Advice sought - Little improvement after 12 months of CPAP use

[IntrepidCosmonaut]

Hello All, 

I have been using my AirSense 10 AutoSet for 12 months. I have never slept well and was diagnosed with moderate sleep apnea and recommended CPAP therapy about 12 months ago. Initially, I did not see any improvement but I put it down to really struggling to adjust to wearing the mask and taking it off during the night. 

After a lot of work at it I can now wear the mask all night and fall asleep with it on without any problems. However, the quality of my sleep is still poor, and i wake up exhausted and with a lot of fatigue and brain fog regardless of how much sleep I get. The support offered through my Dr and CPAP supplier is very limited and unhelpful, so I hope to get some advice on optimizing my machines settings and improving my sleep here. 

I have included information that could be relevant below, please let me know if there is anything else you would like me to provide you with. 

Sex: Male 
Age: 31
Weight: 79KG 
Height: 185cm

Machine: AirSense 10 AutoSet
Mask: ResMed AirTouch F20
Mode: APAP 
EPR Full time 3
Pressure Max: 11 
Pressure Min: 7 
Ramp: Off 

Oscar Screenshots 

1. Last Night 
      
   
2. Zoom in on a section of last night 
      
   
3. Overview 
      
   

Thank you all for your time, I appreciate any advice offered immensely. 

[srlevine1]

It appears that you are maxed out with 99.9% of your time at your top pressure of 11.0. Might I suggest you change the top setting to 14.0 and see if you feel better? Keep working on the leaks.

I am sure other forum users will provide additional advice. I am not sure how the OZ medical community works, but your doc should be more responsive. Have you had a full medical work up including a thyroid study, a pulmonary function test, and an echo-cardiogram?

Best,

Steve

[IntrepidCosmonaut]

Thank you, I really appreciate the input and will wait to see what other forum users have to say before I tweak things. 

I have been working through various tests with my Doctor over the last few months, I will mention thyroid and pulmonary function tests to them when I next see them

[Melman]

From the clustering of obstructive events it appears you are experiencing positional apnea which is caused by tucking the chin towards the chest which restricts the airway. It is similar to what happens to the flow of water when a hose is kinked. It can be caused by using to thick a pillow or, if you sleep on your side, by tucking the chin towards the chest. Please read thus link on positional apnea.
https://www.apneaboard.com/wiki/index.ph...onal_Apnea. I suspect the positional restriction is causing the pressure to top out. Unfortunately no level of CPAP pressure will resolve the problem.

[IntrepidCosmonaut]

Thank you, based on your recommendation I ordered a soft collar and was able to wear it for the duration of last night. My charts do look different and the first section of my sleep was much better but the AHI remains mostly unchanged when averaged across the night. Do you have any further thoughts you can interpret from this result? 

   

[David Clark]

You are still having positional apneas. You need to continue to work on that. Your pressure is still staying at max 99% of the time but that could be because of the positional issue so it's hard to tell if you actually need to raise it or not. Your flow rate doesn't really look bad except for the positional stuff.

[Melman]

Does the collar prevent you from tucking your chin toward your chest? You don't want it to be too tight but want to be sure your chin can't tuck behind it. If it's too soft or not tall enough you may need a different collar. I use an OTC collar from Amazon which comes in several different heights.

[Old Steve]

If you are a back sleeper, try sleeping on your side and see if it helps...