Sierra

Just press the round button to "wake up" the machine. The top "My Options" window should be highlighted. Press the round button again to select it. The "Run Warmup" option will not be initially displayed but if you rotate the round button it will go further down. When it is highlighted, press the round button again to select it. And then once more to make it run. It will do the rest from there.

Another thing you can do with the humidifier if you are not already doing it, is to select the pre warm feature 15 minutes or so before you plan to go to bed. It is on the options menu, I recall next after the mask test option. All it does is warm the water up before you go to bed. It may make the humidifier work a little sooner each night.

I like to keep our bedroom cool too and around 65 deg F. We are just coming out of the winter season here where it goes below freezing each night outside. Our setback thermostat takes a while to adjust to the warmer weather, and sometimes starts warming the house up too early. You are right though. One has do dress right for the temperature.

If you can zoom the scale in on that green CSR section just before 7:00 AM, and post it, I can have a look to see what is happening. The flow graph and Minute Ventilation should show what is happening. I am not exactly sure how ResMed decides it is CSR. The normal CSR pattern has periods of waxing and waning breathing effort with CA events when flow stops between the cycles. This is what ResMed says it looks like but I have never seen anything in my charts quite that uniform.

This is an example of what I see:

Made a post and it seems to have disappeared. The short story is to reduce the min pressure to 11 cm, and max to 12 cm. Trying to find the point where OA events start to appear....

Ouch on the car accident. Good that nobody was injured.

The cervical collar seems to have been the silver bullet for your OA, Hypopnea, and flow limitations. Because they are lower the upsets to flow rates is likely less and they may have been the trigger for the instability that is causing the CA events, as they are down too. Pressure is simply holding at 13 cm, the minimum, all night. That is good.

I think it would be safe to lower both the minimum and maximum to 12 cm and 13 cm respectively. Try that for a night to see what happens. You seem to be making great progress on the leaks too. That helps. On my reports I watch the "Time over the Leak Redline" and like to see it at zero or close. You got 0% which is great.

With the ramp in Auto, the time it holds pressure constant is a good indicator of how quickly you are going to sleep. It will hold it for a maximum of 30 minutes if it does not detect you are asleep. It looks like you went to sleep in about 15 minutes when you first went to bed, and about 5 minutes after the pee break. After 4:40 or so it looks like you did not sleep and there were two very brief breaks in flow when the Auto timer reset. From that time on the Ramp stayed in Auto and did not increase to the minimum pressure, which is fine.

You may want to zoom in on the CA events that occurred at about 2:35 AM and a bit of time before that to see what let to them occurring. In any case things are improving significantly. Hopefully you can find a pressure that controls the OA that is lower than it is now. That may also reduce the CA's. Once that pressure is found, it may make sense to switch to a single fixed CPAP mode pressure.

Yes, that is a major improvement. It seems that the cervical collar may have addressed the OA events. This would suggest that neck kinking while sleeping may be a significant issue for you. I guess more successful nights will tell the tale if it continues to work. What is encouraging is that your pressure stayed at the minimum of 13 and not once did it try to increase to the maximum of 14. I would not try it just yet, but this looks promising that pressure could be lowered. Your hypopnea and flow limitations seem to have gone to zero.

I have not tried the supplements thing, but my wife does. Gaba is one of the ones she takes. I have gotten significant help on sleep from the site at this link. It was started by a Canadian pharmacist and university professor that was concerned about the incidence of seniors taking falls and breaking bones. He blames the use of sleeping pills and instead advocates the use of CBTi, or cognitive behavioural therapy for insomnia. I found the website very helpful.

Sleepwell - It is no Dream!

I found the Hygiene of Sleep Checklist helpful, and generally follow it.

Hopefully the good results continue. If they do, then it probably makes sense to now step the min and max pressures down until OA events start to occur again. Need to see a few more good nights before jumping into that.

