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Request for help - ronyang - 01-04-2025
I have been on APAP for a little over a year now. The results are up and down but there is one consistent pattern. At the start of every session for about an hour, there is a large cluster of events that don’t seem to be broken up by the settings on my machine. Often there are very few other events for the rest of the night. I have read about awake-sleep junk on this forum but this doesn’t seem to be that, as I am pretty sure that I am asleep long before the time the first hour goes by. I thought I would send in some screenshots of my last 3 nights as examples of what I am referring to and see if there is anyone who may have some insights and suggestions.
Awaiting a response!
Ron
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RE: Request for help - staceyburke - 01-04-2025
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.
You also have large amounts of Flow Limits to help with those I would raise the EPR to 3.
RE: Request for help - ronyang - 01-05-2025
(01-04-2025, 11:23 PM)staceyburke Wrote: 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.
You also have large amounts of Flow Limits to help with those I would raise the EPR to 3.
Thanks for your reply.
I found something last night that talked about that, but I'm not sure that is the reason. I usually sleep on my back as I am a little older and have trouble with shoulders that ache and arms that go numb if I lay on my side very long. I am conscious of rolling over on my side from time to time but can only stay in that position for a short time and must return to my back. As you can see from the three different screenshots I took, most of the rest of each session doesn't have the same clusters of events which I would expect if back sleeping were the issue.
I tried a collar last night and it didn't seem to make much difference, but of course one night is not always a good sample I have learned, so will continue to try that. But I think it still may be something else going on. for the reason stated above.
RE: Request for help - Expat31 - 01-06-2025
A collar can work well to do two things, keep the windpipe straight so no impairment of air flow, and also helpprevent jaw drop to stop mouth breathing.
However in the deep sleep phase or REM sleep, when there is a semi paralysis of the muscles (loss of muscle tone), and the tongue and soft palate, under the force of gravity, can fall back against the phalanx wall, blocking the airway. See attached diagram of the upper airway for the zone concerned.
I have found that a collar is ineffective in this particular upper zone, as a collar acts further down the the airway, within the actual neck area to solve the "chin tuck"issue. See this link (trachea) showing the area where the collar is effective.
Unfortunately the only way I have found to prevent this gravity effect during REM sleep, is by avoiding supine sleep position at all costs. Supine was the most comfortable for me, but continual supine clusters were wrecking my sleep quality.
Difficult if you have problems with pain in the lateral sleeping position, probably the job for a medical professional.
RE: Request for help - Deborah K. - 01-06-2025
What Expat says is true for a limited number of people, but for most of us a cervical collar solves the problem completely, including back sleepers like myself. Try the collar for a few more nights before giving up. Maybe yours is too short. Your collar needs to be high enough and just snug enough to hold your chin up.
RE: Request for help - ronyang - 01-07-2025
Thanks for taking the time to respond Expat31. As with the previous suggestion, if this were a result of REM sleep and supine sleeping, I would expect to see the same pattern many times through the night, which typically I don't. It's a mystery to me, but I am looking for answers and checking out all the leads I can find as I am scheduled for a visit to my clinician this week and am trying to understand the variables before I get there!
RE: Request for help - ronyang - 01-07-2025
(01-06-2025, 02:38 PM)Deborah K. Wrote: What Expat says is true for a limited number of people, but for most of us a cervical collar solves the problem completely, including back sleepers like myself. Try the collar for a few more nights before giving up. Maybe yours is too short. Your collar needs to be high enough and just snug enough to hold your chin up.
Thanks for your response. I have tried a couple of nights now with no appreciable difference (and the collar is quite high at the front. Also, when I try the little experiment of pressing up on the soft tissues under my jaw, I don't notice any difference in my ability to breathe. So I don't think this is the problem. And, as I said in a previous post, I would expect this to be a pattern that shows up through out the entire night but typically it doesn't.
I am exploring the links and suggestions posted above and hoping to find some clues!
Ron