[Treatment] William E Johnson - Therapy Thread

[William E Johnson]

[attachment=65616][attachment=65616][attachment=65617][attachment=65618]Can't seem to find settings that will lower my AHI

[staceyburke]

You have 2 major issues.  The first is flow limits - they are huge and the reason your pressures are so high.  The Resmed raises pressures when in finds FL so they do not increase to get in the O or H category. (You can see how apnea is classified in my signature at the bottom of this post.)  To help with FL Change the EPR from ramp to full time.  

Second problem is you have positional apnea.   You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[Narcil]

looks like positional apnea to me which can't be solved by pressure. flow limits and reduced flow rate when events are happening despite the high pressure so i think it's very likely. do you sleep mostly on your back maybe? or "chin tuck" ?

edit: ninja'd

[William E Johnson]

Thank you so much for your response. My problem is that I have lower back pain and while sleeping I keep moving to shift the pain. Will try your suggestions. Thanks again.

[William E Johnson]

I made the change you recommended. The attached results are with wearing a collar. I have the unit in CPAP  mode. If I try to use 
APAP mode I get three times the apnea episodes. Should I just leave in CPAP mode.

[staceyburke]

I don’t think the automatic setting is causing higher AHI it was positional apnea.  It really is up to you but what I have found the lower pressure you can be (and eliminate as much apnea as possible) the more peaceful the sleep. Of course the min has to be enough to not feel air starved and enough to control apnea.

[William E Johnson]

Added wrong screenshot.

[staceyburke]

No positional apnea this night. Great

[Deborah K.]

I think you would do better using Apap again, setting your pressures to 12.6-16.  I believe you need more pressure than you are presently getting.  Your machine will not go higher than you need, so you don't need to worry about that.  It was not the higher pressures that caused your very high AHI, it was the positional apnea, which you have solved beautifully.  Great job!

[William E Johnson]

Thank you. Will give those settings a try.