Sierra

It seems difficult to imagine how the tubing could be blocked, unless it gets kinked when you are sleeping. I guess it is possible if there are sags in the tubing that could allow water to collect, the water may block the hose. However that seems unlikely without noticing a flood of water coming through the mask. Seems like a bit of a long shot but there are silicone seals between the water reservoir and the machine that possibly are not in good condition. This Technical Manual may be of some help in inspecting the machine, if you don't have it already.

Masks are difficult. I tried the Swift FX nasal pillow but I could not tolerate the high velocity air flow out of the vent. I tried a few different things to try and control the velocity but they didn't work. It kept blowing on me or my wife and waking us up. I did like the headgear though, and I created a hybrid mask with using my AirFit P10 mask but fitted it with the Swift headgear. See this thread for details. The P10 mask has a much more controlled air flow out the vent. This hybrid mask has worked quite well for me, and the only issue I have occasionally is that the back strap slips up and the mask becomes dislodged during sleep. I have now fitted a bit of a gripper pad to the back strap and it seems to be helping. This is what my leak chart looks like for last night with this mask. It is probably a bit better than my average night. I use mouth taping so the leaks are from the mask fit.

I tried the F&P Brevida nasal pillow, but found it irritated my septum. My wife now uses it and likes it. She is on the second nasal cushion with it. The headgear is better than the P10 but not as good as the Swift headgear. It is a larger and more bulky mask than the P10 and I suspect gets dislodged as you are experiencing a bit easier than the P10. I do hear my wife's mask leaking at times, but overall she gets pretty good leak reports from SleepyHead. Here is her leak rate chart with the Brevida from last night. A couple of bad spots where she likely had the mask somewhat displaced. Or, she could also have opened her mouth. She has stopped using mouth taping, so that is possible -- especially the one incident with the long flat top.

Resmed and DreamWear have newer masks that have prong type nose inserts. I think one brand has gel and the other is using silicone. However, I have not tried either of these masks. The one that has the hose go over your head may help with mask displacement during the night. I have read from others that the can be louder due to noise in the tubes that go up to the top of your head... Trying is is about the only way to find out if they work for you.

Hope that helps some,

Neither of us have PLMD, but we made the switch from a Queen size bed to a King size. It works quite well. However, a king size deep mattress is a monster to handle. I thought at one point we were going to have to return it as our bedroom is on the second floor, and the stairway was not cooperative. If I had it to do over again I would have gone with two Twin XL mattresses on a King size bed frame. You can cover both mattresses with one King size sheet set. Some hotels/resorts do that to allow flexibility on how they set the room up. My other suggestion is to use a slat type support system with a rigid center support instead of going with a box spring. Last we have found out that a bed frame that encloses the mattress to some degree is a real pain when it comes to make it. It is hard to get the bottom fitted sheet down around the corners and hooked so it will not come up during the night. If I had that part to do over again I would go with a platform style bed frame that has the mattress sitting on top of it. Trying to lift one of those 18" deep King size mattresses while slipping the sheet under the corner is not an easy task. Incredible how heavy they are.

As I had explained before the AutoRamp is not actually a ramp up in pressure. It holds the pressure at a Ramp Start Pressure that you set. For example you could set the Ramp Start at 7.4 cm. It will just hold it there until it decides you are asleep. The advantage of using the AutoRamp is that it lets you select the EPR type as Ramp Only. That way you can get the EPR comfort for going to sleep but not have it negatively impact the effectiveness when sleeping. Having the EPR on full time as you have it now is most likely causing some of the central apnea you are experiencing.

I don't think you are understanding what EPR and Auto Ramp is.

Both of your posted charts show you are using full time EPR at 3 cm. Neither has any kind of Ramp, either timed or Auto.

You currently do not appear to be using Auto Ramp at all. It does not really ramp the pressure up when going to sleep, it just holds it at the Ramp Start pressure that you set. When it detects you have gone to sleep it ends the ramp and give pressure control over to the machine in APAP mode, or if in CPAP mode it just goes to the set CPAP pressure. The other thing it allows you to do is to set the EPR Type to Ramp Only. That allows you to have EPR pressure reduction on exhale for comfort during the ramp period when you are not sleeping, but then have it turned off when you go to sleep. Here is an example of how I have mine set when using CPAP mode. But it is essentially the same in APAP mode.

