AirSense 11 last Monday.  My sleep has gone from bad to worse ever since.

Some of my particulars:  ResMed AirSense 11, pressure set to Auto, 6-15.  They turned the ramp on initially but I turned it off several days ago.  Humidifier on level 2.  Before bed last night i changed the EPR to be full-time on.  Using an AirTouch N20 and mouth taping with Cover Roll.

Things have evolved a bit since last Monday.  They started me off with an AirFit P10 and that was absolutely miserable--felt like I was trying to breathe through a cocktail straw and I laid awake for hours the first few nights.  My events/hour were pretty good those first few nights, right at or a little under 1, I think because I never actually fell asleep!  Friday I went for a refitting and got the AirTouch N20 which I like considerably more.  I don't have nearly as much difficulty falling asleep.  But Saturday, after using the N20 for the first time the night before, I noticed bad acid reflux and the next day it got worse, to the point it's kinda painful to eat.  We were also traveling over the weekend and last night I was able to sleep in my own bed again, which is adjustable.  I sleep in the zero gravity position most nights due to an old back injury.  Last night I slept with my head even more elevated to help with the acid reflux.  I woke up at 2:00 and wasn't able to get back to sleep from the machine cranking out extreme pressures, so I turned it off for a minute.  I see now in OSCAR that I was in the midst of a succession of OA's where the machine cranked itself up to 15.

Any thoughts on what the heck is going on here and what I can do about it?  My diagnosed AHI was only 9.6, so last night was worse than if I just let my jaw flop open and snore away for the night.  I feel like this experience has been nothing but a game of whack-a-mole so far and shelling out $3K for an oral appliance isn't sounding so bad after all.

Thanks!

[G. Szabo]

I suggest using a soft collar, tapping your mouth, and setting your minimum pressure to 9 cm.
Unfortunately, you would need a higher maximum pressure than 15cm, probably because your tongue is sliding backwards. Mouth taping might help with this. During the daytime, you can also train your tongue to stay behind your front teeth and up.

[gainerfull]

This is called positional apnea and is likely chin drop / chin tucking which is kinking your airway. Please consider a soft cervical collar, changing your sleeping positon (side) or sleeping on a slim pillow. No amount of pressure can overcome this issue. 6cmH20 is too low to use EPR 3 full time so you may want to increase your minimum pressure to 7cmH20. Also, it looks like you may want to back off on the humidity with the mouth tape as your lips are sputtering in REM (leak).

[SleepyCrow]

Thanks. I've been worried that was the case since it seems to happen less when I sleep on my side. Sleeping on my back in zero gravity is about the only way to be able to walk when I wake up, though. I have a chinstrap from DME 37 that's supposed to arrive today, is there any chance that would fix it?

[Deborah K.]

I sleep on my back due to lower back pain and have solved positional apnea. First, I wore a soft cervical collar, which worked, but then I switched to a special pillow I found, which also works.  Back sleeping does not mean that you can't solve positional apnea.  When I used to sleep on my sides I often tucked my chin into a near fetal position, so side sleeping is not necessarily any better.