Sierra

Have you used SleepyHead, now OSCAR to track your detailed data? It can be very helpful in determining if there are improvement opportunities in the machine pressure setup. The software is free, but it needs a PC or MAC with a SD card reader to transfer the data.

OSCAR - Open Source CPAP Analysis Reporter

Yes, the ResMed machine does not make it easy to do a restart of the ramp. However it does have some nice features that I find convenient and comfortable. Here is a link to a more technical manual that the basic user guide.

AirSense 10 Technical Manual

Here is how I set my machine for comfort and convenience. If you refer to page 14 on how to get into the Settings Menu, and then page 15 for the settings menu table. I will assume for an example your minimum pressure is 9 and the max is 15 cm. Go down to the comfort section.

Ramp Time - I set it to Auto. This will hold the initial pressure until you fall asleep instead of ramping it up over a fixed time period. I find that to me more comfortable.

Start Pressure - I would set it to 7 cm. If you feel short of air, then set it a little higher, but you can't set it higher than your minimum pressure.

EPR - I would turn it on. This will reduce pressure on exhale.

EPR Type - I find that to minimize pressure during the treatment part of the night, I set it to Ramp Only. This reduced pressure on exhale only during the ramp period for comfort. Also the EPR reduces the effectiveness of the treatment pressure, so the overall pressure is likely to be less when it is turned off during treatment.

EPR Level - I set at 3 cm. If the Start Pressure is 7 cm then it will cut back to 4 on exhale during the ramp.

Climate Control - should default to Auto if you have a heated hose.

Tube Temp - Set to 27 C or 81 F.

When I am starting to get ready for bed, I scroll down the user menu and turn on the prewarm function. It warms up the water and is more comfortable going to sleep.

Hope that helps some. Any questions just ask.

Michelle, the quick answer is that you have to shut the machine off with the button on the top, and take the mask off for about a minute to get it to go into start mode again. I will give you a more detailed answer in a bit.

Normally obstructive apnea is corrected or stopped with the EPAP pressure. It looks to me that your 95% level for EPAP is just 6.28 cm. That is very low. The higher IPAP pressure can help you breath in, but really will not stop obstructive apnea. The issue is that it can cause CA events.

I am not a medical professional and can't comment on the significance of O2 dropping that low for that length of time. It obviously is not ideal, but you would have to ask your doctor if it is a significant concern or not.

With respect to the machine only flagging a 10 second CA, I believe that is because you took a couple of partial breaths that were enough for it to start the count over again. I believe the machine starts the clock when the flow rate goes to zero, and at 4 second it starts a rapid pulse in the flow. It measures the impact that has on pressure. If it cause a larger pressure fluctuation, then it decides there is an obstruction. If the pressure does not have a significant pressure fluctuation then it concludes the airway is open. And when it lasts 10 seconds it flags it as an event. In the first section you can see the slight pressure fluctuation after 4 second, but the total event does not last 10 seconds, so it is not flagged. The smaller middle one did not last 4 seconds, so there is no flow pulse test. The last one starts the pulse after 4 seconds and lasts the full minimum of 10 seconds to flag the event as a CA.

I presume you have a BiLevel machine for a specific reason. Would it be to address central apnea issues? There are two ways that are often taken to address CA. One is to provide a pressure support (which I see is set at 4 cm) to help assist breathing. This appears to be the approach taken in your case. The other method used is to do everything possible to minimize pressure. In many cases the higher the pressure used the more likely central apnea events can occur.

What I see is that your EPAP pressure is very low, and it seems not much is needed to prevent obstructive apnea. However the 4 cm of pressure support forces IPAP to go much higher to 10 cm or so. You could ask your sleep doctor if setting the pressure support to zero would be a possibility. That would most likely keep the pressure up to 4 cm lower, and may reduce the frequency of central apnea events.

Hope that helps some,

Right now they are basically the same thing. However, the last time I tried to go to the SleepyHead download site, my browser flagged it as a non secure site and would not open it. The original author of SleepyHead I believe was Mark Watkins from Australia. He developed it as open source software, and made it free (donations only). Some others from the US got involved, and to make a long story short there was a falling out between Watkins and the US people. There were differences of opinion on what development was needed, who would do it, and who "owned" the software. Mark got frustrated and closed off development of the SleepyHead product. I still use it, and it works fine. So OSCAR started up by using the software developed by Mark and is apparently being improved. The big test will be when ResMed or Phillips releases a new machine, and whether the software will support it. Has not happened yet...

I think the first thing you need to keep in mind, is that you had a low level of apnea with an AHI of 8. In the UK that would not qualify for a CPAP. You don't mention what your AHI is with the CPAP, but even if it is <1, that is still not a very big change. In other words it is a bit of a stretch to say that the poor quality of your sleep (based on how awake you are the next day) was due to apnea. It would seems there must be other issues. I am not a medical professional, and can only give you suggestions based on my experience, and on a second had basis based on the experience of my wife. She was diagnosed with an AHI of >80. Now with a CPAP she is <1. She has noticed a huge improvement in her sleep quality. I was diagnosed with an AHI of 37. With CPAP I am now in the range of 2-3. I have not noticed a huge increase in my sleep quality, but my wife is appreciative of the termination of my snoring. But, I was sleeping quite well before CPAP, so to some degree there was not a problem to solve.

Long story, but I hear what you are saying, and don't have any simple answers either. Sleep can be elusive. I would encourage you to continue following up with your medical advisers. I have seen a useful website that was set up by a pharmacist and university professor that wanted to help people get a quality sleep without resorting to sleep medications. Here is a link to it:

Sleepwell, It's No Dream

Yes, I am sure the insurance companies like the cost of a home sleep study, which in my area of Canada is zero. What is a little more puzzling is the cost of the APAP machine if that is the outcome. On the surface of it, it seems the insurance companies (within their allowance limits) willingly pay $2400 or so for a machine. However, they are sold for about $800 on line. It seems hard to grasp why they would pay so much over the real price. Perhaps what we as the client see as the price paid by the insurance company is not the same as the actual money that changes hands behind the scenes. Perhaps we are getting a $2400 "benefit", that the insurance company really pays $800 or less for it.

There are differing opinions on whether HST overestimate or underestimate AHI. One study I read found that a HST underestimated sleep apnea frequency. To me that study makes sense. A home sleep study divides the number of events by the time in bed (TIB). A lab study divides the same number of event by time sleeping. A smaller denominator makes for a higher AHI.

Yes, my situation may have been a little different than typical. I was not in my opinion having sleep issues. I slept very well albeit with some snoring. I got cornered by my doctor into taking the screening test and failed. I very reluctantly went for the home sleep study, and really wanted to be found to not have sleep apnea. My wife was already using a CPAP and having to sleep with that contraption was the very last thing I wanted. Despite my wishes I failed the HST with an AHI of 37 or so. And here I am.

Short story is that I did not want to be diagnosed with anything. I do have to admit that I now sleep better and don't disturb my wife with snoring.

And as an aside a HST can identify central apnea events, or at least the Phillips Alice NightOne can. It measures breathing effort and air flow as well as oxygen levels, and body position. No air flow + No breathing effort = Central apnea event. Oxygen desaturation events can be also compared to apnea events for verification.