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I started CPAP therapy over 6 years ago. Thanks to this forum, I have managed to achieve an AHI of under 0.5 nightly and have slept well for years now. My nephew, who is 53 years old, is suffering from depression and has sleep apnea. Untreated, it can be as high as a 45.0 AHI. I've been helping him for over a year now and we had some initial success. However, his depression has gotten worse lately and his results have become erratic.
He is considerably overweight and now will not leave his house. He is in therapy and we need to work on his apnea. He has had problems with large leaks in the past, but not every night. On October 19 we tried a Dreamwear full face mask and the leaks are greatly reduced. However, as you will see from the OSCAR screenshots posted below, every night seems to be considerably different. I'm don't how to tweak the settings so that he might achieve more consistent results.
He uses a ResMed Airsense 10 AutoSet with a Dreamwear Medium Full Face Mask. I have it set at a range of 12.4 to 17.0 (cmH2O). It is set to a standard response. He also does not use the APAP for the entire night some nights (as you will see by the short night posting). We have talked about this and he says he will try to do better. I have attached screenshots from the first full week beginning October 19. The considerably different results baffle me.
I would deeply appreciate any advice that anyone can offer.
The first night and the 3rd night he had a lot of positional apnea. You can see positional apnea where either H or Oa events are clustered together. There are not a huge amount but 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.
He has high flow limits and to control them you need to turn on EPR FULL TIME set to 3.
Thank you Stacey. We set his EPR to 3 for tonight. He said that he has been using a fluffy, high pillow. He agreed to begin to use a flat one and wanted to defer the collar until we see if the flat pillow helps. I, myself, have used a SCC for years and it has made a tremendous difference. I prefer the 4 inch height of a Vive SCC and it is not uncomfortable (I usually leave it loose enough for space for one or two fingers). I also have the Eliminator, but it is a bit too short for me and does not work as well as the 4 inch Vive SCC. So. if he decides to try a collar I have some available for him to try. I'll reply again after we see the results.
I think your approach is working well. I mostly saw the need for EPR, but addressing positional apnea with lower pillows is my preference over a collar. You will see a difference. Read our Positional Apnea wiki and you will see we try to defer the use of a collar and use less intrusive fixes first. Off-topic, your nephew might need a dog. Responsibility and a requirement to get out and exercise and a non-judgemental friend. If his personality is suitable to caring for a companion, it could be a good thing.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I'm posting my nephew's last three nights. The EPR set to 3 did help lower flow limits. You will see the first two nights have severe clusters (mostly in the last part of the night) which I think is due to positional apnea, so the lower pillow does not seem to be the solution. The third night, although short (5 hours) is very different. How can this be so? What else might he do? Cervical Collar? By the way, for some reason the top of the left-hand column is my data (Airsense 11 at 9.4 - 13.0), but the data shows his results (minimum pressure 12.4, etc.) The only way that I can figure that this happened is because he used an SD card that had some of my data on it.
Not much we can do with CPAP to resolve the CA events. They seem to be mostly at the "shoulders" of sleep when he is probably cycling between wake and sleep. The clusters of flow limitation and obstructive events are likely positional. The good results on 10/31 are a nice change showing it can be done.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Well now, I'm really at a loss as to what he can do. Last night he wore a Vive Cervical Collar. I showed him and his wife how to wear it loosely so that one or two fingers could be inserted as the purpose was to keep his chin from falling to his sternum. He said that it was comfortable all night long. His first half of the night was fine, then it all fell apart (1st image). The other two images depict some more of his pre collar results. We tried a soft response rather than the standard response. November 12 represents a typical night. November 10 is a one in 7 night exception.
Should he seek a new sleep study at this point? What could be going on?
Reduce maximum pressure to 15. I don't know why there is such a disparity before 05:00 and after, but the pressure won't resolve it. I assume something happened with the collar position.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
The collar does not seem to be working, in spite of what we saw on November 13. I have posted November 14 and 15. The clusters of all types of events were disappointing; in fact they increased and lasted throughout the entire nights. My nephew said that he was very washed out each morning. Therefore, I recommended he sleep without the SCC last night (November 16) to see if he could get better sleep. He said he felt that he slept better. His AHI was lower than 5.00 (4.70), mostly due to a cluster of OA's near the end of his night. Some leakage occurred in the middle of the night.
Where can we go from here? I'm wondering if we should change the minimum pressure, use the soft response or the standard response, change masks or the mask size (he's currently using a Dreamwear FFM Medium), try another pillow (which one?), etc. And, since his sleep study is way out of date, should he have another one done?
As an aside, he is now in therapy and has expressed the desire to help himself.
Is your nephew under a doctor's care? He has severe apnea with pressure at 15 and EPR 3 and you will recall we also saw it at 17 cm. You can try higher pressure, and the CPAP will immediately go to the maximum setting. I don't expect these events to resolve at a maximum pressure of 20 with EPR. The next step is bilevel that offers a bit more pressure and pressure support. I think you need to try a different collar. Avoid anything that can impinge on the front of the throat, but offers firm support to keep his head and neck from collapsing. What brand/model is he using now? How confident are you that he is not removing the collar and telling you otherwise?
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
