Sierra

It is a puzzling condition, and one I have never experienced. A number of people have posted here asking for solutions, and I can't offer much. I usually ask them to use SleepyHead or OSCAR to track their sleep with a CPAP and then post the expanded graph of when they think they have them. Can't recall seeing one on a graph, but I may have forgotten.

My wife does what she calls Yoga Breathing when she is having a hard time going to sleep or wakes up in the night. The routine is to hold your breath three times in a row for a substantial amount of time. When I review her results in SleepyHead I can always easily tell when she does it as this breathing shows up as major obstructive apnea events. It blows her apnea index score out of the water for the whole night. She usually is well under 1.0 for AHI. However when she does the Yoga Breathing routine a few times, it can bump the score up to 1.5 or 2.0, well above her average. It always makes me wonder if there is a net benefit to the nights sleep when you artificially create obstructive apnea events...

You may be interested in this article in the Blog section of this site about Complex apnea and how artificially raising the CO2 levels may be effective in treating it.

Complex Sleep Apnea - Dr. Robert Thomas

I have never had the air swallowing issue, so I don't have any suggestions based on personal experience. My only thought would be to use the lower pressure for some time (weeks), before you try to increase it.

You should probably have a sleep study done to see what type of apnea you are having. There are a couple of issues with the F&P SleepStyle machine. First is that it does not collect data in a form that will allow it to be viewed by a software program called SleepyHead. SleepyHead has been replaced by another free program called OSCAR, but I am not sure that OSCAR supports the SleepStyle either. With the software you can get more information about your sleep apnea.

The other issue with the SleepStyle is that it does not distinguish between obstructive apnea and central apnea. If all you have is obstructive apnea then that is not a problem. If you have central apnea (airway not blocked, but not breathing) then the machine can make it worse. It will increase pressure when it sees a central apnea, and increasing pressure can make central apnea worse.

Keep in mind that if you get even a few apnea events in a short space of time it will show up as a high AHI. The normal acceptable treatment level is for AHI to average less than 5. That said, with CPAP many can achieve closer to 1 for AHI, especially if they AHI is mainly obstructive. With central apnea it is harder to get a real low number.

If you are having central apnea one possible way to address it while using the SleepStyle machine is to switch it to a fixed pressure instead of auto mode. That way central apnea events cannot trigger a pressure increase. The trick then is to find a pressure that is high enough to prevent the obstructive apnea while not so high as to trigger central apnea.

Hope that helps some,

No experience, but the zapping part sounds brutal. I just don't see how that would make for a good sleep. I know some people have had some success with sewing a tennis ball into the back of their pajamas to convince them not to sleep on their back. With a CPAP I don't notice any difference in the sleeping position from an apnea point of view. However, I am more comfortable sleeping on my side.

It is not a good idea to arbitrarily change the pressure. It is best to get sleep clinic advice. But the higher the pressure the harder it is to get a good seal.

If the Essentials has been set to Plus under the Clinical Menu Options there is a pressure displayed in the sleep report that is the 95% pressure (95% of the time pressure is less than that). It is averaged over the period selected for the sleep report. See page 19 in the Clinical Manual.

It is normal to have air venting out of your mask. That flow is controlled by the size of the vent holes and the machine does not count that as leakage. Your leakage looks acceptable, but there certainly is some that changes through the night.

On the Aug 7 there are some obstructive events to look at.

00:14 - You have to line the cursor up carefully on your screen to be right on the event. In the top left of the Pressure graph it should show the pressure at that time (Pressure Set). It looks to me that the pressure was already at 10 cm, but that is where you have to look carefully and expand the screen some if necessary. Sometimes the event causes the pressure to increase, so you have to see what happened first. The event or the pressure increase. By my eye using your screen shot it looks to me that the pressure was already up to 10 cm. So unless you set the minimum pressure above 10 that type of event is likely to happen again.

02:21, 02:28 - Both of these obstructive events occurred at your minimum of 9 cm pressure. A higher minimum pressure may have avoided these events.

04:20 - 05:20 - There is a series of obstructive events in kind of a cluster and from my eye again I think these were all at your max pressure of 11.5 cm. These are the kind of events that could be positional and possibly avoided with a cervical collar. Or it just may need a higher maximum pressure.

On August 8:

01:35 - Obstructive event which looks like is at the maximum pressure of 11.5 cm.

04:08 - Obstructive event at 9 cm minimum

05:15 - Another OA at minimum pressure

05:40 - OA event at maximum pressure of 11.5

Taken together these events suggest you may benefit from both a higher minimum and a higher maximum. I always like to increase the minimum pressure first. My thoughts would be to try a minimum pressure increase in 0.5 cm steps. If you are still having too many events at the higher pressure then I would increase the maximum pressure as a later phase. Keep in mind there is nothing wrong with having the minimum and maximum close together. If you end up with a minimum of 11.5 and a maximum of 12 cm, there is nothing wrong with that.

Hope that helps some,

One reason you may be getting a higher AHI with the AutoSet is that with the minimum pressure set at 5 cm, it is going to take some events to trigger the increase up to say 9 cm if that is what you basically need. So you incur some events early in the sleep just to get the pressure up to where it needs to be.

With your settings this is how I would set up the AutoSet model.

Min Pressure - 7 cm, or you might even want to try 9 cm considering that is what you used before. Max Pressure - 10 cm Ramp Time - Auto Start Pressure - 7 cm or 9 cm (set it to match your minimum pressure) EPR - On EPR Type - Ramp Only EPR Level - 3 cm

Set this way with a minimum pressure of 7 cm it will start you off with 7 cm on inhale and reduce it for comfort to 4 cm on exhale until you go to sleep. When you go to sleep then it will stop the reduction on exhale. Pressure will then be controlled by the machine depending on what events occur. If you are comfortable with 9 cm for going to sleep then it will start at 9 cm and reduce to 6 cm on exhale. That is what I use and find it very comfortable.

I have not heard of anxiety causing central sleep apnea. However, it is a condition that is not fully understood. Here is a Mayo Clinic link that gives some potential causes.

Central Sleep Apnea - Symptoms and Causes

Often sleep apnea is a combination of more common obstructive apnea and central apnea. Some call this complex apnea. Here is an article from the Blog portion of this site that discusses it.

What is Complex Sleep Apnea?

The starting point to try and figure out what is going on is to look at a nightly report from a CPAP machine. A sleep clinic can do this or your can look at it yourself with some free software available. Here is an example of what my sleep report looked like a couple of nights ago. My total AHI (2.72) is a mixture of CA (1.11), OA (0.37), and Hypopnea (1.24) events. Knowing what type of events you are getting and when they happen can be very useful in determining what your specific issues are.

Hope that helps some,

If you go go into the configuration menu under the Clinical Menu at the very bottom there is an an "About" section. In it there is a SW number for the Device, Humidifier, and Modem. Not sure if the SW stands for Software version or not. In any case my Device SW is SX567-0306.