ASV & fails- would side sleeping help?

[Pugsy]

Did your sleeping position change?
Or maybe medications change?

It's odd that you had the 1 really good night on 9/8 and not really many other nights anywhere near that good.
If it worked well one night then we have to wonder what changed on the other nights.

[rosevader]

I wish I knew so that I could get there again, but I can't think of a single thing that was different. Same meds, same effort to stay on my side, same bed, same pillow- nothing stands out as being different, just feeling like I'm getting teased by the whole thing: nyah, nyah see how much better you could feel if this all worked the way its supposed to, well too bad you don't get that! Sigh..

[palerider]

I wish I knew so that I could get there again, but I can't think of a single thing that was different. Same meds, same effort to stay on my side, same bed, same pillow- nothing stands out as being different, just feeling like I'm getting teased by the whole thing: nyah, nyah see how much better you could feel if this all worked the way its supposed to, well too bad you don't get that! Sigh..

the simple fact of the matter is, you need more epap to prevent obstructives, more pressure support to control the hypopneas, and way more for the centrals.

with the machine throttled like it is, it's no wonder that it's not working.

I understand the aerophagia issue, and I think the epap is the main thing for that, maybe if that went to 9 it'd be an acceptable compromise.

some pressure support minimum, like Pugsy says.

I don't believe that ipap matters as much with aerophagia, because even if it does let some air in during the intake breath period, dropping back to epap should let it back out. (unless I'm just wrong on this, but that's my vague understanding (insert disclaimers here))

you've got a good machine, that's being chained down so it can't help you.

[rosevader]

Anyway, went to see the sleep doc yesterday and he changed the settings on my ASV as the previous settings yielded double digit AHI readings
Here are the newest settings:


Here is last night's data:


Any comments? Should I just go back for another adjustment? Try another night at current settings? Go rogue and change settings myself?

Another question, would my aerophagia be less with a nasal mask plus chin strap as opposed to a FFV mask? Aerophagia is an ongoing issue that is keeping pressure settings down.
Thanks for any help, as I'm feeling more depressed about this ever working for me!

[palerider]

Anyway, went to see the sleep doc yesterday and he changed the settings on my ASV as the previous settings yielded double digit AHI readings
Here are the newest settings:
minepap 10, maxipap 17, minps 0 maxps 7

Any comments? Should I just go back for another adjustment? Try another night at current settings? Go rogue and change settings myself?

Another question, would my aerophagia be less with a nasal mask plus chin strap as opposed to a FFV mask? Aerophagia is an ongoing issue that is keeping pressure settings down.
Thanks for any help, as I'm feeling more depressed about this ever working for me!

not a good idea to base anything on a single nights sleep. you need to work with averages over a few days time.
those settings should have resulted in less obstructives, which is where your big problem is.

I wouldn't think the mask type would matter with the aerophagia, but that's just a guess, hopefully others with experience on that will have suggestions.

[rosevader]

Well, a second night on these new settings was even worse. I had to nap yesterday because I felt so drained. 6 hours per night on the machine and I still feel like something the cat dragged in. Is 2 nights enough to go back to the sleep doc and say "hey, this doesn't work either!"?

[rosevader]

So, if I have mostly OAs with ASV compensating for the CAs, maybe I should add a positional helper so that I can stay on my side? Has anyone any suggestions about things that can help maintain a side sleeping position? Has anyone used one with some degree of success?

[Pugsy]

Quite some time ago I had occasion to want to find out if my pressure needs changed with sleeping position so I tried multiple things to keep me on my side and off my back. I was seeing some pretty significant pressure variations during the night and I didn't know if it was related to REM or being on my back.

So over a period of a month or two I tried everything I could think of and find to try to keep me on my side.
I didn't want to do the tennis ball trick or anything that caused discomfort or pain to wake me up so that I would get off my back. I always felt that was not the smartest thing to mess up my already fragile sleep.
So I tried things that didn't cause pain or wouldn't cause discomfort that would wake me up.

