Need some help getting AHI down even further (OSCAR)

[isquealatnight]

Hi guys,

I've been on CPAP on and off for a month now and I've learnt a fair bit. I have mild sleep apnea and my at-home test back in April 2022 reported an average AHI 4% of 3.8 (9.1 in REM). After the test I used a mandibular advancement device for just over a year before finally concluding it wasn't helping much and it was making my teeth hurt (I actually retested with the MAD in and my average AHI came out worse at 6). Anyway so I decided to get a CPAP. First two weeks with the F30i mask and default AirSense 11 settings were rough, my AHI would vary wildly anywhere between 4-15 AHI, I started off with EPR off, then to ramp only but it didn't have a huge effect but it made the experience before going to bed much easier. Week 3 I set EPR to full time and this helped drive down the average AHI to 5-9. I always had issues with bad leaks in the morning that would wake me up and eventually came across the concept of mask liners. Regardless of whether I wash my face before bed, by about 5-6am my face will be oily enough to the point where the silicon has no chance forming a respectable seal. Roll on week 4 and I got both a CPAP pillow and washable, reusable cotton mask liners and now I have got my AHI consistently down to ~3-4 AHI. While this apparently simply matches the results of my first at-home apnea test, i'm feeling way more refreshed than ever! However I reckon there is still room for improvement but I'm not sure how to interpret my OSCAR data. Hope someone can help

Backup link in case attachment fails: https://imgur.com/a/EH21YzF

[Miss Emerita]

You're doing a lot of good problem-solving, and it's great you're feeling more rested.

Your OAs tend to come in little clusters, which suggests you may be tucking your chin down toward your chest from time to time during the night. If that's going on with you, you could try a lower, firmer pillow (though you're probably already using one if you're using a PAP pillow). You could also try sleeping on your sides as much as you can. And it might be worth experimenting with a soft cervical collar to see whether that helps to keep your head in a better alignment.

If none of that helps, the next experiment you might try is to raise your minimum pressure. You might go up in increments of 1, spending at least a few nights at each new pressure to see how things are going. Whenever an increase is uncomfortable for you, back down to a smaller increase over the last minimum that was comfortable for you.

[isquealatnight]

Thanks for the suggestions. I got a 2.8 last night with no changes! Yeah the CPAP pillow is both low and firm (name of it in my signature). I am a side sleeper but I know I unintentionally end up on my back sometimes. I occasionally briefly wake up in that position too with no leaks which may be a significant factor. I'll look into soft cervical collars and report back, I have to admit though that the thought of wearing one is very unappealing

[Pugsy]

Thanks for the suggestions. I got a 2.8 last night with no changes! Yeah the CPAP pillow is both low and firm (name of it in my signature). I am a side sleeper but I know I unintentionally end up on my back sometimes. I occasionally briefly wake up in that position too with no leaks which may be a significant factor. I'll look into soft cervical collars and report back, I have to admit though that the thought of wearing one is very unappealing

You know if it were me and I wasn't exactly thrilled with wearing something else on my face/head/neck....and a cervical collar would be last on that list...and I wanted to maybe reduce OA/hyponea clustering then I would try a small increase in that minimum pressure first before going to a list of stuff that I really didn't want to try.

That minimum pressure does the bulk of holding the airway open and often a small increase will prevent the clustering from happening (no matter what the cause).

You know it might be REM stage sleep related and not necessarily position related.
Increasing the minimum just a little could possibly be all that is needed.

Remember anything flagged while awake doesn't count and you can't fix those with pressure changes.
It's a sleep problem and not an apnea problem when we see events that are awake/arousal related.

If you aren't asleep...they don't count except to point to not being asleep and our goal is to go to sleep and stay asleep.

[Lucky7]

That pillow looks nice

Agree, I'd bump up the min pressure first. You are getting up there anyway,so....

[isquealatnight]

I thought I'd post an update after a lot more learning on this apnea journey. The F30i mask + CPAP pillow + linen mask liner only got me so far. I was still having fairly inconsistent results with AHI ranging between 3 and 8.

I bought the F&P Vitera full face mask and that was actually considerably worse for me than the F30i (money down the drain!) with my AHI going up sharply to 6-12.

Next step I tried out a cervical collar with the F30i and this definitely helped with AHI coming down between 3-5. This gave me the next clue in that my mouth falling open when I sleep seems to be a huge problem leading to large leaks etc. There is nothing the F30i can do to stop me from opening my mouth.

Decided to try a drastic change, bought the P30i and a chin strap. Immediate massive drop in AHI to between 1-3!

I then bought mouth strips (Like a Log!) and this has ended up being the ultimate solution and i am now between 0.63 (new record) and 3. Plus I find it more comfortable than wearing a chin strap.

I think that pretty much concludes my journey to reducing AHI way down (I might still play with pressures and EPR but i guess dont fix what ain't broken). Out of curiosity If I had gone into a hospital for a proper sleep study would they have been able to deduce this for me? I only ever did at-home tests..

[Miss Emerita]

Thanks for the update, and congratulations on all the additional great problem-solving. (No, an in-lab sleep study wouldn't have helped you with the issues you've addressed, if that was the question.)

And agreed: if it ain't broken, don't fix it!