Sierra

That one is pretty good with some accuracy too. The only thing missing is the length of the hair. I took my motorcycle for a ride the other day and was still able to get my helmet on, so it must not be too bad yet...

And if you like to figure out graphs here is challenge. This is our province of BC (most westerly province) explanation as to where the virus came from. I think they are basically blaming it on all the other provinces in Canada...

Genomic Tracing

I checked your profile and your previous posts. It seems you have a DreamStation Auto and it is now set to 7 cm and 15 cm? That 7 cm minimum should be enough. What specific brand and model of a mask do you have?

Yes, some people have this issue initially but usually get over it. What APAP machine do you have, and which brand and model of mask are you using? Some masks come off easier than others, and perhaps your machine is not ideally set up for comfort. One common setup issue is having the minimum pressure too low. When the pressure starts out too low, or goes low during the night, it can feel like air flow is kind of restricted or suffocating. That might prompt you to pull the mask off to get more air. Do you know what your minimum and maximum pressure is?

I think overall this is a pretty good setting. Not sure I would lower the minimum pressure unless you have to. There are a number of times when the pressure is at 9 cm and you are still getting some OA events. On limiting the maximum pressure to 10.5 there are some times when you are having events when the pressure is limited. They mainly seem to be flow limitations and hypopnea. I don't think limiting it is hurting you too much. Central events and PB do not seem to be a significant problem.

I think your options would be to try the Flex at maximum (3) without changing anything else. That should determine if it will help or hurt.

The other option to try would be to put the machine in straight CPAP mode and use a pressure of 9 cm. It is a bit time consuming to get the right pressure in CPAP mode, but with what you have done so far you are pretty close with 9 cm. After a week you could try 9.5 fixed or 8.5 fixed to see if they may be better. One upside of a fixed pressure is that the machine is not adjusting the pressure all the time. This may be more restful, if it achieves the same end result for AHI.

This all said, I would be pretty happy with what you have now. This is just a week of data, but your average is better than I can achieve.

The most common sleep apnea is obstructive and is caused by your tongue and throat relaxing when you sleep and blocking the airway. This is most often associated with someone that is overweight and has a large neck size.

The other type of sleep apnea is central apnea. That is when you just decide to breathe more and less, and sometimes just stop for a while. There are a few different causes, but one is use of opioids. I don't believe cocaine is technically an opioid however. Here is a link to check out on Central Apnea.

Both obstructive and central apnea are diagnosed the same way, with a sleep test. An in lab sleep test has someone watching you while you sleep, so they may pick up other issues in the sleep.

Hope that helps some,

I think that sometimes sleep professionals lack actual experience with a CPAP. That is not surprising as in many cases they are young, fit and trim, and do not have the issues that can make a CPAP necessary. The treatment aspect can be quite theoretical, but the comfort aspect not so much. A professional that listens to all their clients and keeps notes at to what works and what does not, probably can gain experience over time. But, for the most part we are left to our own trial and error methods to find what works for us.

I find the single most common issue is that the minimum pressure on an APAP is set too low (often at 4-5 cm). The technicians think they are doing you a favour by giving you a low pressure. For most however a low pressure like that on top of wearing a mask on your face that feels constricting is not comfortable at all. And, in general, masks are very personal. What one person likes, another may hate. Unfortunately the only way you can find out what works is to try it.

