Recommitting to CPAP

[Tactful3149]

I was diagnosed with mild sleep apnea 2+ years ago.  Started CPAP (Resmed Airsense 11) with P10 mask, struggled for 4 weeks with mouth leaks and mouth breathing, tried chin straps, cervical collars, then tried F30i mask for 8 weeks, caused nasal skin irritation, then tried AirTouch F20, and have been able to tolerate it.  Over the last 2 years, I have adjusted some of the settings ... experimented with other masks (e.g. F40), but the only mask I have been able to tolerate is the AirTouch F20.  That said, my sleep quality (how I feel, and what my SpO2 and Heart rate show) has been unchanged pre and post CPAP.  I have detailed data (avg, min, stddev) on SpO2 and Heart rate, minute-by-minute level, and the stats are nearly identical with and without CPAP.  Two things are different with CPAP:  I am spending money and time to maintain the CPAP and masks, and my snoring has stopped.   Even though the CPAP has not improved how I feel in the morning, I really want to get this right, because I still believe that with the right settings, my sleep quality with CPAP could be better than it is. Attached is the OSCAR chart for a pretty typical night.  Open to all ideas!  Thanks in advance!
   

[Old Steve]

I would try setting your minimum pressure at 8cm or perhaps 9cm with the max at 16cm and keep 3 EPR.  As you already have the EPR at 3, you need the pressure increase to help lower you flow limits as they are too high and 4cm is really too low for an adult.  Flow limits are like little apneas that the machine doesn't record but can be causing arousals. You may also be having some Positional Apnea, the pressure will not help that, search Positional Apnea on this site for things to help it.   Give the higher pressure a try for two or three nights and see if it helps then post some more charts.  Good luck.

[Tactful3149]

I did one night with 7-16 EPR 3, and one night with 8-16 EPR 3.  Both nights felt like an improvement over the 4-18 EPR 3 setting, quantitatively (AHI 4.2 > 3.92 > 2.8) and qualitatively (felt rested up on waking).  I have attached the OSCAR charts for both nights.  What should I do next?

Night with 7-16 EPR 3:
   

Night with 8-16 EPR 3:
   

[Old Steve]

The 8cm is getting you in the ballpark.  On the 8cm night the cluster of apneas both early and late appear to be Positional Apnea and pressure will not help fix it.   It is caused by chin tucking, sleeping on your back, too high of a pillow or anything that gets your neck in a position that causes your throat to collapse.  It is like bending over a garden hose causing the water to shut off.  I have positional Apnea and I have to sleep on my side or my charts will look like yours.  Some folks have success using a soft cervical collar to help keep their neck straight.   If you hope to get better results you will have to take care of the Positional Apneas before you treatment can be fine tuned.   Once you get the positional taken care of, I would also start cutting the time you are in ramp until you can turn it off completely.  You are getting no treatment when you are in ramp and when you go to the bathroom it starts again.  

Search the forum for ideas and more info on taking care of Positional Apnea...

Get the positional Apnea under control and post some more charts...

Good luck with your treatment.





Good luck.  

[Tactful3149]

Old Steve,
Thank you for your thoughtful replies.  I appreciate that the suggestions you offered so far have made noticeable and immediate improvements.  I may try 9-16 EPR 3, with ramp time 5 minutes instead of Auto.

My sleep study confirmed that there is a significant positional aspect to my apnea:  when sleeping on my side, the AHI was 6, and when sleeping on my back, the AHI was 16.  The aggregate AHI was computed as 13, given that I had been spending considerably more time on my back than on my side.  I have experimented with several devices to train myself to sleep exclusively on my sides.  Of course, I don't know what position I'm in when I'm completely unconscious, but I have a device which makes it physically quite uncomfortable to be on my back, so I believe the data you are seeing are the results of me sleeping on my sides.  I have tried 5 different types of pillows, and the current one seemed to give me the best AHI results.  I also tried a cervical collar, but found it so warm and uncomfortable that I had significant trouble falling asleep.  So at this point I feel the best I can do is use the CPAP in its most effective settings.

The one device I have not tried is a tongue retention device - that may be my next experiment.  Any insights?