[Treatment] BiPAP but no solution: AHI, aerophagia and zombiehood

[ak99]

Hi, I am hoping someone can help interpret my Oscar charts and PAP machine function. I am a new Oscar user (altho I have been intermittently failing at PAP since 2008). In PSGs (2008,2011,2012,2019), I have moderate to severe apnea on my back and mild on my side. I was most recently on 6/10 flex3 on PR DreamStation AutoCPAP from Nov 2019-Feb 2020, but I couldn't sleep due to mask hiss, aerophagia, etc.  From June 2020-June 2022 I used an MAD mouthpiece, but my jaw moved forward 1.5mm, my bite is way off, lisping, biting tongue, etc.  And I was still just a zombie and my WellueO2Ring data (used since last Oct 2021) indicated many periods of SpO2 drops.  I am due to get a tongue-depressing mouthpiece next week. I will see a new sleep specialist Dr in 3 weeks (appt made last Oct). 

In the meantime, for the last month, I have been using my old (but little used) PR SystemOne60 BiPAP because I am miserably short of sleep. I have tried various settings on the SysOne over the last month but on any setting my AHI varies wildly and my sleep is always bad. Your Zombie chart is appropriate.

I have read as many Oscar articles as I can, but I can barely think anymore, I am so chronically short of sleep. I thought that probably maybe I have a positional apnea problem. I have tried using a soft cervical collar, which definitely prevents chin tucking, isn't too tight, but has no effect on my sleep, either subjectively or by the numbers. I usually sleep on my side, but I also lowered my pillow height so that if I go on my back my passage is not kinked. I also tried keeping my chin more tucked when on my side; I didn't note that on my record but I believe it made things worse. I could try it again...?

Even at the same setting, everything varies: some nights only OA, some over half CA. Over the last two weeks, AHI has ranged from 3 (the only time <5) to 45, usually 20-30. I have tried settings on both AutoBiPAP and BiLevel; from I/E 6/4 to 10/6; various levels of PS and flex. I am guessing that something like 10/5 might work, if I could use it on BiLevel so I don't wake up with aerophagia and cramping and turn the whole thing off. 

But about BiLevel: I have more trouble with aerophagia on AutoB: I wake up feeling about 7 months pregnant and bending over to minimize cramping. But I have not been able to figure out the machine's pressure response on BiLevel: for example, on 7/26 the setting was 10/4 +flex2, AHI of 45 but Max pressure was only 5.9. Why didn't it use 10 as the pressure? It seems to ignore the pressure setting every time I try BiLevel (I thought BiLevel would be better for aerophagia). 

So I went back to AutoB, but on three recent days the machine seemed to turn itself off. The first time (8/1 AutoB) it ran for 90 minutes, then there was a 90 minute gap, until I woke up and restarted it. The next day (8/2 AutoB) it ran 30 minutes then shut off. The next day (8/3) I tried BiLevel, being very sure I turned it on, and it failed to record the entire first half of the night, until I woke up and restarted it. Last night (8/4) I put it back on AutoBiLevel and turned off the AutoON and AutoOFF in settings. It ran the course, but with aerophagia 7 and cramping, AHI 31. 

I am puzzled in so many ways, I don't know what to try next.  I *assume* using the BiPap is better than nothing but I can barely think anymore I am so chronically short of sleep. I am not sure whether I told you what you need to know, and I apologize if I told you things you don't. I have attached three charts. The first is the wide view of session 8/4 (AutoB, AHI 18), the second is a close up of a section of that. The third is a close up from the previous day, which had a lot of CA (BiLevel, AHI 30). 

Thanks very much.

[staceyburke]

You have positional apnea. Positional apnea is when you sleep in a position that cuts off your own airway. No pressure changes help. You have to find a way to stay out of that position.

It is also known as chin tucking where your chin drops down to your sternum cutting off your airway.

It happens more often than sleeping on your back ( but not the only reason) or maybe sleeping on to high of a pillow(s).

If it is not those reasons you will need a. Collar. I have a link to collars in my signature- please take a look. It shows people without using a collar and the same people with collars- high difference.

To get the right size measure the distance between your chin and your sternum.

[ak99]

Hi, I do have a Velpeau soft cervical collar that is 4" high in the center. My neck measures 5" to 5.5" from top of sternum (in jugular notch) to chin...depending on position of chin (tall person with long neck). That seems to be as high or higher than the brands I see listed in your article. (The Futuro says adjustable height "for necks 2.5-5 inches" but it appears its uncompressed (max) ht is actually 3.25 inches.)

Doing a search on Amazon for "5 inch soft cervical collar," I find a *firm* collar 4.5" high on Amazon, or 5" collars that have rigid structures, which don't seem appropriate? 


When I have my collar on and try to tuck my chin it doesn't feel like it would close off my air, but then I don't feel my air is cut down if I completely dip my chin as described in the article. But I am completely on board with the idea that positional apnea is my problem, it would explain the irregularity, and I appreciate you confirming that. I did not feel confident looking at wave shapes.

I will try to rig up some way to wrap/tie another inch of padding on top of the collar I have. I will repost after a few days trial.
Thanks again.

[ak99]

Progress...thanks for steering me in the direction of positional apnea. That successfully got my AHI down...now I need to figure out how to sleep with all that Stuff.

I cobbled together an extra tall (5.5 inch) collar, which improved my AHI noticeably. Then I added a homemade backpack to keep me off my back. Those together with BiPAP (full face mask) and a Full Breath mouthpiece put my AHI below 5. This would be great, except that I am sleeping extremely fitfully because I am so encapsulated I can barely move. The later the night goes on, the more various things hurt. By morning my neck is killing me, so I think I will try taking the collar down to 4" tonight (and try to angle the closure so that I can't cheat in my sleep and force my chin down inside it anyway). My neck continues to hurt all day so I think I have to change that somehow.

I also cheat the backpack in my sleep by twisting in the straps or any number of other moves. I have tried/built a half dozen different ideas, and finally ordered an expensive sleep backpack that *might* solve some of those problems.

There are a lot of "experiments" I would like to try, to see what has the most effect and what I can do without entirely...but I have been waiting to get more rested. So far I am not rested at all because instead of suffocating I am tossing. I thought if I gave it time...but after 12 days the sleep-with-Stuff hasn't improved at all and things hurt more and sooner. I feel the same in the morning as I did with AHI 40. But "my numbers" are, in fact, good, so that is part way there, right?

Any ideas welcome....