My specific settings are for a Ramp Start pressure of 9 cm. I have EPR set at 3 and the Type set to Ramp Only. What this does is give an inhale pressure of 9 cm (red line on graph) and exhale of 6 cm (green line). Then when the machine detects I am asleep it ramps pressure up to my set CPAP pressure of 11 cm, and at the same time stops the EPR pressure reduction on exhale.

The only difference between the CPAP and APAP mode is that in CPAP it stays at the set fixed pressure. In the APAP mode the pressure adjusts automatically between your min and max depending on what the machine is seeing.

I am not a doctor and will restrict my comments to your two posted daily report screen shots.

June 6 - This one looks fairly normal and many, including myself would be quite happy with a result like this one. I tend to have more CA events than you had on this night. That said your ratio of CA to OA events is higher than normal. Most people have almost all OA events. The one change I would make is turn off the EPR except for ramp only. I would use the auto ramp function, set the start pressure at 7.4 cm, set the EPR at 3, but also set it to Ramp Only. When set that way you will get 7.4 on inhale and 4.4 on exhale until you fall asleep. That should be quite comfortable for going to sleep. Once you go to sleep the reduction on exhale will stop and the pressure will be the same as on inhale and vary according to what the machine thinks you need. There are two potential benefits in doing this. First it eliminates the low pressure on exhale which may be causing your OA events, and as a result of having the events, the machine is increasing pressure. The increased pressure may then be causing CA events. If the OA events are better controlled, then the machine will not have to increase the pressure as high. The pressure may not have to even go much above your minimum 7.4 cm.

June 10 - This one is not nearly as good. The first thing I would wonder is if you were actually asleep when having those CA events. They may be sleep wake junk, as some call it. You are waking up and going to sleep and in the process just holding your breath long enough to count as a CA event. You can get some idea what is going on by expanding the time scale to see the nature of the flow curve. If you move the minute ventilation graph up a bit you can compare to what it is doing. It seems during this time it is very erratic. Ideally it should be a flat smooth curve.

Both Charts - I cannot see any obvious benefit in having a BiPAP machine. You are no where close to needing 25 cm of pressure. You are also not going to be able to take advantage of the higher differential between IPAP and EPAP (pressure support) as you can't go lower than 4 cm, and look like you don't need more than 8-9 cm. With EPR turned off you will likely need even less for pressure. And if anything, using EPR in the sleep phase may be hurting you more than helping you.

Another option that might work for you is to put the machine in CPAP mode with a pressure of 7.4 cm, and with EPR on ramp only. It could work just as well or perhaps better than Auto mode.

Hope that helps some,

There should not be much difference between 9 cm and 8.5 for a minimum pressure. Going up in pressure usually makes the air swallowing issue worse, not better. Have you tried the Flex back on again at 3? I am not sure how it would help, but since it is there, it is worth a try to see what it does.

The other option is to switch the machine into basic CPAP mode and pick a pressure to try. I would suggest 9 cm to see what you get. From there you could try lower or higher. The one advantage of CPAP mode is that you will not have the pressure cycling up and down all night long. Flex should also work in CPAP mode if you want to try that as well.

First, what make and model of a CPAP machine do you have? There may be some opportunity to improve the comfort settings.

Some of the issues with sleeping through the night can be in trying to sleep too long, and napping during the day. To optimize a single quality sleep it is better to try and sleep 7-8 hours and avoid daytime naps. It can also help to go to bed later and avoid liquids during the evening.

The basic objective is to get AHI under 5. I generally sleep on my side and have not noticed much difference. You are using a fairly high pressure though, so that could be a difference. I tried to find that mask and could not find much. Is it like this one? It looks a lot like the ResMed Quattro. I have tried the Quattro and could not make it seal. If you can get it to seal then that is a good start. The headgear looks quite substantial and it would seem it should stay on. Perhaps it is just a matter of time until you get used to it. One of the solutions to my mask coming off has been to use a satin pillow cover. It has a zipper to make it fit tight and secure on the pillow. The satin is very smooth and does not seem to grip the straps from the mask. The best pillow type I have found is called a down alternative. It is soft and gives like down but is a synthetic material. It does not push back on the mask.

On your AHI readings have you considered downloading OSCAR? With a PC or Mac and a SD card reader you can view the detailed data on your SD card. It may give you some idea what is going on before your mask comes off. It also could uncover some opportunities to optimize your pressure. On a DreamStation there often can be a benefit in increasing the minimum pressure.