[Treatment] New to APAP. High number of "Clear Airway events". Not sure what to do.

[SarcasticDave94]

How did you feel during and after therapy? It seems like there's the sacrifice/trade off to avoid CA via settings that FL are on the increase at times.

My opinion I think we're going to have to rely on feel of therapy results and find a best possible middle ground. When there, you'll need to to determine is it good enough.

There's options at that point. If it's good enough therapy, stick with that. If it's not good enough, maybe VAuto and the settings regarding trigger to minimize some CA effects. However we can go further than that if required by the CA specific machine, ASV.

Note that CA will be up then down randomly, it's been called consistently inconsistent. So the CA may in fact reduce a night then come back big the next. You'll need to factor that as well.

[stevew168]

You might need to have asleep study in a clinic to look at the type of your apneas, with an option to split it to titrate for an ASV if the first part shows a signifcant number of central apneas.

[lujojo]

Most days so far I still wake up in the middle of the night a few times. From what I can tell I it seems most CA events happen after I fall back asleep.

The CA events however have gone down more. I've gotten most close to when I fell asleep and before I fully wake-up.

Last night was the lowest so far, with just 0.85 CA events per hour (Although they were in two groups close to each other). But I had pretty high OA. This may just be positional however, they were very clustered and my mask did not have the greatest seal. I am having a hard time adjusting to nasal pillows (If there are any recommendations there, I'd appreciate it!).

From what I've heard, in-clinic sleep studies have a long wait time just in case, so I may still make an appointment while I play around with the settings and get used to it.

[SarcasticDave94]

My opinion there's a few things that may be a hindrance. It appears you're developing and presenting a positional apnea pattern. See the clusters of (blue) obstructive events? Positional Apnea in this case isn't what your doctor will discuss. Doc will be concerned with back, side, prone body positions. We're concerned with a head and neck alignment, which places a kink in the airway, a physical blocking off of the airway. Due to its physical, external nature, it requires a physical, external shield to prevent it. This will be a soft cervical collar that's worn to help prevent the airway kinking. Take a look at the wiki involving the collar.
HERE!

Also, in regards to the Central Apnea, you need to try getting yourself off the Ramp. It's been shown to cause pressure swings and disruptions that work against things like CA.

[lujojo]

I am a bit confused with "getting off the ramp", you mean getting off APAP and making it a CPAP?

Last night was the worst night by far. I actually do have a soft cervical collar I bought on Amazon, but it does not seem to help much apparently (At least when sleeping on my back). This is the one I bought: https://www.amazon.com/dp/B0C6SWK5YJ?psc...ct_details

My left nosetril was getting stuffed, which I think contributed to it, since my right nosetril has a slightly deviated septum, so airflow is a little more limited there.

[SarcasticDave94]

The Ramp is set to 10 cmH2O for 10 minutes. That's what I mean, you may need to begin trying to get away from that. However ironically that's not your big issue right now.

We'll need others better at the charts than myself, but this looks very much like bad Positional Apnea most of the night. Those long clusters of Obstructive Apnea along with FL are ruining the therapy. You can see where the pressure is pegged at your max 14 almost the whole session. More pressure will not fix this if it is actually positional in nature. Reminder positional Apnea is a chin tuck aspect that kinks your airway.

[lujojo]

I just removed the ramp completely, but the minimum is still 10mm.

Last night improved much more, my left nostril was not clogged, which I believe it influenced. I also improved placement of my cervical collar. I still had a ~3.5 events per hour for OA. Not sure if more pressure would help with those.

I do notice from all of these nights that I have the most CA events just after falling asleep. I had two clusters of CA events which both happened just after I fell asleep.

Overall, I can tell a HUGE difference from yesterday to today! I feel so much more rested today (Which makes sense considering yesterday 's AHI was over 40).

[lujojo]

My nose is getting so clogged up at night time . I woke up with the clogged nose. 

I think the OA is getting worse due both the position and my nose being stubborn.

Last night I had the longest time without any apneas. But, the cluster of OA occured, so AHI was pretty high.