amurorx - Therapy Analysis

[Jay51]

Thank you very much for posting that amurorx.  You have tried many things, but your 95% flow limitation was an incredibly high 0.59!   That is way too high.  

If this is the best that is occurring with your current set up, I see 2 options:  try to move to a different machine (a bilevel); and/or consult an ENT for nasal breathing issues.  A bilevel can give more pressure support than just the 3 EPR that your current machine provides.  Increasing pressure support (PS) can help break through these massive flow limitations.  

Take some time to think about these things and what your future plan might be.  If anyone sees anything else, please feel free to post also.

[amurorx]

At this point I have no choice but to wait for my pulmonologist to come back from maternity leave (late August???). They have no one available to see me. So I'm stuck with this machine until I see them.

[Jay51]

Sorry to hear that.  If you are stuck in that situation, you could raise pressure to get better results, but I know you said it starts getting uncomfortable closer to 20.  Your decision.

Also, sometimes people accidently get the wrong collar, or wear it too tight or too loose, etc.  Experiment with the collar a little bit and your may get better results.  It should be large enough to almost immobilize your neck during sleep (to prevent chin tucking).  Any specific questions you have about your collar, just ask them here and we could probably better optimize your collar.

[Dormeo]

A prescription for a machine can be written by your regular doctor, a dentist, or a nurse practitioner. If you can find someone to write the prescription, I would warmly recommend your trying a ResMed Aircurve VAuto. No guarantees that it would help, but it might. Or, as Jay says, you might try to work with an ENT.

Your FLs are extremely heavy, and your snores are fairly heavy too. It's possible that the FLs originate in your nose, but the snoring suggests to me that they, like the snores, originate further down. That's where pressure support might be able to help you. But it'd also be good to determine whether you have an anatomical issue in your pharynx (or really anywhere in your airway).

[amurorx]

I have 20-21" neck do any folks recommend a soft collar for thick necks like me. The one in using I added Velcro to extend it but I'm thinking perhaps it's not sturdy/stable enough.

[amurorx]

I setup an an appointment with my primary physician for 6/19 the earliest I can get. To discuss with him on a referral with an ENT or who ever else can refer me to.  He's a bit of a hard ass so he would definitely not prescribe a different machine.  He wouldn't even change the pressure from the factory default.

I'm plan to change insurance and doctors after all this 

A prescription for a machine can be written by your regular doctor, a dentist, or a nurse practitioner.  If you can find someone to write the prescription, I would warmly recommend your trying a ResMed Aircurve VAuto.  No guarantees that it would help, but it might.  Or, as Jay says, you might try to work with an ENT.  

Your FLs are extremely heavy, and your snores are fairly heavy too.  It's possible that the FLs originate in your nose, but the snoring suggests to me that they, like the snores, originate further down.  That's where pressure support might be able to help you.  But it'd also be good to determine whether you have an anatomical issue in your pharynx (or really anywhere in your airway).

[Jay51]

Thank you for posting all of that.  From the cpap literature I have read, the large the neck size, the greater the possibility and severity of sleep apnea.  

I have seen some very large collar when shopping online for them.  The places I usually search first are:  our supplier's list, amazon, ebay, etc.  Just type in extra large or jumbo might get a hit.  I wear a very large collar also.  Mine are either 4.5" or 5" in height.  I have done the same thing also to a few collars:  using more velcro straps to extend the collar.   The collar may have been too loose with the set up that you have described.  I hope you can find a suitable collar.  It made a big difference for me personally.  On my s9 Adapt ASV, I went from an AHI of 20 (using high ASV pressures) down to 0 AHI with a collar.  Positional apnea is real (but it doesn't affect everyone).