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Back after a while sleep onset events

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p3000g +0 points · about 1 month ago Original Poster

Hi folks

Back here after a while. Havent been active here due to other health issues. To give am update: I am on a Resmed air sense 10 for about a year with a fixed pressure of 11cm ( no ramp or epr). I had initial issues with sleep onset apneas and cpap seems to have helped ( at least it keeps my AHI numbers down) .

However , of late have been noticing sleep onset events creeping back up. Does anyone think I should reduce the pressure a bit ( I was prescribed 10cm ) ? Do CPAP machines lose effectiveness over a period of time? Should I start using EPR and ramp again?

Thanks all for your valuable insight

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Sierra +0 points · about 1 month ago Sleep Innovater

If it was me I would use an AutoRamp and set the EPR to Ramp Only, at 3 cm. I use a fixed pressure of 11 cm, with a 9 cm ramp start pressure. If the extra pressure does not bother you, you could use a Start Pressure of 11 cm. Reducing pressure would only be indicated if you are having central apnea events.

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p3000g +0 points · 30 days ago Original Poster

Thanks again. Unfortunately, the Resmed Airsense 10 does not have any EPR setting for ramp only. Just two settings : on and off. I set it to on and the pressure to 11.6 . Lets see what happens.

I also noticed that most of these events occur in the morning as I am just waking up and going through the sleep/ wake cycle

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Sierra +0 points · 30 days ago Sleep Innovater

I could be wrong, but I think all the AirSense 10 machines have an EPR setting for Ramp only, and an Auto Ramp. See pages 14 through 16 of the manual at the link below to see how to set it this way. The EPR and Ramp are in the Comfort section of settings.

AirSense 10 Technical Manual

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p3000g +0 points · 21 days ago Original Poster

I checked again . I dont see any option for ramp only EPR. By the way, does a bipap machine help with Sleep onset centrals? I had a horrible night last night. I think I will go back to the doctor and ask for a bipap. Thanks

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Sierra +0 points · 21 days ago Sleep Innovater

No I don't see how a BiPAP could help with a sleep onset apnea. All it does is provide more than 3cm of EPR which would hurt more than help. It also provides a maximum pressure of up to 25 cm instead of 20 cm. Again would not help unless you are at 20 cm already and need more.

Have you read that manual on how to access your Clinical Menu on the machine? I still think you should be able to set it to ramp only. Turning EPR right off may be another option and then use no ramp at all.

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p3000g +0 points · 21 days ago Original Poster

I have turned off both EPR and ramp. Do you think reducing the pressure would help? I was originally prescribed 10cm , but now it is set at 11.2 cm. I am thinking of reducing it to 10.8 cm and see . I read somewhere that increased pressure can cause centrals

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Sierra +0 points · 20 days ago Sleep Innovater

Are you using SleepyHead or Oscar to determine if the sleep onset apnea events are central or obstructive? If they are obstructive, then more pressure would be better than less. If they are central, pressure might make them worse, but that would be less certain. If you are sure they are central and they are happening before you go to sleep, then you may want to use the Auto Ramp, with a much lower ramp start pressure.

What specific model of AirSense 10 do you have? Auto, Elite, or CPAP?

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p3000g +0 points · 20 days ago Original Poster

I have airsense 10 CPAP. I use sleepyhead. I don't have the charts with me now, but the AHI numbers are well below 5. Most of the events are hypopneas with a few Obstructive and Centrals in between

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sleepydancer +0 points · 28 days ago

I just reset mine to ramp only so try checking again

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Sierra +0 points · 20 days ago Sleep Innovater

If it is a AirSense 10 CPAP model do you actually get any detailed data on the SD card? My recollection is that the CPAP model does not capture detailed data, and only the Elite and Auto model do.

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p3000g +0 points · 19 days ago Original Poster

My bad . It is Airsense 10 Elite

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Sierra +0 points · 19 days ago Sleep Innovater

It should have Rutoramp and ramp only EPR then.

However I would focus on determining exactly what type of event is occurring at sleep onset. If you zoom in on the SleepyHead data you should be able to determine what the cause is.

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Sierra +0 points · 19 days ago Sleep Innovater

Here is an example of what you are looking for in SleepyHead. In the screenshot below there are three events in succession. The first one is classed as a CA event or clear airway or central apnea. The next two are classed as OA or obstructive apnea. If you look at the mask pressure during the event you will see the trace paint a band of up and down pressure fluctuation. That is the machine increasing and decreasing flow quite rapidly to determine how the pressure responds. If the airway is clear the pressure does not fluctuate as much up and down. If the airway is blocked the blue band that is painted by the mask pressure is wider (up and down). It is not a huge difference, but there is a difference if you look closely.

Also be aware that during the ramp or autoramp the flagging of events is suppressed. So if you want the best picture of what is happening when you are going to sleep, you may want to try turning the ramp off. Then events will be flagged right from the time you turn the machine on. Once you find out what is actually happening then there is probably a strategy with the ramp and ramp pressure that could minimize it.

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p3000g +0 points · 18 days ago Original Poster

An example of my data today. Although AHI is 0, I am interested in knowing what does the circled irregular breathing represent? Machine is not flagging any events , but I know, I took a deep breath at that point and woke up from a transient state of sleep/wake

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Sierra +0 points · 18 days ago Sleep Innovater

Do you think you were asleep? It certainly does not look like a classic central apnea event. The machine starts testing after 4 seconds, and there is still no airflow after 10 seconds, it declares it an event. It looks like you may have been drifting off to sleep, but woke up. Some call this sleep-wake noise, where breathing gets irregular when the body is deciding whether or not to actually go to sleep. Most do not consider this apnea.

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p3000g +0 points · 17 days ago Original Poster

Well, I was not completely asleep as in a deep sleep or REM sleep , but drifting in and out of sleep. It is when these events occur and wake me up, and the cycle repeats itself several times before I fall asleep

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Sierra +0 points · 17 days ago Sleep Innovater

I think many suffer from that to some degree, and about all you can do is make the going to sleep part as comfortable as possible. I would suggest going to the Clinical Menu (hold home key and round set key at same time for about 5 seconds), and set you machine as follows:

Go to the Comfort section of the Clinical Menu and make these settings:

  • Ramp Time - Auto
  • Start Pressure - 7 cm (although if that does not feel like enough air, you can go higher. I use 9 cm)
  • EPR - On
  • EPR Type - Ramp Only
  • EPR Level - 3 cm

This will make breathing easier until the machine decides you are asleep. When you are then it will ramp up to your normal 10.8 cm fixed pressure.

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p3000g +0 points · 15 days ago Original Poster

Okay. Thanks Again.. Much appreciated. I will try these settings

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