[Pressure] Changing Max Pressure and starting a BiPAP trial

[Lampshade]

I have used the Resmed AirSense 10 AUTOSET for many years and it made a great improvement in my sleep for most of those years. I recall AHI scores less than 5 most of the first few years. I found a nasal pillow headset that works well for me, except I have to tape over my mouth to avoid dry mouth.

For the last year, I began to have headaches and foggy brain (never had COVID-19), so I made an appointment with the PA at the Sleep Center. I had to wait 3 months for that appointment, and after a 40 minute appointment, the Max Pressure was changed from 11 to 12 cmH2O and I was told that they would look at the data after 4 weeks. I did mention during the discussion with the PA that I had tried changing the max pressure months ago and found the higher pressures had pushed a lot of air into my stomach, and I woke up to burp it up, so that may have influenced the PA from going to a higher setting.

I took the memory card to my DME provider and got two 30 day Compliance Reports printed, one when it was set to a max pressure of 11 and one when it was set to a max pressure of 12. The min pressure on both was 6 cmH2O.

AHI was 9.6 for Max Pressure of 11 cmH2O with a 95th percentile of 10.9 cmH2O.
AHI was 9.9 for Max Pressure of 12 cmH2O with a 95th percentile of 11.8 cmH2O.

Since I was concerned about this high level of AHI after looking at the reports, I decided to go to a Max Pressure of 16 cmH2O to see if that would have an effect.  Averaged over 11 days, I have a report at this new setting.

AHI was 7.1 for a Max Pressure of 16 cmH2O with a 95th percentile of 14.0 cmH2O, maximum of 15.8.

The PA mentioned that a BiPAP might reduce the amount of air that goes into my stomach and wrote me a script for a trial, so I am going to pick that up this Friday. While I wait for that, I am going to see if setting the Max Pressure to 20 cmH2O will give any incremental benefit on my AHI score. I decided to change the Min Pressure to 8 cmH2O without having any particular reason for that change. It did feel less comfortable trying to get to sleep. Please reply with any thoughts on this or my upcoming BiPAP trial which will be with a ResMed AirCurve 10 VAuto.

One of the questions I have is how to choose the Min Pressure setting.

Other settings on this machine are:
EPR: FULL_TIME
EPR Level: 3.0 cmH2O
EPR Enable: ON
EPR Patient Enable: ON
Ramp Enable: OFF
Essentials: PLUS
Response: STANDARD

I looked at the data in ResScan 5.9, and I installed OSCAR 1.4 but I only got summary data in that and not graphs.

[Dormeo]

A whole lot depends on the break-down of your AHI into obstructive apnea, hypopnea, and central apnea. You can get that information off your machine's screen if you opt for more information via the clinician's menu.

But I wonder what the Oscar problem is. Is your SD card unlocked? Is it pushed all the way in? Is there any way your card-reading method could be failing? Others may have additional ideas about this.

[Lampshade]

I retried Oscar and I got graphs this time. I will add some screen shots now.

From the ResScan summary of my 11 day test at a max pressure of 16,
Apnea Index: 6.8
Obstructive: 5.3
Central: 2.0
Unknown: 0.0
Hypopnea Index: 0.3
AHI: 7.1
RERA Index: 0.1

[Lampshade]

       

[Gideon]

You have 4 clusters of obstructive events which typically imply a positional apnea caused from tucking your chin down. Your thoughts?
Pillow mod to use 1 vs 2 or a less firm flatter pillow. The next step would be a soft cervical collar, see signature for a link.

FYI these charts show you effectively using an AutoSet with settings to perform as a biLevel with min EPAP=5 and PS=3

Post a copy of your BiLevel trial after 1 night.

[Lampshade]

Thank you Gideon for your comments.  I will look into the cervical collar as I already use a single flat pillow. I am amazed that after several visits to the sleep center at a university hospital, this is the first time I am learning about positional apnea. It shows the need for the Apnea Board!

[Sleeprider]

Lampshade, Please take a look at our wiki articles on positional apnea and the soft cervical collar The pattern of obstructive apnea clusters is unmistakable. The problem is that when your airway is positionally obstructed, even very high air pressure cannot break the obstruction. Simply avoiding the chin-tucking or other torsion of your airway can enable you to get very good therapy at low pressure. If we can accomplish that with a soft cervical collar, you will be able to achieve consistently less than 2 AHI with lower pressure and no problems with aerophagia.
Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar wiki http://www.apneaboard.com/wiki/index.php...cal_Collar

Be aware the sleep doctors and clinics have never acknowledged an awareness of what we call positional obstruction. $10 to $20 collars don't pay the bills like $3500 sleep studies and $1000+ machines and clinical follow-ups.

[Lampshade]

Thank you for your comments Sleeprider. I read the wikis and the reviews and decided to get a soft cervical collar from CVS the day you replied so I could test it last night. I adjusted the collar so it was loose and effective at preventing my chin from dropping to my chest. It was okay to sleep with. Attached are the screen shots from my first night with the collar. There was not a dramatic drop in AHI, but I am willing to gather two weeks of data to compare to the last two weeks of data without it.

I see the gap in the recording at 00:15 when I woke up to release the buildup of air in my stomach. Looking forward to seeing if the BiPAP I get tomorrow will reduce the frequency of that.

[Sleeprider]

Keep working with the collar or try others with a different fit. There are good reviews of several collars on our review forum pages http://www.apneaboard.com/forums/Forum-O...ct-Reviews . You can see the clusters where the collar failed to prevent obstruction, and the fit may be too loose or the collar not have adequate support.

[Lampshade]

Thanks for the advice Sleeprider. I just ordered the Coreflex Ultra, which will take a week to get here, but seems like it may perform better since it is made to my measurements as opposed to the one-size-fits-all model I purchased at CVS.