Been a while

[Jack o]

Last night - Best AHI so far since starting the "magical" cervical collar on Tuesday.
Still too much gas/aerophalgia with high setting at 13. But less gas than the night before when set at 15.
I will always use the soft cervical collar and flattened pillow.
Pressure Monday: Low 8 - High 15 - AHI was 9.6 (no cervical collar)
Pressure Tuesday: Low 8 - High 15 - AHI was 2.8 (started cervical collar)
Pressure Wednesday: Low 8 - High 15 - AHI was 2.3
Pressure Thursday: Low 8 - High 13 - AHI was 0.9
Pressure Tonight/Friday plan to set at: Low 8 - High 12. AHI - TBD
I will continue to gradually lower / monitor pressure with the goal being no or little gas while maintaining AHI below 2 or 3.
Thanks for all the continued input from everyone.

[Pugsy]

Consider adding in a minimum of 7 and see if that helps relieve the aerophagia issues without causing too much of an increase in the OAs or hyponeas.
A lot of people have found that when using the cervical collar they can reduce the minimum pressures.
That minimum is where you are at all night and it could be a significant factor in the aerophagia....it's not limited to just the max.

[Jack o]

Thanks Pugsy - I will do 7 and 12.

[Jack o]

AHI still good with pressures lowered to: L-7, H-12
Gas/Aerophagia better than at higher settings of low at 8 and high at 13 or 15 but gas still there for hours and annoying.
Any suggestions on whether to stay as is for a while and see if aerophagia lessens by itself?
Or should I continue lowering further either the low or high pressures or both, maybe in .2 increments?
Maybe set to L-6 and H-11? But I think that may increase AHI.
I have attached the last 2 nights' reports in case something stands out.
Humidity is set at 7.0 - Dry mouth but not a major concern.


Pressure Monday: Low 8 - High 15 - AHI was 9.6 (no cervical collar)
Pressure Tuesday: Low 8 - High 15 - AHI was 2.8 (started cervical collar)
Pressure Wednesday: Low 8 - High 15 - AHI was 2.3
Pressure Thursday: Low 8 - High 13 - AHI was 0.9
Pressure Friday: Low 7 - High 12. AHI - 2.1
Pressure Saturday: Low 7 - High 12. AHI - 2.3

[Pugsy]

The machine is essentially setting a new minimum for you so I don't know that lowering the minimum is going to do much.
You aren't spending nearly the time at the minimum as you are the maximum.

How are you feeling sleep wise and energy level wise? If fairly well rested and decent during the day if it was me I would reduce the max 1 cm and see if that helps reduce the aerophagia and not allow too much of an increase in that AHI.

If I had to choose between an AHI of 4.0 and feeling decent and no aerophagia over AHI of 2.0 and belly issues...I would take the 4.0 AHI any day of the week. Not everyone will notice a big difference in how they sleep or feel between lower AHI and higher.
I am one of those people....one of my best days in terms of how I felt was with an AHI of 10.2 the night before. Go figure that one.
Even today if I could feel that good today I would gladly take the AHI of 10.2. I felt like superwoman that day.

[Jack o]

Thank you for your continued help and guidance Pugsy.
I thought you would frown at an AHI over 2.0.
I accept my leak rate because the F30i is the best mask I have ever used with respect to leaks with only the mouth covered combined with under the nose nasal style. No side leaks is great since the F30i is not a truly full face covering mask (not claustrophobic either). Nasal push up under the nose is where it leaks for me due to left side nasal decon. / deviated septum and the the challenge of how loose or tight to make it (different decon. every night).

It's a shame that a pulmonary doctor and his technicians have so limited knowledge. They had me in a large mask for my first 5 years of on and off use. And they have never said a word about a cervical collar.

So I will leave the low as-is at 7.0 and lower the high from 12 to 11 tonight and test for the best AHI/belly comfort
balance over the next week, using an AHI of 4.0 as my limit. I will report back in about a week or maybe sooner. Thanks

[Pugsy]

It's not that I think everyone should have an AHI of less than 2.0 or they aren't adequately treated.

