Zeno's therapy thread

[Zeno]

Hi folks. I’m a month into my second attempt at CPAP therapy. I tried before in 2018 but quit after 4 months because it was too painful, I couldn’t get enough sleep and I had other medical stuff going on.

This time I’ve found a mask I can live with and it doesn’t leak, so that’s a better start. However, AHI is too high and variable, ranging from 3.5 to 11.5, compared with recent WatchPAT study result of 9.6. (I was averaging about 1.0 back in 2018). I’m not sleeping any better than without CPAP.

Here are OSCAR charts for 3 recent days. Many thanks for any help anyone can give me to get things dialed-in.

   
   
   

[Jay51]

  Zeno.  

The first thing you might want to try is to stop positional apnea that you may be having.  Positional apnea is when your chin tucks towards your chest and "kinks" your airway like a garden hose can kink when twisted.  

Some things to try are:  lowering pillow height, possibly side sleeping instead of back sleeping, and trying a soft cervical collar if the first 2 things mentioned don't work to lower your OA clusters.  

Here is some more reading on positional apnea from our Wiki:     Positional apnea

[Zeno]

Thanks for the comments Jay51. 

I'm predominantly a side sleeper and my pillow is already very thin, but I'm pretty certain that I do tuck my chin towards my chest when I'm on my side.
I ordered a Caldera Releaf a couple of days ago and will try that out as soon as it arrives. Thanks for the link to the Wiki - there is so much great information on this site!

[Deborah K.]

I suggest that you also raise your pressure settings so that they are 9 to 15, possibly higher later.  You are zooming up to 9 quickly and your median pressure is 11.2.  You also bump against your high pressure setting an awful lot.  That's why I say you may need to raise one or both of your pressure settings once we see how you do with these changes.

Good luck!

[Zeno]

I increased the pressure as you suggested and the chart is attached.

I woke after 2 hours and inexplicably removed my mask and went back to sleep - not done that before.

Despite only having 2hrs of data for 1 night there seem to be some changes:

• Only 1 event (CA) recorded. I usually have many more in the first 2 hrs
  
• Flow limit chart is much much lower than usual. (that's a good thing, right?)
  
• I had increased the max pressure to 15 but since the pressure didn't even reach 13, I don't think that could have had any effect.
  
• I had increased the min pressure from 7 to 9 and so started the night at higher pressure. Could this cause the flow limits being so much lower?
  

I'll do a few more nights on the same settings and then post data, but in the meantime any insights into what's going on?

     

[Jay51]

Increasing your min epap pressure can help decrease flow limitations.  Your 95th percentile is 0.07   That is fair.  Your EPR is set to2 full time.  You could try increasing EPR to 3 - that could possibly decrease your flow limitations even more.  The only downside might be some central apneas (CA;s); but hopefully you won't get any.  Good job.

[Zeno]

Many thanks for your help Jay51 and Deborah K. I think I'll do at least 2 full nights on the present settings and then try bumping up the EPR. Still waiting for the collar to arrive so I can try that if I continue to get clusters of events.

[Zeno]

My neck collar (Caldera Releaf) arrived and I've used it for 3 nights so far. I find it comfortable, not really aware of it during the night.
Results are a mostly good. Last night I had a couple of clusters of OAs but better than before (does this look like it's still some positional apnea?) but the night before I had virtually no obstructive apnea at all. With the collar I can still move my chin quite a bit towards my chest so should I try a taller collar? Any recommendations?

So far, I have kept the EPR at 2 because I'm getting mostly CAs. Should I try changing that now or based on the charts are there other adjustments I should try?

Many thanks.

   
   

[SeePak]

Hi zeno, welcome.

i too have the caldera, unfortunately it is too short for me, maybe you too?
Should be from chin to sternum, most i have seen are only 4 inches, i need 5.5 , long neck!

Did you have a sleep study and what was the prescription?

Is your mouth dry when awakening in morning?

I have different ideas about your therapy possibly, and i see others are helping out.

I'm sure you will get to where you want to be!

[Deborah K.]

Yes, I would guess your neck collar is not high enough.

Did your sleep study show a lot of CAs?  If you don't know, please post a copy of the sleep study with the personal information blacked out.  That would help us help you.  If you don't have a copy of the sleep study ask your doctor's office for it.  If they won't provide it you could ask them to tell you the AHI of each type of event that occurred in your study.  That would help us determine if you have real CAs or if yours are treatment-emergent.  Treatment-emergent CAs will lessen in time as time passes and are nothing to worry about.