Bed pillows as a wall didn't work due to they slid around too easy. I tried a foam wedge but it also slid out from under me too easily. I ended up trying a buckwheat pillow that I had been using for my neck issues. I put it behind my back when I was on my side and it pretty much would stay put and not try to slide out from under me so easily.
Plus when I did sort of roll sort of onto my back I would end up being in a sort of half on my side and half on my back position and I found the support that the buckwheat pillow offered actually felt really good against my back.
I was able to get enough nights using the buckwheat hull pillow as a gentle prop against my back that I found out that I had the pressure changes even when on my side so it was determined that REM sleep was the culprit and I couldn't do anything about REM so I abandoned trying to stay off my back since the machine was going to have to work a little harder in REM anyway.

Whatever you try...pick something that doesn't cause pain or discomfort because you don't want to go trading one cause of crappy sleep for another cause. Pick something that is comfortable and won't cause you to wake up if you roll on to it.

[raisedfist]

Just a thought - this may be stupid. Have you tried using a nasal pillow mask and taping your mouth shut or using a chin-up strip to promote nasal breathing? Maybe that will reduce swallowed air and allow you to use the ASV as intended.

[Sir NoddinOff]

I ended up trying a buckwheat pillow that I had been using for my neck issues. I put it behind my back when I was on my side and it pretty much would stay put and not try to slide out from under me so easily.
Plus when I did sort of roll sort of onto my back I would end up being in a sort of half on my side and half on my back position and I found the support that the buckwheat pillow offered actually felt really good against my back.

What Pugsy wrote above was my experience with the buckwheat pillow placed along my back. As a bonus, with my body half rolled over I also got some relief for my sore hips. I've written about it a lot in the past... go up to members button top right and search for my posts using the term 'hybrid sleep position'.


This old photo is from when I was using some rolled up towels to achieve the proper 45% angle, however the buckwheat pillow is a better option for the reasons Pugsy explained.

[rosevader]

This is a big help. What kind of buckwheat pillow did you use? How big? Amazon has many different brands and sizes! Did you go big so that it extended the length of your back or use a regular pillow size? Did it improve your AHI due to OSA?

[Julie]

You have to try diff. sizes to see what works for YOU. No one else can do that. And many people don't like buckwheat pillows. Some wear backpks to stay on their sides however.

[rosevader]

Yes I'm aware of the need for personalization, but I'm just looking for a starting point. I would love to hear what people actually use successfully to side sleep. I have had enough fails with therapy right now that I'm feeling completely discouraged and really need something to work. I've been trying various solutions for months, and in spite of full compliance, no leaks, etc. cannot get therapy to work for me. Last night I had an AHI of 21 using ASV. I really need something to work!

[Pugsy]

Get one that you can add or remove the hulls to make it more to your liking.
Some out there don't have a way to alter the amount of hulls.
I used the previous incarnation of this pillow (see link) when I was doing my testing and it only had the hulls and not the foam.
I am currently using this pillow which is essentially a new and improved version of my orginal.
https://www.amazon.com/CPAPfit-Pillow-- ... fit+pillow

I have often thought that if I was using one long term that I might go for a longer version but since I abandoned my side sleeping because the pressure needs didn't change. How long of one will you need? I don't know because I don't know your height or size or wants or needs. I am not quite 5 ft tall if that helps you out any.

It didn't change my AHI but then my OSA was particularly worse when I was on my back (but it is for many people) because it was worse in REM sleep. If REM hadn't been a culprit I might have worried more about staying on my side since I actually prefer it anyway.

[Sir NoddinOff]

I used the previous incarnation of this pillow (see link) when I was doing my testing and it only had the hulls and not the foam.
I am currently using this pillow which is essentially a new and improved version of my orginal.
https://www.amazon.com/CPAPfit-Pillow-- ... fit+pillow

To answer your question, rosevader, the one Pugsy linked above is the best as far as I'm concerned and the one I use. A CPAPtalk member makes them and sells them at a very fair price. Yes, you can adjust the pillows with more foam or hulls for various firmness degrees... kind of like a sleep number bed - okay, a little bit harder than that, but still effective.