I think that OSA is optimally treated when a bunch of things come together besides just the AHI.
The AHI is just part of a big complicated end result of cpap therapy.

My main goal in all this....improve sleep quality and feel as good as possible during the day. An AHI of 5.0 isn't the end of the world if you sleep great and feel great. Is it "worse" than 2.0...sure but it's not horribly worse and it won't kill you and it's unlikely to cause serious prolonged desats.
It does no one any good to get an AHI of 0.0 or 1.0 or 1.5 if to get that result you are miserable during the day with belly pain. I have been there with belly pain...it's miserable and I see no sense in having to accept that just to get an AHI below 2.0 when an AHI of 3.2 or 4.2 is quite acceptable as a compromise.

Yes, it would be ideal if we could get an AHI of less than 2.0 and sleep great and feel great and no belly issues but sometimes in life we don't get ideal so sometimes we have to compromise and maybe do some trade offs.

Besides...I know that there are always some false positive flagging happening to inflate that AHI a little bit ....happens to everyone.

[Jack o]

Hello, (Pugsy if you are available?)

I have been testing a couple weeks now with different pressure settings and have really gotten gassed up with the high pressure set in double digits. I am now trying to avoid so much gas, bloating, constipation and probably dehydration. My current thinking is to see how goes with pressure set at: Low – 6.0 & High- 8.0 for a week or 2. Hopefully AHI averages 3.0 or lower and the gas etc.. resolves itself with the Low at 6 and High at 8. Not much time is spent at 6.0 but maybe 20% is (see last nights below). Cervical collar is absolutely helping. Do you have any suggestions based on the below testing and my planned future direction?

17 Day AHI history – at various pressures
Pressure 3/23: Low 8 - High 15 - AHI 9.6 (no cervical collar)
Pressure 3/24: Low 8 - High 15 - AHI 2.8 (started cervical collar- ongoing from here on)
Pressure 3/25: Low 8 - High 15 - AHI 2.3 (gas)
Pressure 3/26: Low 8 - High 13 - AHI 0.9 (gas)
Pressure 3/27: Low 7 - High 12. - AHI 2.1 (gas)
Pressure 3/28: Low 7 - High 12. - AHI 2.3 (gas)
Pressure 3/29: Low 6.6 High 11.4 - AHI 2.9 (gas)
Pressure 3/30: Low 6.6 High 11.0 - AHI 3.6 (gas)
Pressure 3/31: Low 7.0 High 11.6 - AHI 4.4 (gas)
Pressure 4/1: Low 6.8 High 12.0 - AHI 7.6 (gas – getting worse)
Pressure 4/2: Low 7.2 High 12.4 - AHI 2.9 (switched from F30i back to F30 - less air noise/less exiting air)
Pressure 4/3: Low 7.4 High 12.8 - AHI 2.3 (gas - getting worse – constipated – must be dehydrated )
Pressure 4/4: Low 7.4 High 13.2 - AHI 3.3 (gas - getting worse – constipated – must be dehydrated )
Pressure 4/5: Low 6.0 High 9.0 - ***AHI 1.9 *** (water gurgling in hose with pressures lowered – shook it out)
Pressure 4/6: Low 5.0 High 7.0 - AHI 3.5 (lowered Humidity from 7 to 6 ongoing) Note: From Aug. 2019 thru Jan. 2020
low pressure settings ranged between 4.6 to 5.4 and High between 6 and 9 with avg. AHI at 4 -5 (but fluctuated higher at times – probably due to chin tucking. Then AHI spiked in Feb. 2020 I assume due to tucking my chin (more).
Pressure 4/7: Low 5.0 High 7.0 - AHI 4.9
Pressure 4/8: Low 6.0 High 8.0 - ***AHI 2.0 ***

[Pugsy]

I would use the settings that kept the AHI fairly low and no gas issues.
The fact that the machine might max out that lowered max pressure I would just ignore.