That is not quite classic CSR, and the machine has not flagged it as such, but it is a strong indication of instability in the control system regulating breathing rate. There are a couple of upsets right at the beginning of this zoomed in area around 3:09 and 3:10. Then it settles out until 3:14:30 or so. There is a bit of a blip in flow limitation and then that starts off the cycles of periodic heavy breathing with the flow waxing and waning. This is most likely when the feedback on CO2 levels in the blood are too slow. This causes an over correction, and that start of the cycle over and over again. Is suspect this is the basic cause of your CA events. If I could tell you a simple solution, I would. But, I have pretty much the same thing, and have found ways to minimize it, but not stop it. One of the things I have blamed it on is one of my blood pressure medications; a beta blocker called bisoprolol. This med slows the heart rate down and I think it may have been over doing it, causing my blood flow and CO2 feedback to be low and slow. I convinced my doctor to let me try half the starting dose of this medication (0.5 mg) and it seems to have helped some. But the issues for every person are likely to be different. If you cannot get the frequency of CA events down to an acceptable level (<5 per hour), it would be worth talking to a cardio pulmonary specialist about it.

It is becoming more and more apparent that like me, you are suffering from what is called Complex Apnea. That is when a significant part of your apnea is central (CA) in nature. It is difficult to treat as in general more pressure reduces obstructive (OA) events, but increases central (CA) events. With a CPAP about all you can do is find a happy medium pressure where CA and OA are in reasonable balance and the total is not too high. The standard treatment guideline for apnea is for AHI to be under 5. However, I believe in the UK they do not treat apnea, or at least will not pay for a machine, until it exceeds 15. So the AHI<5 limit may be somewhat negotiable as to what is acceptable.

If you want to do some reading on Complex apnea I suggest two credible articles that are in the Education Blog section of this website. Read the first one first, and if you want to dig deeper then go on to the second one.

What is Complex Sleep Apnea?

Complex Sleep Apnea

If you have any questions, I will try to answer.

Yes, that is more helpful. Minute Ventilation is a measure of how much air is being inhaled and exhaled over a small period of time. A high amount means that the automatic control system in your body thinks you need more oxygen. It bases this on how much CO2 is in the blood. The problem comes in when the blood flow is too slow, and by the time CO2 has reduced in response to deeper breathing, there can be too much oxygen and too little CO2. Then the body starts to reduce breathing volume. When it gets out of sync it is like a dog chasing its tail. Breathing effort goes up and down in a cycle. That is essentially CSR.

Your CA events right at 00:15 are interesting. There seems to be two CA events but the Minute Ventilation is very steady. This indicates these are not CSR type of events. But later starting about 03:15 there is another series of CA events while Minute Ventilation appears to be cycling up and down. These events may be occurring when the breathing effort cycles down to zero.

This relationship is best seen when you zoom in on the scale around those times.

That looks much better, but one night is just one night. Some suggested changes for the settings:

• I would increase the minimum pressure to 13 cm. Leave max at 14 cm. Some of your obstructive apnea events are occurring when the machine is ramping the pressure down. This will limit the pressure that it can go down to.
• If you find it comfortable I would increase the ramp start pressure to 9 cm. This gets the pressure up a little higher before the ramps ends.

You may want to consider rearranging the order of your graphs. You just left click on the title of the graph and drag it up or down. You can also scrunch the height of each graph down until it starts to mess up the title, but left clicking on the border between the graphs and dragging down. This lets you see more on one page. Your apnea issues are not much different than mine. Here is the order I have mine set up in. I don't find the Tidal Volume graph useful and push it down near the bottom. But I do find the Minute Ventilation graph quite useful. Ideally you want to see that quite constant and not cycling up and down. That can be the source of CSR and CA events. Sometimes what happens is a OA obstructive event messes up the breathing and after that Minute Ventilation start to cycle, and if it gets to the point that breathing stops, then you get a CA event. If the cycle continues then you can get one CA even after another.

I still think you should try the soft cervical collar if you think you can sleep with it. Some of your obstructive events, hypopnea, and flow limitation events (around 4:15 AM) look like they may be caused by your sleep position or a kinked neck which is obstructing the flow. If your neck is kinked then it makes it hard for pressure to keep the airway open. Reducing the kinking may allow you to lower the pressure used.

At some point, but not now, it may make some sense to try a fixed pressure. Currently it looks like a fixed pressure of 14 cm might work ok. But, leave that until it is more certain what pressure you need.

Good luck and get lost! The biggest problem is your attitude, not the A11 machine.