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+--- Thread: [Treatment] drowsyboy - Treatment advice (/Thread-Treatment-drowsyboy-Treatment-advice)
drowsyboy - Treatment advice - drowsyboy - 06-13-2024
Hello folks. I'm looking for some advice on how to dial in my treatment. When I started CPAP in January my events with default pressure 4 - 20 seemed to be much lower, usually less than 2 events per night and recently it seems they have been increasing. My diagnosed AHI is 10, which I know is considered "mild" but definitely does not feel very mild
. I believe that most of my events seem to be positional judging by what I have learned reading this forum, most of my events appear in small clusters that space out during the night. I'd like to know what you think about this.
Thankfully I have no trouble tolerating CPAP, I fall asleep easily and stay asleep the entire night without discomfort.
Things I have tried so far
- Default machine settings 4-20 with EPR 3, this worked kind of well for a few weeks then my AHI started increasing for some reason.
- Increased pressure to 8 - 20, didn't seem to help much
- Increased pressure to 10 - 15, didn't seem to help
- Increased pressure to 12 - 15, didn't seem to help
- Used an inflatable backpack to avoid sleeping on my back, AHI was unchanged by this
- Soft cervical collar, I tried this last night and it did not seem to help at all, my events were a little higher than usual wearing it but I will try it with a softer lower pillow tonight also.
I'm also wearing a chin strap to stop my mouth from opening during the night, I've also tried mouth tape which I tolerate quite well. If it's helpful information my weight is in a healthy range, I'm quite thin and in decent shape. I've attached my OSCAR chart from last night with a soft cervical collar.
Thanks in advance for helping
RE: drowsyboy - Treatment advice - PeaceLoveAndPizza - 06-13-2024
First, please read the link in my signature on “Formatting OSCAR Charts”. It would be helpful to see those graphs on the same page.
Without seeing OSCAR charts on what you tried, I cannot comment. What I do see in the posted chart is your pressure needs to be higher and you should not use ramp.
Try the following:
Mode APAP
Min pressure 12
Max pressure 16
EPR 3 full-time
No ramp
Also, are you a full-time back sleeper without the backpack? The way the pressure graph swings and then settles suggests that whatever position you were in from 02:40 to 04:30 or so is the best for you.
I also think there is some positional apnoea going on as the OA’s are clustered in a few spots. If the collar alone is not helping try a flatter pillow as well. The chin strap may be part of the problem as well since some tend to pull the jaw back.
RE: drowsyboy - Treatment advice - drowsyboy - 06-13-2024
Hi, thanks for your help. I've added the chart below with the information from the guidelines. I'm mostly a side sleeper but I have a habit of sleeping on my back once I fall asleep which is why I bought the backpack in the first place. I was using the backpack to help before I was able to get a CPAP machine but no longer wear it, I just wanted to test and see what would happen.
I'm going to try a flatter pillow tonight with the collar, my current one is quite firm memory foam with a lot of height. I will also try without the strap and mouth tape instead as I have a habit of waking up with a dry mouth from leaks.
Thanks for the advice on the settings, I'm quite new to this and wondering what kind of negative effect using ramp might have?
RE: drowsyboy - Treatment advice - PeaceLoveAndPizza - 06-13-2024
Thanks for the chart.
Definitely positional apnoea going on. A collar is the logical thing to try, so possibly you have the wrong size. I’ve attached a diagram showing how to measure for a proper sizing.
Mouth tape works for many, but it will not solve the positional challenges. We have to use a pillow and/or collar for that. Even if you just take a second pillow and prop it under your chin to stop it from dropping, it would be a help.
RE: drowsyboy - Treatment advice - UnicornRider - 06-13-2024
I agree with PL&P, Turn Ramp off, you get no therapeutic value during Ramp, I would also suggest you turn off Smart Start as you get no therapeutic corrections during smart Start either. You need a higher Press Max to allow the flexibility for corrective actions to take place and increased Pressure Minimum to get you within therapeutic range. You may have to increase that pressure minimum in the future depending upon what results a flatter pillow and mouth tape produce for you.
Get rid of the calendar, it adds no value to the OSCAR Report, and takes up space that more useful information will occupy.
In the meantime Welcome to ApneaBoard!
RE: drowsyboy - Treatment advice - Deborah K. - 06-13-2024
I would continue with the mouth tape if I were you. It's probably what is keeping you from having leaks bad enough to interfere with your therapy. It will also protect you from extreme mouth dryness. If your mouth is dry with the tape you might like Xylimelts. These are little disks that stick to your gum/tooth and slowly dissolve overnight. My husband and I both tape and use and like the Xylimelts.
RE: drowsyboy - Treatment advice - drowsyboy - 06-13-2024
Thanks folks. Will try what has been suggested here tonight and over the next couple of days with different pillows and repost some charts. Really appreciate the help
RE: drowsyboy - Treatment advice - drowsyboy - 06-24-2024
Hey folks, back with an update. I tried two different collars and none of them seemed to have a noticeable effect on my AHI. I tried the collars with various pillows of different firmness and heights. Nothing really seemed to have much if any effect. I think subjectively I did feel less sleepy the nights after using the collar but it's hard to say if it was using it that had that effect. Also, tracking my o2 levels, they seem to be more stable using a collar even if the AHI is unchanged. I think what is rather strange is that I had a drunken sleep on Saturday night with my lowest AHI in weeks. I'm a bit at a loss for what to try next
RE: drowsyboy - Treatment advice - UnicornRider - 06-24-2024
I think what is rather strange is that I had a drunken sleep on Saturday night
Getting mixed reviews from this household.
It has been known to happen, usually not with positive PAP results., How did you feel the next morning.
Post some OSCAR Reports.
RE: drowsyboy - Treatment advice - drowsyboy - 06-24-2024
Generally I think I felt better rested when wearing the soft cervical collar, even if it didn't lower my AHI. Uploaded a sample below from one of the evenings using a collar. I had more centrals than usual on this night, sometimes it's 0, this night was on the higher side. I didn't really begin to get many CA's until I upped my pressure. The thing I keep looking back at is my first few weeks on CPAP when my events overall were quite a lot lower using the airsenses default pressure settings.
