Sierra

Modafinil can also make it harder to get a good sleep. Strikes me as a drug that should be used with a lot of care and consideration of the side effects.

I really have no idea what the significance of the RERA events are. I can find something similar in my sleep files, but they tend to be in the middle of the night. I wonder if they could be a cough because of the spike in pressure. I also note that they are often accompanied by an increase in the Flow Limitation value. If you are not using any ramp then you will be at full pressure when it is happening to you.

I believe RERA stands for respiratory effort related arousal. Not sure how the machine measures it, but it much be based on the amount of air you are breathing and a disturbance in the rhythm that indicates you have woken up. The RERA events should be flagged in SleepyHead on the bottom bar of the event tag section. I have them occasionally but really don't see anything out of the ordinary associated with them. I basically ignore them.

Did you ever figure out how to set the EPR to ramp only? I looked back through some old posts and see that was an issue. Perhaps your issue was that to set EPR to ramp only you have to have a ramp and ramp start pressure set. Perhaps you do not.

Go to the Comfort section of the Clinical Menu (Press the round button and rectangular button at the same time for 5 seconds or so) 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

If you are having issues at sleep onset I would try to use as high a Start Pressure as you find comfortable. I use 9 cm. More pressure should keep the airway open and potentially avoid RERA events as well as apnea events.

Elevation is one of the things that can aggravate central apnea issues. I live at only 2000 feet, but do notice an improvement when I manage to go on vacation at sea level. Have not gone to higher elevations since starting using a CPAP, but I expect it may not be good in a place like Denver.

A commonly prescribed (and very good) machine is the ResMed AirSense 10 AutoSet. A common mask is their AirFit P10. It also is a good mask, but the straps can be a little flimsy. It is true that with a nasal or nasal pillows mask you need to keep your mouth shut. Some find if they keep their tongue at the top of their mouth and right behind their top teeth it can help.

If it is an AutoSet model it will be set up to control a range of pressures and adjust automatically during the night. The minimum pressure is 4 cm, and the maximum is 20 cm. A pressure of 16 is fairly high and can be hard for new users to adjust to.

If you want to learn more about the machine here is a link to a technical manual. There is a lot of good information in the manual, but for a person new to CPAP it can take a while to digest.

I have this machine, so if you have any questions about it, just ask.

But, at this point I think the best tip I can give you is to get used to using the machine while you are awake and preferably distracted by TV or a book.

I am not so sure about the value of a sleep test if you are sleeping well and the AHI is low. The pressure you need to achieve that AHI is an indicator or how severe your apnea is. With a pressure of 10 cm working well for you, that suggests moderate apnea, perhaps at the higher end. But it is not really more than a curiosity if you can control apnea with a pap machine.

You can get some idea of the volume of air you are breathing by looking at the "Minute Ventilation" graph in OSCAR. It tells you the effective air transfer rate in Liters per minute. Ideally this should be a fairly smooth graph and not vary during the night. I have no idea if my value is typical or not, but when the level is smooth and steady it is about 5 L/min. With OSCAR you can left click on an area of interest to zoom in, or use the up and down arrow keys. The value on the graph will be displayed right at the top of each graph. This graph indicates how stable the control is of breathing. If it cycles up and down it indicates your body is trying to find the right level. In my case it is one of the sources of central apnea events. CO2 plays an important part in how your body controls breathing rate.

Just checked my wife's graph and her normal Minute Ventilation looks closer to 7 L/min. She never suffers from CA events. Perhaps I am a shallow breather as well...

I did not adapt well to a CPAP either. It takes some time to get used to it. My suggestion would be to put your machine in a location where you can watch TV or read, and use the machine for a few hours during the day while you get used to it. What is your machine brand and model? Do you know what the pressures are set at?

I have used the P10 mask pretty much from day 1. I did try a F&P Brevida but did not like it as much, but my wife did, so she now uses the Brevida. I also tried the Swift FX nasal pillow mask, but I could not tolerate the high velocity air exit from those holes in the mask. It kept waking me up during the night. My issue with the P10 is not the mesh vent, as I love that part of it. I find it amazingly quiet and no high velocity air. What I dislike about the P10 are the flimsy straps. Tried various things, and then finally decided to make a hybrid mask which is the P10 modified to accept the Swift FX headgear. That is what I use now. Here is a link to a post where I described how I made it.

FX-P10 Hybrid Mask

I am not sure what to think of the CO2 being a problem. These masks are all designed for a certain vent flow that is to keep the CO2 in control. In general the larger the volume of the mask, the higher the purge air flow.

This is a clip of the technical specs for air flow on the Swift FX. At 10 cm pressure it looks like the air flow is pretty close to 32 L/min. The volume of the mask is 103 ml.

And here is the P10 mask. I see the air flow is almost identical, but the volume of the mask is a bit larger at 123 ml. So yes in theory on a relative basis to the volume the FX has a higher flow.

These specs can be found in the user manual. For my purposes in reducing central apnea, the lower purge rate, and higher CO2 may be helpful to me.

Do you have a heated hose, which ResMed calls the ClimateAir? If so, when you plug it in with the AirSense 10 it should put the humidity control into Auto. I find mine works fine in Auto Humidity control. I leave my temperature setting at the default. The only time I have a problem is when I forget to fill the humidifier with water. That is not comfortable at all. I usually figure it out some time during the night, and get up to fill it....