Papa G.'s Therapy Thread

[Brazen]

Requesting some help optimizing my Papa's therapy.

He is 74 years old, heart troubles, kidney troubles, diabetes.  He's tired and naps on a regular basis but I think that's age and medical issues on top of apnea.
He's been on cpap for at least 15 years. His current machine is a Resmed S9 Elite. Set at a fixed 10cmw. I don't know the capabilities of that machine.
I put the SD card in his machine yesterday so we only have one night of data but I think there is room for improvement.

The first thing I noticed was mask leaks... he said he struggled a bit last night with that and made some adjustments. He likes his mask (Dreamwear, med headset, small nose piece).

AHI and flow limit too high.  
Suggestions?

[Gideon]

See how the hypopneas are grouped together? That is a signature for bad cervical alignment. That is the first thing that needs correction. Basically he tucking his chin toward his chest resulting in a form of positional apnea no amount of pressure can overcome.
.see if he is positioning his head on a similar position to that for rescue breathing. It may be as simple as using 1 pillow instead of 2. Use your nurses training. If that doesn't work there is a soft cervical collar, please read the wiki in my signature either way.

[Brazen]

@Gideon
Thank you! 
I thought that might be the case but I'm still a newbie so definitely needed expert opinion. 
He only uses one thin pillow and he definitely chin tucks.
I'll talk with him, I might be able to get him to agree to use a rolled blanket/pillow up by his neck to prevent some chin tuck but he won't agree to a c-collar.

Since he has never adjusted his settings from his only sleep study years ago I was actually happy to see his numbers weren't worse.

[OpalRose]

Brazen,
When I first started out, I used a travel neck pillow (toddler size) turned around with opening in back. This allowed me to support my chin. It was small, soft and worked wonders. If anything, it made me aware of my chin tucking.

On another note... would your dad be open to using the EPR setting? Maybe start with EPR 1. He shouldn't notice that too much. It may help with the flow limitation.

[Brazen]

@OpalRose
Thank you! Yes, I think I'll have him try a travel pillow and I'll set the EPR.