More nights at 6 min and 8 max is what I would do.

[Jack o]

Thank you Pugsy!
Will do.

[Jack o]

Hello Again,
I have been monitoring my CPAP settings / numbers for 3 weeks.
I was loaded with gas / aerophagia / constipation as a mouth breather/ air swallower with the High setting in double digits.
As I have lowered the high pressure settings, the AHI, on average, continued to improve down to a setting @ High 7.0 and Low 5.0. Does that make any sense?
Could that mean I may have central vs. obstructive apnea?
The cervical collar has been the biggest God-send of all for me. Thanks again Pugsy!
I plan to continue with settings at High 7.0 and Low 5.0 – and maybe try lowering the high into the 6’s after a while, in case that may be enough at some point.
Is there a way to monitor AHI with just a cervical collar on? Maybe set at H4 and L4 which if it goes high means I need the CPAP along with the collar? Or should I have Pulmonary Dr. prescribe the at home medical wrist mechanism?

Most Recent readings:
Pressure on 4/9: Low 6 - High 8 - AHI 3.0 (still gas/aerophagia)
Pressure on 4/10: Low 6 - High 8 - AHI 2.5 (still gas/aerophagia)
Pressure on 4/11 Low 5 - High 7.6 - AHI 3.9 (still gas/aerophagia)
Pressure on 4/12: Low 5 - High 7.6 - AHI 4.3 (less gas/erophagia)
Pressure on 4/13: Low 5 - High 7.6 - AHI 4.8 (less gas/aerophagia) – AHI was 2.0 at 5am (5 hrs.) then went all the way up to 4.9 for the full night by 7am – 7 hrs. Hypopnea 2.56 high?
Pressure on 4/14: Low 5 - High 7.6 - AHI 4.4 (less gas/aerophagia)
Pressure on 4/15: Low 5 - High 7.6 - AHI 1.6 (almost OK gas/aerophagia) How 1.6? Nothing different, Sleep mostly on back.
Pressure on 4/16: Low 5 - High 7.6 - AHI 2.6 (close to acceptable gas/aerophagia) AHI was 1.6 at 5am (5 hrs.) then went up to 2.6 for the full night by 7am – 7 hrs.
Pressure on 4/17: Low 5 - High 7.6 - AHI 1.6 (close to acceptable gas/aerophagia) very congested – 90% mouth breathing but excellent AHI.
Pressure on 4/18: Low 5 - High 7.0 - AHI 1.3 (close to acceptable gas/aerophagia) tightened cervical collar more with lower high setting.

Pressure on 4/19: Low 4.0 - High 6.2 - AHI 3.2 (acceptable gas/aerophagia) cervical collar “tight” and will continue going forward
Pressure on 4/20: Low 4.4 - High 5.6 - AHI 5.0 (acceptable gas/aerophagia)
Pressure on 4/21: Low 4.6 - High 6.6 - AHI 3.7 (acceptable gas/aerophagia)
Pressure on 4/22: Low 5.0 - High 7.0 - AHI 2.5 (acceptable gas/aerophagia) (report pasted below)

Thanks for all the help!
Jack

[ChicagoGranny]

cervical collar “tight”

What is the purpose of adjusting the collar tightly?

What size (width) collar are you using? Is it rated Firm, Medium, or Soft?

[Jack o]

I "just thought" adjusting tight would limit chin tucking the best.
It is not uncomfortably tight.
Collar is Soft, Size - Universal, Height 3.25" and Thickness -1.25"
Thanks

[ChicagoGranny]

I "just thought" adjusting tight would limit chin tucking the best.
It is not uncomfortably tight.
Collar is Soft, Size - Universal, Height 3.25" and Thickness -1.25"
Thanks

I use a 4-inch firm which holds my chin up well. By using a wider, firmer collar, it can be adjusted loosely. The adjustment can be as loose as possible without letting the chin fall inside the collar.

YMMV

[Jack o]

Thanks - Chicago Granny.
Next time at the pharmacy I will get one and try it out.