[Treatment] Help with therapy

[KPink]

Hello.  I have been using cpap therapy with 100% compliance since March 2023.  My sleep study was done in a lab but I have never been through a titration study.  My machine is a Philips Dreamstation 2 with auto cpap. 

My daily results have always been all over the place but based on all of the changes that I've made in the settings, mask type etc., it seems that I am at the end of my limited expertise to get better results.  So, I'm asking for suggestions on improving my therapy.

Current settings:  Min 12  Max 16  EPR/flex off
Current mask:  F&P Evora FF  (OK mask, OK results but not as comfortable as I'd like)
Past mask:  Resmed P10 Nasal for her  (Love the mask but serious mouth leaks).  I've tried mouth taping but had a allergic reaction to the glue.

So, any input is appreciated.

Thanks,  Kat

[KPink]

I'm perplexed.  Is there nobody out there that wants to help me to get my OA's down to a level that allows me to feel rested?  

Thanks
KP

[KPink]

Here's a screen shot of last nights report

[Jay51]

Welcome to ApneaBoard, KP.  
You might try lowering your min EPAP pressure from 12 to say 8 or 7.  
Raising your max EPAP pressure might help also:  you are already hitting the max during therapy.  It is currently at 16; you can try 18. 
Clusters of Obstructive apnea, hypopneas can indicate a positional element to your sleep apnea.  By chin tucking or moving your head in a way that twists your airway, can decrease the open space for air to travel.  Ways to help this are:  decreasing the pillow height.  If a tall pillow use a shorter one, etc.  Next, you could try sleeping on your side (if you currently sleep on your back).  And lastly, a soft cervical collar can help keep your chin from tucking and compromising your airway.  If you decide to try one, measure the distance between the bottom your chin and your upper chest/neck to find the correct size of collar.  
You could try to decrease your leaks also.  
Your median minute ventilation is low at 3.88.  Your respiratory rate median is just fine (16.2). Your tidal volume was not shown in your upload, but the median must have been around 237 or so.   That is low also.  By keeping your airway more open (stopping chin tucking) these numbers might increase to the normal range.  
If anyone has a PR Dreamstation auto cpap advanced and wants to post, please do; or anyone that sees anything else that could help post. (would changing the EPR/flex settings help?) 

Here is a link to help prevent mask leaks.  Mask Primer

[staceyburke]

Yes last night you had positional apnea and as noted, no pressure can help only finding a way to stay out of that position.  I have only experience with resmed machines so I don't give suggestions on pressure on the cpap you use.  I think that is why there have not been many people giving suggestions.

[KPink]

Thank you both for your replies and suggestions.

I prefer not sleeping on my back but I have gotten somewhat used to it since CPAP.   Still hate it though.  I prefer sleeping on my stomach but it's almost impossible with a mask on. My body naturally tries to roll over on my stomach throughout the night.  Every night is a battle.  I do use a really flat cpap pillow with big cut outs that somewhat allow me to lay on my side.  But...I'm not a side sleeper either.  I tried a cervical neck collar but I just couldn't sleep with it on so in pure disgust I just threw the damn thing in the trash.  I've tried a chin strap but it did absolutely nothing to keep my jaw from falling back.  I now have one of those snore eliminator neck pillow things and although more comfortable than the cervical collar I'm not thrilled with it.  It hasn't been tossed in the trash though.....  so there may be hope for it yet.  I haven't used it in about a month so maybe I'll give it another shot tonight.

Regarding raising my pressure, I've had it as high as 18-20 but all it does is cause massive leaks that make it hard to tell if I'm actually having an OA or if the machine is giving a bunch of false readings.  Or, maybe the excessive pressure is causing me to subconsciously tighten and close my throat.  I have no idea.

Tonight I'll retry the snore eliminator collar tonight and report back.

Thanks again
KP

[OpalRose]

..... Regarding raising my pressure, I've had it as high as 18-20 but all it does is cause massive leaks that make it hard to tell if I'm actually having an OA or if the machine is giving a bunch of false readings.....

As explained by Stacy and Jay, your are experiencing what we call "Positional Apnea".
You can see this on your graph. Look where the Obstructives are clustered together.
You are most likely chin tucking. If you sleep on your back, use a thinner pillow, one that won't push your head forward. It's much easier to try this first than wear a collar.

Higher pressures are not a good idea as more pressure won't help with positional apnea.

Respironics does not have EPR. It is called Flex, and believe me, it does not come close to performing as well as ResMed's EPR. With that said, you need some Flex to help with the Hypopnea, flow limitation, and any Reras. I suggest to try Flex set at 2.

We'll keep an eye on the clear airways. We may lower the pressure overall, but first work on the Positional Apnea.

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[KPink]

Thank you OpalRose.  Will do

KP

[KPink]

Worst AHI since starting therapy.  The highest OA's (64) ever.

Well, I added flex/epr 2 to my settings.  All other settings stayed the same.

So, even though I swear my night was spent nearly all on my back it's pretty clear that there where chunks of time that whatever position I was in was not good.  Chin tucking, head turning, who knows.

After getting back from the bathroom break it took a long time to get back to sleep.  I even removed my flat cpap pillow and slept without a pillow for the rest of the night.

So.....what now?

Thank you
KP

[staceyburke]

As I wrote before you have a large amount of positional apnea and NO CHANGES IN PRESSURE WILL HELP. you have to stay out of that position.

Have you looked at the link in my signature about collars? It shows people wearing callers and the SAME people without collars. Huge difference. Nothing will change until to address positional apnea problems.