Resmed myAir Sleep Report

With a PC it is quite easy to capture a screen of your daily report if you want to post it here. All you need to do is maximize the window to full screen and press F12. This will save an image in a SleepyHead data folder under your documents, and then in a sub folder called screen captures or something like that. When you post a message here, just left click on that file name in Windows Explorer, and drag it into the body of the message. It will upload and display with your message. Seeing what your typical daily reports look like will be very telling as to what the problem might be, and what may need changing.

Changing settings is actually quite easy. I believe the AirCurve is the same as the AirSense machines. You hold down the round knob and the home key at the same time for about 5 seconds. This will get you into the clinical setup menu, and you can change pressures etc. However, I would caution you to not do that until you have a good understanding of what you want to do. The other way is to get some input here as to what needs to be done, and then do it yourself or ask your provider to do it.

The main thing to look for in the daily report in SleepyHead is the events bar. Mouse over the obstructive apnea events, and make note of what your mask pressure is compared to your maximum pressure settings. (They should display on your machine screen each night when you start up the machine.) If all of your events are happening when the actual mask pressure is at the maximum pressure settings then it would seem your maximum pressure needs to be increase. If most of the events are happening when the pressure is at your minimum pressure setting, then it may need to be increased.

Hope that helps. If you can post your daily report screen shot it would be very helpful.

That screen shot is very informative. First the good news. About 60% of the events are obstructive apnea, and you have room for more pressure. And all of the events seem to be confined to defined periods during the night. Perhaps that means they have a sleep position relationship back vs side? Or could you have been awake for the part of the night that was pretty much clear of any events?

The central events are a bit high, and it may be more difficult to address them. However, they seem to be concentrated right at the beginning of your night, and you do not appear to be using a ramp which blocks event reporting during the ramp up time. Some people tend to have central events when they are falling asleep. I notice that you get a concentration of them just before you shut the machine off in the morning too. It is cheating a bit, but you could turn on the ramp function with a EPAP start pressure of about 8 and a time of 20-30 minutes.

SleepyHead sometimes does not report machine setup accurately, but lets assume it is correct for now. It is showing you are in VPAPauto mode which does not quite match the clinical manual I have, but it seems to be the Auto mode. The pressure settings reported are:

Minimum EPAP: 12 cm

Maximum IPAP: 16 cm

PS (Pressure Support): 4 cm

The use of the terms minimum and maximum seems to confirm it is in Auto mode. However when the minimum EPAP is 12 cm, and the maximum IPAP is 16, and the PS is 4 cm, the machine is essentially frozen in a fixed pressure mode. IPAP is EPAP plus PS. There is no room for the EPAP to increase without hitting the IPAP max.

So if you are brave enough to try making a pressure adjustment, I would suggest you go into the Clinical Menu as I described above and change the Maximum IPAP to 17 cm to see what that does. It is a small increase. If that is tolerable for pressure, and provides a benefit, but does not get your obstructive apnea incidence down enough you could then try 18 cm. Note that this does not force the pressure to go up, but it gives more room for the machine in Auto to move it up. You will at least be able to see what the machine is trying to do during the night. Right now it is frozen. Keep in mind that your machine is capable of going up to a maximum IPAP of 25 cm. Right now you are not really getting any benefit of having a BiPAP machine because you are operating in the range of a standard APAP.

The other thing to watch if you go ahead with a change is your incidence of central apnea. In some people more pressure can increase central apnea. But at this point, I'm not so sure all of that central apnea is real.

I also see that your mask is working well and you do not have any excessive leaks. That is a good sign that you may be able to handle more pressure.

Hope that helps some...

One thing you should check before jumping in is the very first Mode setting. Check to see that it is in fact in Auto mode. Here is a link to a detailed manual for this machine, which should help you navigate the options. I would download this pdf and save it. They come an go on the internet.

AirCurve 10 Manual

Increasing the maximum IPAP is the most straightforward way to address your excessive obstructive apnea. The other method would be to reduce the pressure support (differential between EPAP and IPAP). I didn't suggest that because there may be reasons why you are using a higher pressure support than can be supplied with a standard APAP. It is an option though.

In any case whether your make the adjustment yourself or go back to your provider, you do need an adjustment. An AHI above 20 is not good. I strongly suspect the machine you have can deal with it, and it just needs to be set up properly. If you choose to go back to your provider ask about increasing the maximum IPAP, and the pros and cons of reducing pressure support. The normal way of going about this is to get your obstructive apnea under control first. Then adjustments up or down in the pressure support may improve central apnea.

I agree that a BiPAP is a bit more complex than an APAP, and one needs to understand what they are doing and why when making adjustments.

The situation may vary widely depending on the region one lives in, but having access to a professional and one that actually is knowledgeable is not a given. I know from your comments here that you are very knowledgeable, but not all sleep technicians are. The one I had told me that the CPAP machine she was recommending would cure my diabetes, which I have had for 20 years. Ok, sure... And then the machine she recommended does not even detect central apnea which is my main problem. I left her and the machine behind and went on my own.

I think the other part of the issue is that sleep clinics make their money doing sleep studies and selling machines (may vary by region), and not by doing followup and adjustments for existing CPAP users. My son has an AirSense 10 and bought it from a source that said they would monitor and adjust his setting remotely. He has had it for nearly 3 years, and I looked at the machine history a few weeks back, and it had never been adjusted once from the initial setup which was not very good.

My conclusion from my experience, my wife's experience, my son's experience, and that of a friend, is that clinic follow up is poor to non existent. I think a user has two choices if they want the best results from their CPAP or BiPAP. One is to use SleepyHead, and learn what is good performance for your machine, and when it is not, then be persistent with your supplier to make changes. And that may not be so easy if they will not monitor your results remotely, and even more difficult if they want to do subsequent titration tests, instead of reviewing your machine data and just doing an adjustment. The issue is that doing adjustments is time consuming and often ends up being iterative. In this posters case, I would expect 3-4 adjustments of IPAP Max will be required to get optimum results. Then if central apnea frequency is not acceptable, then possibly even more adjustments of the pressure support may be needed. It takes time and not all clinics are prepared to do it. The user of course has nothing but time.

So the other option is for the user to educate themselves, do their own monitoring, and make their own adjustments. In my view those users in the end will have the very best results from their machine. Nobody has more interest in getting things right, than the actual user. But, one has to take the time to become informed.

Just my view. I like to provide the information and some advice, and let the user decide what they want to do.