I use the AirSense 10 AutoSet machine with the SmartStart enabled, and have never known the machine to start by itself. My wife uses the ResMed S9 with the same feature turned on and no issues with it either. I turn my machine off manually in the morning, but my wife lets it turn off automatically. it seems to work. I have heard of some having issues with the machine not turning off. That I think can be related to the using a very low set pressure. The flow switch that turns the machine off must not see enough flow to trigger it. My thoughts would be that you probably have a defective machine. It should not just start all by itself. Is it still under warranty? You may want to try going that route. Here is a link to a technical manual for the A10. There may be some troubleshooting help in there that I have not thought of. As far as reliability goes my wife has been using the S9 for about 4 years, and myself the A10 for about 2 years. No problems experienced with the machines, but my wife did have a problem with a DC to DC adapter we bought for camping. It would trip out during the night. ResMed supplied three of them before I gave up getting it to work. It would work with the humidifier and heated hose turned off, but would trip out when they were turned on. I suspect the design was flawed. The auto cutout was set too low. I use the same type of adapter with my A10 and do not have the problem even with the heated hose and humidifier turned on. Other than that, the machines have worked well.

If you go with another machine brand, I would suggest the Phillips DreamStation Auto. They tend to be a little less expensive. The only thing I don't really like about them is that they do not allow you to set the Flex (like ResMed's EPR) so it is on during the ramp, and off during sleep. I also like the auto ramp feature on the ResMed. The DreamStation has something similar, but not as good in my opinion. Here is a link to a DreamStation technical manual. It gives you some idea of the features it has. The manual however can be somewhat confusing as it covers the whole range of DreamStation manuals, so you have to pick out what applies to the Auto version. One advantage of the DreamStation is that it uses 12 volts DC instead of the 24 volts that ResMed uses. So it can run with a simple power cord from a 12 volt battery without any expensive DC to DC converter.

The machine I would suggest you avoid is the Fisher & Paykel Icon+. I used one during my trial period and did not like it. The data from it cannot be read by SleepyHead, although OSCAR may have been updated to read it. It also does not distinguish between obstructive and central apnea. I think that is a significant limitation especially if you suffer from central apnea events. The machine should be smart enough not to increase pressure with a central event, but increase if for a obstructive event. The F&P can't do that.

Hope that helps some,

I do not monitor my heart rate all that often, just when I occasionally take my blood pressure. However what I do notice is that my blood glucose rises each morning to a lesser degree in the 30 minute or so before I wake up and the 30 minutes or so after. I use a FreeStyle Libre monitoring system for BG and each morning I see that effect to a more or less degree. I think it is normal, and your body's way of waking you up for the day. The liver dumps some glucose which is the sign it is time to get up. Would it also cause the heart rate to rise? Possibly, but like I say, I don't measure that very often.

It is certainly not obvious that you are benefiting from the 9.5 cm minimum over the 9.0. I also see some CA events showing up. My thoughts would be to go back to the 9.0 minimum and perhaps a 10.5 maximum. I would try that for a week or so to establish an average which will be recorded in the Statistics tab. Then you may want to try try the Flex to see if it helps or hurts. I would go for the maximum Flex (3?) so the difference will be more obvious. When you set the 10.5 maximum you should check to see if there is any persistent pattern of events occurring when the pressure is limited to 10.5. If there are then it could be bumped back up a bit.

On the Periodic Breathing, that does not look like classic CSR. I would not worry about it unless it becomes persistent. CSR would have CA events between each breathing pulse, not OA.

The whole series of flow limitation events when at 12 cm pressure makes me wonder if you are having some head positional issues. Some claim significant benefits from using a soft cervical collar to keep the neck straighter during the night. You can get them at Walmart for $15 or so.

On switching mask types I have noticed some differences in that some masks seem to need more pressure to get the same results. I suspect that they really don't need more pressure, but the machine indicates that the pressure is higher. These machines do not measure pressure right at the mask, only in the machine. They only estimate mask pressure based on theoretical pressure drop calculation for the loss in pressure from the machine to the mask. So the bottom line is that in my experience anyway, a different mask design can change the required pressure that is indicated. It is a good idea to settle on a mask type and keep that part consistent during your testing for the optimum pressures.

About all I can say is that my mask and heated hose is a little over 2 years old. My wife's heated hose is probably 4-5 years old. I have replaced the nasal pillow insert in my mask a few months ago. I pay out of my pocket for what I use, and have no insurance.