[Pressure] central sleep apnea because of high Bipap pressure??

[Geer1]

I already have collar and pillow adjusted.
So positional issue meaning I keep using bipap plus adjust not to sleep on my back ever? I dont have problem with bipap as it seems to reduce my AHI but I already have shoulder issues sleeping on my sides. No matter what I do I always end up sleeping on my back because of side shoulder pain.

What I mean is that your main improvement is probably going to come from treating positional apnea and finding an ideal combination of collar/pillow/position is going to take some fine tuning. Try making adjustments (sleep with head a bit further up on pillow, try narrower pillow, try no pillow, try adjusting pillow stuffing to adjust how head naturally rests etc) and see if the adjustments improve or worsen your sleep/OSCAR data (like you did with trying a soft and then a hard pillow). With some experimentation you will find out what works best for you. 

You can try side sleeping to see if that helps but as you mention your shoulder pain may not make that a viable long term option (or it might require significant other bed/pillow changes for it to be comfortable). 

As mentioned the goal is to try and minimize the occurrence and severity of this positional apnea then we can try adjusting pressures further to fine tune. There isn't a whole lot more that can be done with pressure settings to resolve this issue (trying higher pressure is about all you can do but already at 16 cm and 20 is max). As you can see in your data you don't need that high of pressure when your positional apnea isn't an issue and you will sleep better with lower pressure if it isn't needed.

[SarcasticDave94]

Positional Apnea is like kinking a garden hose. There's not enough water pressure available to power its way past this kind of physical blocking airflow.

[sanemonk1]

My last nights setting was PS 3.0 over 8.0-18.0 (cmH2O) and got AHI down to 4.32.

I consider it success and i am very thankful to everyone who pointed me at the right direction.

I know there is still a lot of area for improvement which can be addressed later but the only thing that i am concerned right now is me not being able to sleep through out the night with the bipap therapy. Even when pressure settings were low i kept waking up after 3-3.5 hours of therapy. Not sure if it is because of the pressure setting or sth else I keep waking up gasping for air so i take off the mask and go back to sleep. During therapy i do not wake up for about 3-3.5 hours, then i wake up gasping. So, its not like i can't use the bipap at all.
Anybody gone through this phase? is it only the matter of getting used to?
Regardless will continue to use it as it is helping me even if i am able to use it for only shorter period of time.
Please let  me know.

[Gideon]

Could you make sure all your event flags and chart flags are selected on. They are not. The two lower corners of the charts have these dropdowns.

Thanks.

I'd try a PS=4 You have enough obstructive events going on that this could help.

[sanemonk1]

Thanks. Will be posting with PS 4 and the screenshots are attached.

[Geer1]

Part of me wonders if the full face mask is making things worse. Some people have higher AHI or require higher pressure with a FFM. I believe nasal masks are more effective at keeping airways because they only apply pressure to airway which helps push tongue etc forward. A FFM applies pressure to tongue side (if mouth is open) which would negate some of the pressure being applied through nose. My grandfather has this issue, we tried to get a FFM to work for him because he has bad mouth leaks but we weren't able to find settings that work for him and he does better with nasal mask. He has the same positional style apnea but isn't able to treat it well because thick neck (collar is no use as it slides up over his chin).

The main reason to use a full face mask is if you are a mouth breather (naturally or if you have nasal obstruction/congestion etc). If you don't have any worries this way you could try a nasal mask to see how it feels. Resmed P10 is a common one that lots of people like.

[Sleeprider]

I don't see the CA as a problem. Events are mainly obstructive, and we are seeing a pretty high flow limitation. My suggestion is to take PS to 4.0. If the pressure is tolerable, you need to increase the EPAP min to 10.0. All of the OA events arise out of pressure near the current minimum.