Sierra

My wife and I both use a CPAP but have no insurance. We have bought our own machines and pay for any parts or accessories we use. Some time ago I got a package of 60 filters from Amazon for about $17. In comparison to the OEM ResMed filters I find these filters to be better quality. They are much finer and fit well in our A10 machines. I replace them every 4 months, so it will be quite a while before I have to order more. I do not consider them as defective, but actually superior to the ResMed filter. As far as I know the ResMed filters have no specifications either. But, they are obviously much courser in texture, and probably last longer before they start to plug up as they don't catch as much dust. I judge how effective the filter is by how much dust collects on the outside of the filter and how thick that coating is by 4 months. For these filters and our house dust conditions, 4 months seems about right.

It is best to download OSCAR to view the detailed data to see when you are snoring. It may be that your minimum pressure is too low, or that your maximum is too low. OSCAR will tell you what is going on.

https://www.sleepfiles.com/OSCAR/

You have made a big improvement. If you want you can download OSCAR which is a freeware program that allows you to look at your results in detail. Your CPAP has to be compatible with OSCAR, but most ResMed and DreamStation machines are. You also need a PC or Mac to run OSCAR, and a card reader to get the data from your CPAP to your computer. If your machine does not have one, at least the ResMed machines take a standard SDHC card of 4 to 32 GB. OSCAR can likely identify opportunities to improve the setup of your machine. Acceptable AHI is to be under 5, but many can get under 1, with some tweaking of the pressures.

Both my wife and I had a home sleep study with Phillips Alice Nightone equipment. I did not sleep real well but the machine said it was enough and I got diagnosed at 35 AHI or so. I think the equipment works.

There is a dentist who has a Youtube video on the benefits of mouth taping for a better sleep. However, I don't think it is a good idea to mouth tape under a full face mask. The tape is likely to get soggy and come off. It would require a switch of masks to a nasal pillow type mask like the AirFit P10.

Demineralized water is just as good as distilled water, so that is unlikely to be a concern.

As long as the CPAP keeps the AHI to a low number under 5 there should be no problem with weight lifting.

Yes, a fixed pressure of 8 cm would not have worked well at all. Way too low. Your 95% pressure is 15.5 and that is what is typically used on a switch from APAP. Your median pressure is 12, which means half the time it is above that, and the half it is below.

What I am not sure about is how the machine treats hypopnea during large leaks. It does have the ability to classify apnea events as unidentified apnea or UA. I have seen those. They are apnea events, but the machine just cannot determine what type they are, obstructive or central.

My wife had a bad night for leaks a couple of nights ago and even got the red unhappy face on the sleep report. That takes a lot to bring that up. Here is what it looked like. As you can see AHI was still very good, and no events flagged during or after the largest leak period.

And the other thing you can do if you think the machine is not reporting events properly is zoom in and look for apnea events where there is no flow. I did that for this large leak period and only found one potential apnea event and zoomed further in on it. See this graphic. The event starts where the green vertical cursor line is and continue on for near 10 seconds. After 4 second the machine starts to oscillate the flow to test for the apnea type. You can see that as the high frequency cycle in the mask pressure, starting at 4 seconds. However it does not flag it as an apnea event. I would have expected to see it flagged as a UA. I'm thinking it ended just short of the 10 second length required before it is classified as an apnea event.

In any case you can see how to manually check for events during a high leak period manually and decide if there are missed events or not, Hypopnea is harder as I have trouble seeing what the machine classes as hypopnea. But, you could use a similar process to look for them. Find a hypopnea event that is flagged as such, zoom in and see what it looks like, and then search for that pattern during your high leak rate periods to manually look for them.

If you think your machine is not responding properly to events due to high leakage you can always switch to fixed pressure CPAP mode. That is how my and my wife's machines are set. Unless the leak is super huge, like the mask falling right away from the face, the pressure is maintained right through the high leak periods. The standard way of switching to a fixed pressure is to look at the statistics page and find your long term average of the 95% pressure and then just set the fixed pressure at that value.

Hope that helps some,

By "sneaking in" I mean that when the leakage rate is below the 24 L/min redline the machine can report events. For apnea events for sure, it stops trying to classify apnea events when the leakage rate exceeds 24 L/min. I am assuming the same may apply to hypopnea events. In other words they are not likely false, and are there during high leakage but are not being reported. Then when leakage drops below 24 then it starts reporting them again. One issue with high leakage is that when the rate goes over 24 the machine stops responding with more pressure to events. When the leakage returns to normal the pressure can be lower than it needs to be and events then occur as soon as leaks go below 24. There can be a burst of events right after a high leakage rate period.

Yes, EPR at 3 as well as a higher minimum pressure should help reduce flow limitations. I agree that your minimum pressure could be quite a bit higher. The 95% pressure is at 15.5, and if you were to switch over to fixed pressure CPAP mode that would be the first pressure to try. In auto you could try 12 or 13 for a minimum to see if that helps with flow limitations. If it does then it may not be so quick to increase pressure further.

Hope that helps some,

I think it is the flow limitations that are driving your pressure up. You appear to have your EPR set at 2 cm. You may gain some reduction in hypopnia and flow limitations by increasing that to 3 cm. I get a very significant reduction in my hypopnea with 3 cm of EPR.

The detail is missing, but I kind of think those hypopnea events are sneaking in when the leakage drops below the leak rate redline for brief periods of time. When the leakage is higher they are probably being suppressed.

A BiPAP machine like the ResMed AirCurve 10 VAuto may be of benefit to you. EPR is limited to 3 cm on the AirSense 10, but the similar pressure support on the BiPAP can be set as high as 10 cm. And max pressure will go up to 25 on a BiPAP. You are pretty much at the limit of 20 that the APAP can do. But, normally they will not prescribe a BiPAP until you can't stay under the 5.0 for AHI. At least on this night you are doing it.