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[attachment=55761]Greetings all. I am one month into my therapy. Based on reading and advice, I got a cervical collar (ReLeaf neck rest) and really improved my scores (from 30+/hour and even 40), to as low as 1.2/hour. But results are erratic, going up to 13/8/hour (total of 39 minutes in apnea two nights ago). At first I thought it was just that the collar was too loose, but I am rethinking that. Last night, the collar was definitely snug, and my chin was resting on its support every time I checked it. I woke at around 1 AM with less than 1/hour. By 5 AM, it was 6.14, collar still snug. The collar is 3.5" high and 1+" wide at chin location. I am a small person and it is definitely supporting my chin.
I would appreciate your help in determining whether these apneas are positional or need more pressure. Because of my thin face, I had so much trouble with leaks, farts and squeals that higher pressure was actually making my numbers worse. When I got the cervical collar, I thought that was the solution and I did not need those higher pressures and left it at 12.4 max, but now I wonder. For a variety of health reason, I sleep on my back and raised. I can't really change that and need to figure out how to deal with it. Your advice would be greatly appreciated. Many thanks, k888
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RE: really all positional apnea? need your expertise
The proximity between the events suggests you're still experiencing positional apnea specifically in your last REM segment. I also think you're minimum pressure is too low.
Have you tried a couple different masks to see if you can find one that fits your face better? Have you considered a constant pressure?
I'd be surprised if you ordered a Resmed F20 fit pack (includes all 3 sizes of pillow) and it didn't fit your face.
RE: really all positional apnea? need your expertise
Thank you. There is something I'm not clear on. I have read multiple times that positional apnea can't be addressed with pressure (kinked hose, etc.) So, if Im still experiencing positional apnea, how will increased pressure help? Perhaps I don't understand the mechanics.
RE: really all positional apnea? need your expertise
(11-03-2023, 12:03 PM)k888 Wrote: Thank you. There is something I'm not clear on. I have read multiple times that positional apnea can't be addressed with pressure (kinked hose, etc.) So, if Im still experiencing positional apnea, how will increased pressure help? Perhaps I don't understand the mechanics.
I think you're experiencing two different problems:
1. In general, your OSCAR data suggests you could use more minimum pressure based upon flow limits throughout the night. Flow limits are lesser versions of obstructive events / hypopneas that can ruin your sleep quality. Ideally, you'll want to base your CPAP settings on how you feel in the morning and not chase 0's in Oscar but the opportunity does exist. It would be interesting to see you trial a higher minimum pressure so you start seeing flow limits only while in REM and then check in with yourself to see whether the change was worth it or not.
2. For positional apnea, you are correct - pressure will not overcome a physical obstruction but it looks like you're experiencing positional apnea only in your last stage of REM. Have you considered recording yourself sleeping on a camera w/ night vision? You can buy a cheap camera for $50 and it may reveal what position you're getting into that is causing issues.
RE: really all positional apnea? need your expertise
Yes most if not all are positional apnea. You will need to try a collar sense you must sleep on your back. To get the correct fit measure the distance from your chin to your sternum.
I have a link to collars innmy signature at the bottom of the post.
RE: really all positional apnea? need your expertise
Thank you for explaining the flow limits issue. That is very helpful. I will try increasing my minimum tonight. And yes, I do get the importance of how you feel vs number chasing. Today I am tired, so hopefully tomorrow will be a bit better.
RE: really all positional apnea? need your expertise
Grouped Oa and H events are usually positional apnea and you have grouped events. You also have a number of central apnea grouped and that does NOT always mean they are position apnea. The problem is these may or may not have been positional apnea because central apnea does come grouped together.
RE: really all positional apnea? need your expertise
k888, I am sort of in the same situation you are in. I always have been a mouth breather and tried many full face mask. But I too have a narrow face and full face mask always leaked no matter how I adjusted them. I have found more success with nasal hybrid masks such as the N30i I am using now but continued to still leak out my mouth. A few months ago I started using mouth tape and that basically stopped my leaks. Great stuff. I have also used a soft cervical collar for the last 3 years in which it kept my positional apneas to a very minimum. My yearly AHI average was 0.9. Then all of a sudden like flipping a light switch on, my positional apneas shot way up even though I am still wearing the collar. I even tried different brands and ended up ordering a brand new one just like I had used for 3 years. Then I recorded myself sleeping and saw that the collar was keeping my chin from tucking. And all of my apneas were from sleeping on my back. The minute I would roll onto my side the apneas stopped. So apparently something in my airway has changed restricting air flow even more than before and a collar is not going to fix that problem. I am going to try and use one of the products you wear on your back that is supposed to keep me from sleeping on my back. Time will tell. I know you said you can't sleep on your side but just wanted to relate my experience using the collar.
RE: really all positional apnea? need your expertise
Hi mawmaw1992, Thanks for your post. I did figure out that my collar(s) was/were failing. It seems I need a high one and then exert a lot of pressure down, so they tend to compress and then fail. Also, I think there may be two things going on. Chin tucking is clearly an issue. But there are also nights when my nose is really stuffed up and I breathe through my mouth (I have the hybrid Evora FF mask.) Even though I can feel that my chin is resting on the collar, I can have a bad session of positional apnea – maybe my tongue or other tissue is blocking the airway even though the chin is supported? I got the FF mask because I knew I would have to breathe through my mouth sometimes, but I really dislike having to do that. Still trying to figure it all out, and a good night's sleep to you. k888
