mtnjames - therapy thread

[mtnjames]

Hi all,

I have had my machine (Resmed Airsense 11) for about 4-5 months now. After several struggles with every mask in existence, chin straps, etc., I think I have at least finally reached some modicum of stability and comfort. However, the numbers still aren't fantastic and I'm not quite sure what to change.

Currently using a Resmed N30 mask and a soft cervical collar. I am using a scunci headband around my head/mouth instead of a chinstrap (found to be more comfortable and effective for me vs. chinstrap/mouth tape)

Current settings:
9-13, EPR3

Ramp is essentially off (5 minutes, starts at 8)...honestly, this is because I turned it all the way off once and for some reason EPR turned off too (even though it said it was on). Maybe a weird fluke.

I've attached Oscar charts from the past two days. The one is pretty typical, I would say. The one with tons of CA events in the morning seems to happen maybe 1-2x a week.

   

   

Recently, I tried bumping up pressure to 10-14 recently for a week and CA went way up and sleep quality tanked (more nights looked like the second chart).
I have tried EPR2 in the past with 9-13, but don't recall the outcome and would have to dig around in Oscar to try to find it (which I can do, if it is helpful).

[staceyburke]

You really have a problem with flow limits and with that your pressures are maxed out.  I would try a different approach if you are willing to try.

I would change to cpap mode and make the setting 10.  You will not have a min or max with the cpap setting.  Leave the EPR 3.  

Next I would try a collar for positional apnea.  The main measurement is the distance from your chin to your sternum.  That will keep your chin from dropping to your sternum and help with the O and H events.  Collars can be purchased at almost any walmart or walgreens for less than 20$.


The other alternative is a different machine.  A ResMed AirCurve VAUTO I think could help the flow limits but that is a lot more money without a sure cure.  Please try the collar and new settings for a night.

[mtnjames]

Hi Stacey, thanks for the input!

I am already using a soft cervical collar and a flat pillow. Specifically, this collar: https://www.apneaboard.com/forums/Thread...-Neck-Rest

I HAD recently wondered if I need to try to find a taller one because I am still able to tilt my chin downward a fair amount from neutral before the collar stops me.

That said - willing to try different settings, for sure.
I do have pretty good insurance, so if I can convince the doctor, getting a different machine should be a possibility.

[mtnjames]

Tried the settings:
CPAP at 10
EPR left at 3
Same soft cervical collar
Same flat pillow

Overall, things got quite a bit worse:
CA up, H up
OA down a bit
Flow limit issues slightly down

   

I have a taller cervical collar arriving today that I can try.

[staceyburke]

You still have positional apnea, getting the new collar should help.  If you look at your chart the centrals were not bad until the morning, about the time you were waking up.  I would try again tonight with the new collar and see how you do.

[mtnjames]

Definitely happy to try again with the new collar.

Just to be sure I'm following you - what are you seeing that indicates positional apnea? I understood this to be clustered OA and/or H events - I do see a few clusters, e.g. around ~22:20-22:40 and maybe ~3:00 and ~4:00.

And I'm not totally following what you are saying about the centrals that are happening near when I wake up, are you saying those are not necessarily an issue?
FWIW (which may not be much), if you had asked me, I would have said I was half awake during that time period and trying to get back to sleep...But then I'm not sure which is the cause and which is the effect - am I awakened semi-constantly because of the lack of breathing or is me being half-awake somehow throwing off the reporting?

Thanks for the help so far!

[staceyburke]

Yes the main thing we look for is OA a H close together. They can be a combination of the 2 maybe 2 O and 3 H events. You group of centrals to me looked suspect. All night you had separate central events and then all of a sudden a huge amount of centrals. The machine experiences no breath and tries a series of short bursts of air and if the air is not returned it is a central. A sleep lab has belt around your chest and pickup spots attached to your body to record IF you are making an effort to breath and that is recorded as an obstruction. Obviously the sleep study is pretty accurate while the cpap does not do as good a job recording centrals. With the new collar I hope we see a reduction from the central apnea.

[mtnjames]

Thanks for the added explanation!

Things seem a bit better with the taller collar last night.
I did choose to get out of bed early this AM, after about 15 minutes of trying to go back to sleep (unlike the last charts).

   

[staceyburke]

Yes that does look better.  You need to go up a little more- move it to 10 and we will see if that improves the H events.

[mtnjames]

Sounds good! 
Just to double check - I assume you mean up to 11 since it's currently at 10?