Sierra

I doubt that the EPR is doing you any favors. Think about it this way. If you set pressure is 8 and your EPR is 3, then you are getting 8 cm on inhale and 5 cm on exhale. You are most likely to have centrals on the inhale higher pressure and obstructive events at the lower 5 cm exhale. My suggestion would be to:

• Set the CPAP pressure at 8 cm
• Set the EPR at 3 cm, BUT for ramp only, NOT full time.
• Turn the AutoRamp on, with an initial pressure of 7 cm

This will give you 7 cm on inhale and 4 cm on exhale while you are going to sleep. Should be quite comfortable. However, if you feel short of air, change the initial pressure to 8 cm. When you are asleep you will be at a constant 8 cm. This is lower than your 9 cm, and it is not being reduced on exhale, which should reduce obstructive events.

If this works you could then try 7 cm for CPAP. This will require the ramp start pressure to be reduced to 7 cm as well.

You really cannot compare one night to another. It takes a minimum of 1 week, and ideally 2 weeks at the same settings, so you can get an average result. Then compare it to the average result of another setting. You will end up chasing your tail, if you try to compare one single night to another.

To get the benefit from reducing EPR I think you have to lower the fixed CPAP pressure too. It is most likely the pressure that is causing the central apneas.

It looks like Oscar has some of the inaccurate setting issues that SleepyHead had. What your machine says is the accurate way it is.

I think you may be confusing pressure ramping during the startup phase with during the night. You can still use AutoRamp when your machine is set into fixed pressure CPAP mode. That is how I have mine set. The AutoRamp ends when you go to sleep. It will not go into that mode again unless you get up and shut the machine off. If you do that, it will AutoRamp again until you go to sleep. This is what my machine looks like with AutoRamp turned on. I have mine set to an initial pressure of 9 cm, with a 3 cm EPR for Ramp Only. The pressure cycles from 9 cm down to 6 cm on each breath until I fall asleep. Then it ramp up to my fixed set pressure of 11 cm. This is what it looks like. The purpose is to make it more comfortable when you are going to sleep, and more effective when you are asleep. You are highly unlikely to have any apnea events while awake.

In addition to put the AutoRamp back on, I would suggest turning the EPR to ramp only, and making your fixed CPAP pressure 8 cm instead of 9 cm to see how that works. If your AHI is acceptable at 8 cm you may then want to move your fixed pressure down to 7 cm. It is kind of trial and error to see what the minimum pressure you can get away with is. With EPR off, you should be able to get effective treatment with a lower (more comfortable) pressure. Also, the lower your pressure the less likely you are to have central apnea events. Shallow breathing is usually what preceeds a central apnea event. If you use the arrow keys to zoom in on your breathing before a central apnea event you may see a shallower and shallower breath pattern, until the breathing stops and a central apnea occurs.

Hope that helps some,

I don't think there is any direct reason for the mask setting to affect the AHI. The main purpose is to compensate for the air flow through the mask vent, so the air leakage can be reported more accurately. In general the larger the mask the higher the "dead" volume in the mask, and the higher the required purge flow to keep the air fresh in the mask. If you look at the mask manuals they usually have a flow rate chart. If you want to match masks from one manufacturer to another, you should match the flow rate chart as close as possible.

What is the largest portion of the AHI increase? CA's or OA's?

I am coming up to only 2 years of CPAP use. If you use SleepyHead to monitor your results and the machine is in Auto that should give some indication of how necessary the CPAP is.

I also do not use the EPR full time. I set it to be on in Ramp Only. I think that allows the pressure to reduce some and avoid some of the central apnea events.

I think your readings during the night look pretty normal. My recollection is that you have come a long way in getting a longer uninterrupted sleep. The recommended target for sleep is 7-8 hours at night, and ideally no naps during the day.

It looks like a constant pressure is working well for you. It looks like you are using full time EPR at 3 and no Auto Ramp. My suggestions for changes would be:

• Turn the AutoRamp back on with a starting pressure of 7 cm.
• Leave the EPR at 3 cm, but switch it to Ramp Only

This way you will get 7 cm of pressure on inhale and 4 cm on exhale while going to sleep. Then when you go to sleep you will get a constant 9 cm on inhale and exhale. The problem with having the EPR on full time is that it reduces pressure down to 6 cm on each exhale, and you could be getting obstructive apneas at that point. In other words the effective CPAP pressure you are getting is only 6 cm. If you go to ramp only EPR your effective pressure is 9 cm. I think what you might find if you go to ramp only EPR you could reduce your CPAP fixed pressure from 9 cm to something lower, perhaps as low as 7 cm. That would likely make wearing it more comfortable, and it would also likely reduce the central apneas.

I see that SleepyHead is reporting that the climate control is in Manual. That may be a reporting problem. In any case I find having it in Auto is most comfortable if you have a heated hose.

That is about all I can suggest for improvements.

One thing you have to change when you change mask types is the mask type in your CPAP setup. This Compatibility List shows what the mask setting should be for each ResMed Machine-Mask combination. I would assume if you use a DreamStation you would use the same settings as for an AirSense 10 machine. There are only three mask setting specified; Full Face, Nasal, Pillows. The AirFit F30 uses the Full Face setting. And surprisingly the AirFit N20 uses the Pillows setting. The mask type setting compensates for difference in the amount of purge flow each mask uses.

For the occasional nasal congestion I use an Otrivin nasal spray. I try to only use it infrequently and in one nostril.

I have a recollection of some tape that is specially made for mouth taping. It goes between the lips instead of over the top of the lips

No, I use the P10 nasal pillow mask and do not have that problem. However, I also tape my mouth shut so I do not lose air out my mouth. You may want to look into mouth taping.

One issue with the AirSense CPAP is that it does not capture detailed data on the SD card. The Elite model does, and the AutoSet does. If you had detailed data on the card I would suggest using SleepyHead to determine if your pressure is OK. With no detailed data about all you can do is keep reducing the pressure until AHI becomes unacceptable.