Zeev - Therapy Improvement?

[Zeev]

Hi All,

I had posted over on reddit but was referred here. 

41yo male, large build, sleep on my back. I was diagnosed with Sleep Apnea back in August via an at-home sleep test (took a few to get a good result) and started with CPAP (Airsense 11) on Sept 3. Tried the first mask (F&P Vitera full face) for a couple nights but it was obvious it wasnt going to work. Uncomfortable and high leaks. Switched to an F&P Evora full face and its been great since. I took to it much better than I thought and immediately found that I was more able to get a "full" nights sleep more regularly and found it easier to focus at work. Its not perfect and, lately especially, feels like Im waking up a bit more often but with young kids and a stressful (at times) job, waking up in the middle of the night isn't uncommon so not sure if that's CPAP or "life".

My AHI on my sleep test was 51. 40% of the time, my SP02 was dropping below 90% and 10% of the time, it was dropping below 85%. The respiratory therapist I saw was pretty clear that I needed to start CPAP and I'm glad that I did.

With CPAP, I've been seeing an average AHI of 8.5 (74 days of data) and haven't made any adjustments since I started besides ramp pressure (6) and ramp time (recently dropped it from 30 mins to 20 as I get used to it). I am wondering if there's something I could be doing to further lower that number. I've attached a few of my latest charts - hopefully got the screenshots correctly formatted.

Also - I dont really like wearing my smart watch to bed, but I have a few times and have found that my SPO02 stays above 90% now.

Thanks in advance!
- Z

[staceyburke]

I have quite a few things you can do that will help you.  First all of your nights show 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.  Just stopping the positional apnea will help a great deal.

You need a higher min pressure, I would try min 8.

Any time you use the ramp, you are not getting therapy.  We always suggest it be shut off.  If you just can't get along without it, make it as short of a time you can.

EPR is used to help with flow limits and your flow limits are very high and we should try to get them down.  When you have flow limits your cpap raises pressures (that is why your pressure graph looks like a mountain range). The smoother the pressure graph the better the sleep...  To use EPR you need the min set to 8 - already suggested that - and the EPR needs to  be set to full time and EPR 3.

I hope you will make those changes and post again.

[Zeev]

Thank you for the detailed reply! I really appreciate it.

I guess my first question is whether I should try these all at once or try em one at a time to see the effect?

I use the same pillow i've been using for... wow. years. I've been thinking its time for something new, so I think that's the first thing I'll try.

I've been working on lowering the ramp this week as I've been thinking about trying to improve my therapy. Im going to try dropping it by 5 mins every few nights.

Should I try a new pillow and reduced ramp first or are the other suggestions (min pressure to 8 and EPR settings) going to help anyway and I should do those at the same time?