Sierra

Oh, and one other thing you should check out is OSCAR. It is open source software that allows you to look at your detailed sleep data from your machine. It is captured on a SD card, and you need a SD card reader, and a PC or Mac to run the software. It will let you determine how well the machine is working for you, and confirm how much pressure you really need. If you get your machine from a clinic you will want to make sure they leave the SD card in the machine. That is one the tricks that some use. The pull the SD card out so you can't look at your own data. Very dirty trick, and not one that the on line providers would do. The machines come from the factory with a card.

It would be very helpful to have this during a trial, as you could form your own opinion on what you really need for a machine. It is possible to post the daily report screen here for comments on what it means.

I would strongly encourage you to so the at home trial machine as a first step. You will find out for sure that the machine is going to work for you, and even more importantly find a mask you can tolerate. Getting a mask that stays on your head, and is comfortable through the night is the biggest obstacle you will face. If you can get a situation where you can try the machine and a few masks, that is ideal. Better still is if you can do it, without being forced to buy. If price is a consideration, you can probably get overnight or 2 day delivery of a machine from an on line place, to not have a gap in the trial period to your own machine.

If you end up needing an APAP, the one I would recommend first is the ResMed AirSense 10 AutoSet. It is best to get one with the heated climate air hose, and you may find a bundle with a mask choice included. CPAP.com is a popular place, but doesn't have the best prices. You may want to do some searches for a better price and package. A second choice would be the DreamStation Auto. They are nearly as good, and less money. If you ever camp or use an RV off the electric grid, they are easier to power up as they run on 12 volts. The ResMed needs an expensive adapter as it needs 24 volt.

If you really do need a BiPAP, and I would not use one, unless you really do need that 25 cm of pressure, I would recommend the BiPAP versions of these same two machines.

ResMed AirCurve 10 VAuto BiLevel

DreamStation BiPAP Auto

In Canada most often the testing is covered by healthcare, but I believe only Ontario pays any significant amount for the machine.

Hope that helps some. Any questions just ask.

The things you need to ask about are breakdown of your apnea events during the home sleep study. They will classed into obstructive apnea events, central apnea events, and hypopnea events. If they are virtually all obstructive apnea and hypopnea events then you are a likely candidate for a CPAP.

Ask to see the results from you in lab test which is a titration study to determine what pressure works for you. They increase the pressure over the night to determine how much pressure is needed to control the obstructive events. Generally as the pressure goes up the obstructive events stop at some point as the pressure holds the airway open. However, more pressure can generate more central apnea events. Central apnea is when you do not breathe but the air flow is not blocked. They are sometimes called clear airway events. So, the trick is to determine how much pressure will stop the obstructive apnea without causing central apnea.

As far as a machine goes, there are automatic ones (APAP) and manual ones (CPAP). The APAP machines cost very little more than a manual fixed pressure CPAP machine. I would resist being given a fixed pressure CPAP machine. Insist on an APAP. If necessary they can be set to CPAP mode. There is no disadvantage of an APAP other than a small (<$100) extra cost.

A BiPAP mainly provides more pressure than an APAP. APAP machines max out at 20 cm of water pressure. A BiPAP will go up to 25 cm of pressure. They also can increase the pressure between inhale and exhale more. The unfortunate part is that going over 20 cm pressure can be quite uncomfortable for sleeping. My thoughts are not to go there unless you have to. That is why you should ask about the pressure needed during the titration study, and if a BiPAP machine is really necessary.

I am less sure about the market in the US, as I am in Canada. Here there can be a huge difference in the cost of a machine from an on line vendor than from a sleep clinic. My sleep clinic wanted me to pay $2400 for a machine. I asked for a prescription and bought one on line for about $900. But, I was paying out of my own pocket. You may not get that freedom to buy on line if your insurance company puts restrictions on what you can do. It sounds like you have a generous insurance plan, and it may be all covered if you just go with the flow. Just make sure you get the right machine for your needs, and have the ability to exchange it if it does not work for you.

In Canada the next typical step from where you are is to get a trial machine and then use it at home for 2-3 weeks to see if it works and you can tolerate the use of it. Then, at least here, you get the option of buying it or not. I took the "or not" and just bought a better one on line for much less cost. As for brands I think ResMed is best, Phillips DreamStation is second best. I would avoid the other brands.

Hope that helps some,

On the CPAP control of UARS, yes I believe it can to some degree control it. The RERA count should be some kind of indicator of the degree to which it is being controlled. I don't recall if you have the For Her version of the A10, but it so, the For Her mode may respond earlier and quicker and control it better.

On your other issues, with your AHI so well controlled at night, I don't think apnea can be blamed. But I am not a doctor. With the heart rate and blood pressure issues, you may want to see a cardiologist to get some testing. I take bisoprolol which is a beta blocker like the metaprolol you have been given. Bisoprolol is probably a better drug as it is more uniform in how it acts over a 24 hour period. It does a bit more than mask the symptoms. It slows the heart rate so it delivers a more powerful and effective blood flow. But you probably should see a cardiologist to determine what the underlying issues may be.

This seems to be a very detailed report, but there seems to be an absence of conclusions. Is there a sleep doctor involved that is supposed to make the conclusions and recommendations?

I am not a professional in the field, just another apnea sufferer. What I noticed is that you only had one central apnea event, which is very good. Also no full obstructive apnea events which is also good. Based on a comment in the text the hypopnea events were described as obstructive, but were not broken out that way in the report. Your main AHI component is hypopnea which appears to be obstructive in nature (flow restriction). AHI is 4.2 which is at the high end of the acceptable range for apnea which is 0-5.

My thoughts would be that the MAD device is working fairly well. How does the 4.2 compare to a study done without the MAD in place?

There is a dentist or two that specializes in this field that checks in now and then. They may have some better comments than I can provide.

I think the spam filter here blocks posts with lots of images in it. Try with one image only in each post. Wait a while between posts.

The best mask for me has turned out to be a hybrid mask which is basically a ResMed P10 but with the ResMed Swift FX headgear. See this link for details:

P10- FX Hybrid mask solution

My wife uses a F&P Brevida and likes it too. The headgear is more substantial than the P10.

What I really like about the P10 is the quiet exhaust. The Swift FX was like a jet plane taking off on your face.

If you still have the Swift FX mask you may be interested in the Hybrid mask I made out of the P10 and FX. It is not too difficult and has been much superior in staying on my head and in reducing the frequency of leaks. ResMed could have easily used the FX headgear on the P10 mask. Sometimes you have to wonder what they are thinking. Another alternative with better headgear than the P10 is the F&P Brevida. My wife uses that one, but it irritated my nose more than the P10. Replacement parts for the Brevida are a little more costly too. In any case see this thread for some more detail on my hybrid mask.

P10-Swift FX Hybrid solution

I have the AirSense 10 and the AirFit P10 mask. Have had it for nearly 2 years now. I replaced the headgear with that from a Swift FX mask, because the P10 headgear is too flimsy. And a few weeks ago I replaced the nasal pillow insert for the first time. The new one seems little different from the old one. The need to replace more frequently than once a year, unless it gets damaged, is just a scam.

I could be wrong, but I think all the AirSense 10 machines have an EPR setting for Ramp only, and an Auto Ramp. See pages 14 through 16 of the manual at the link below to see how to set it this way. The EPR and Ramp are in the Comfort section of settings.

AirSense 10 Technical Manual