[Treatment] AHI skyrockets when going from double to single pillow?!

[Cpapaya]

   
       

I've recently been having some neck pain, that may or may not be related to a frequent feeling of faintness/dizziness. Originally I sought CPAP treatment for this same issue, which was only mildly relieved from treatment (1.5 yrs in).  I've been seeing a physiotherapist who recommended I switch from two pillows to one. I used one pillow a long time ago (pre apnea diagnosis), but switched to two with the idea of alleviating symptoms. I also use a snore guard.

Attached are two OSCAR readings - one with two pillows (AHI 2.8. the night prior), and one with a single pillow (AHI 8.79, last night). It occurs to me that at the testing centre, I also used two pillows.. so maybe my pressure (of 8) is too low to properly support a single pillow setup? I am a side sleeper, and the single pillow I use is definitely on the firmer side - I'm not sure about a perfectly straight neck while sleeping.

I'm also considering a cervical collar, but of course with these current neck issues, adding something to the mix might not be a great idea at the moment.

Is there anything standing out as obvious to our experienced readers here, that I ought to consider?

(Edit note: my profile states nasal F&P - I switched to the Resmed F30 on forum advice, which did seem to improve my overall score and outcomes).
(Edit: Based on what I'm seeing in other posts, I've added a close view of the OSCAR data worst spot).

[Phaleronic]

You're likely chin tucking, a camera to record what you're doing during your sleep positionally may be of the most help here. For now I would turn EPR off since you're at 8cm in cpap mode, this should clear up some of the CAs and help the OAs a bit, also try to sleep on your sides as much as possible, you can keep the slightly thicker pillow with these settings and trying to sleep on your side to see how it goes.

[Cpapaya]

To update, I turned ERP down from 2 to 1, since fully off felt a little bit much. I will work towards totally off in a week or so. I also tried to keep a pillow under my jaw while sleeping, to prevent tucking even a bit. So far my AHI has dropped to 2-3 average. At times I was able to be under 1 in the past, but it is allergy season here, I assume this contributes a bit.

Many thanks for your help!

[SeePak]

Hi Cpapaya.

How has your sleep been?
Tired during the day? Fatigue?
Dry mouth?
What did your sleep study say about pressure as a prescription?
Do you have obstructive and/or mixed apnea?

[Cpapaya]

Hi, thank you for responding!

How has your sleep been?

It has been 'ok' - I haven't been waking up in the night regularly which must be a good sign. I wasn't having a lot of daytime issues (besides panic/anxiety issues, which may be apnea related), so improvement was more oriented towards long term health.

Tired during the day? Fatigue?
Not particularly - more often anxiety!

Dry mouth?
Mildly - I use humidification, set to 4. This seems to prevent dry mouth. I do occasionally wake up breathing through my mouth (drool and all), but this is why I switched to a full mask. When I wake up, I crave some water - but it's not like sandpaper mouth, which I have had a couple of times when using nasal pillows with no humidification.

What did your sleep study say about pressure as a prescription?
It recommended 8 as noted in my profile. The prescription details: CPAP
or APAP Unit @ 8 cm H20. AHI = 36.0 /Hour. Mask to
Fit (Start with nasal mask). Successful Titration. 7 Day Download with ADP. Mask.


Do you have obstructive and/or mixed apnea?
Obstructive was diagnosed, though I have wondered with some of the CAs if something might have been missed there.

[SeePak]

the pillow test i dont know, not enough data there for me, unless i could see RAW oscar data maybe.
But getting a flat pillow is usually prescribed around here, myself included, not toosoft, not too firm.

But you may be doing something there with your neck and the pillows.
A neck collar an really allow a fair amount of guesswork out of interpreting your data, it really does look obvious at times on oscar with the OA/H and even CA events all stacked in a short time period.
Check out if you have a pinched jugular vein area, is that by chance where the pain is?
I have something going on there and when i try to massage it is really touchy and i can feel faint so i pull back, worth a check.

So i agree with Phaleronic for neck collar due to positionals and get rid of EPR for the CA events.

That will allow to see what happens with OA and H events as well, cause your 8 cm prescription should get rid of majority of OA events, but NOT using any EPR, cause that drops your CPAP pressure BELOW your OA level as per Titration.

So, i would really go to 8cm and EPR0 as soon as possible to get rid of some events, less time in apnea, and see how you feel.

Not sure if your machine is AUTO, just in case somehow it is,   8 min 9 max   EPR0 would be a good setting.

Anxiety, there is Lots of Breathwork going on out there, and for good reason! We are breathing wrong!
Check out Patrick McKeown and his app for sure!

I should add, the dry mouth is so often due to mouth breathing, so you need to get that under control too.
Even with a full face, which i also used for a bit, is a problem cause you are changing your CO2 chemistry so much by mouth breathing.
Again check out Patrick Mckeown, as one who understands all this.