Strategies to Reduce Hypopnea Events?

[mark.apnea]

Hello,

I've been on CPAP therapy for just over a year.  My sleep study AHI was 14.x.  I had been getting consistently good results over the winter and spring with AHI in the 0.5 to <2.0.  The vast majority of my events were CA, with a few H event scattered in.  Almost zero OA events.  My Airsense 11 range was 8.0 - to 14.0, EPR 3.0.  I am a fulltime side sleeper, but do flip from right to left many times per night.

Early this summer AHI began to creep up >2.0 to 5.0.  With good advice from this form, I lowered my EPR to 1 and saw some improvement.  Again, AHI consistently dipped below 2.0.  CAs were still my primary event type, a few H events and still zero OA events.  Most nights I continued to exhibit long stretches of periodic breathing.  A few nights CSR events were flagged, but folks here suggested probably not valid, likely positional issues.

As I had zero review/feedback from my PCP or DME provider this past year, I decided to visit a pulmonologist just to check-in and get some suggestions on the periodic breathing thing.  As I feared, she essentially blew me off saying, "your 90 day average of 3.x is below 5.0, so you're good".  I pressed a bit on the periodic breathing thing.  She suggested to set my machine to cpap mode @10.0 and ERP off as I could tolerate.

At 10.0, I was getting excessive leakage again (full face hybrid mask - evora), so I dialed back from 10.0 to 8.0, leakage improved.  AHI remained high at 3.0 to 5.0.  CA events were nearly gone, but H events have really increased.  Last night @cpap pressure 9.0, AHI was 6.3, very few CAs, but long stretches of H event clusters among consistent periodic breathing.

Question:  Any strategies to address my high H event rates, and keep the CA events low?  I think periodic breathing is just "normal" for me.

I was thinking to go back to apap mode, starting in the 8.0 to 14.0 range, with EPR at 1.

Any suggestions?

[mark.apnea]

Here are last night's charts:

   
   

[staceyburke]

H events and O events are the same thing, only difference is the amount of obstruction.  Take a look at my signature to see how they are Classified.

You are having 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.

[mark.apnea]

Can side sleeping cause positional apnea?  

I understand how sleeping on your back could cause chin tucking or tongue relaxing/falling and obstruction.  Not clear what mechanism would be at play with side sleeping.

Thank you

[Deborah K.]

Many people sleep in a fetal position on their sides, with their head dropped down.