Newbie Choice: Sore Neck or Higher AHI

[dizzyhead]

I started on a Auto CPAP (PR System One REMStar 60) about four weeks ago. Prior to CPAP, my test showed I was at 19 AHI.

Within the first 7-10 days, my AHI was down to about 2. However I began to get a sore neck and realized that while getting used to my new mask, I was sleeping with my head too far forward. I then began "trusting" that my mask wouldn't leak and was able to sleep in a better position with my head not so far forward which improved my neck pain.

I then realized that my AHI had increased over about a week back up to around 6-7 and I didn't feel as well rested. I tried to think what might have caused the increase in AHI. The last thing I thought of was my change in head position so for the last three nights I tried sleeping with my head in a forward position again and voila, now my AHI is back down to about 3.

Any thoughts or advice? Do I need to have my minimum pressure increased from 4?

Thanks!

[kaiasgram]

What a choice! When you say "forward position," I'm trying to visualize -- do you mean whole head and neck stretched forward and out, or more like head bent forward with chin tucked? I quick grabbed a couple of images off Google since I'm not sure I'm describing the difference well enough.

[Xney]

You might just need a higher pressure in that position. 4 is a very low pressure. What's your range set to?

[kaiasgram]

You might just need a higher pressure in that position. 4 is a very low pressure. What's your range set to?

I'm thinking possibly higher pressure too -- depending on your particular anatomical features, head/neck position could certainly affect the openness of your airway. I was thinking that if the OP has her head forward like in the first image, she'd be stretching her neck and possibly keeping her airway more open as a result and having a lower AHI. Letting the head drop back a little could theoretically make it easier for the airway to relax and "fall in" more.

Before I knew I had OSA I was sleeping supine but with my head turned to one side and my neck kind of stretched out like in the first image, now I'm thinking that was an unconscious strategy to try to keep my airway open.

[dizzyhead]

Thanks for the quick replies!

My head was forward more like the first picture as I was initially trying to keep more of my mask straps off of my pillow. My machine range is at the original setting of 4-20.

[kaiasgram]

Thanks for the quick replies!

My head was forward more like the first picture as I was initially trying to keep more of my mask straps off of my pillow. My machine range is at the original setting of 4-20.

Hmm, with your settings wide open like that I would have expected the pressure to go up to keep those apneas at bay. I wonder why that didn't happen -- maybe it did to some degree but not enough to prevent your AHI from going so much higher. A confusing situation, hopefully there will be more ideas coming.

Love your username by the way -- many of us could have adopted "dizzyhead."

[Pugsy]

My machine range is at the original setting of 4-20.

Probably that 4 cm pressure is not quite enough to do a good job of preventing the apnea events.
Likely the positioning is creating a need for just a little more pressure. The PR S1 machines don't increase the pressure extremely fast. Instead they take their time and test things as they increase and if it takes too long to get to where the pressure needs to be then the events come and go while the machine is making its way upward.
Really no different than someone needing more pressure when supine sleeping as opposed to side sleeping. It happens to some people. One position may need more pressure than another. Same thing with the neck position.

Solution is to increase the minimum pressure a bit to give the machine a better head start. Probably wouldn't take much...5 or 6 minimum would likely get the job done. With an AHI of 6 to 8...you are very close anyway.
Perhaps 5 minimum or 5.5 minimum. At this point sometimes 0.5 cm pressure difference makes a pretty big change.
Then sleep in whatever position with your neck that promotes good sleep and no neck pain. Let the machine do what it is designed to do.

[-tim]

I started out with a Zest mask but I tried a FX and it worked great but by jaw hurt and my head hurt. I put the Zest head gear on the FX mask and that worked for me.

[dizzyhead]

Thanks all. I'll set the minimum pressure to 5 and see how it goes!