Sierra

Welcome to the forum and congratulations on the weight loss. That can help with the apnea frequency. I use a AirSense 10 AutoSet and initially ran in Auto mode. I was diagnosed with a home study, and immediately put on the APAP with a setting of about 8 to 15 cm, and EPR at 3. Since my wife was on APAP before me and the provider of the equipment told us about SleepyHead, we had been using it on her machine, and then my machine. It told me that unlike her, I was having a high proportion of clear airway (central apnea) events. I went through many different iterations for pressure and EPR. After several months I finally concluded that my hypopnea events were driving the pressure up to 15 cm, and my suspicion was that the hypopnea events were central in nature, not obstructive. My first step to address that was to lower the maximum pressure and increase the low pressure. I got to the point where my pressure was almost fixed, so I made the change in the machine from AutoSet to CPAP. I tried a few different variations in pressure but settled on a fixed pressure of 11 cm and EPR at 3 cm, but in Ramp Only mode. I found that having EPR on increased my pressure requirement when I was sleeping. But still having EPR on when going to sleep was more comfortable. I think that is the best feature that the AirSense machine has. Now my settings are a Ramp Start pressure of 9 cm, fixed pressure of 11 cm in CPAP, and EPR of 3 in Ramp Only.

I can't explain why the doctor would have given you a Auto machine and then immediately put it in CPAP. The traditional way of diagnosing apnea with an in lab study, that is usually followed by a titration study which determines the optimum pressure. A pressure too low usually does not optimize the reduction of obstructive apnea, and a pressure too high can cause more central apnea. An AutoSet is almost the same price as a AirSense Elite which is a fixed CPAP pressure only, so you got the Auto machine in case your needs changed. Just a guess. My thoughts are that if one suffers from central apnea a fixed pressure may be better than an auto pressure mode. This is just based on my experience only. My wife still runs her machine in auto mode.

The reality is now with Auto machines, the titration study in most cases is not necessary. I never had one. If you look at the results with an initial wide pressure range for the Auto machine with software like SleepyHead you can determine what your pressure requirements are. It is kind of like having a titration test every night. However even with a machine in Auto, most users will bring their max pressure down just to prevent unnecessary excursions up, and they also bring the minimum pressure up. Having the pressure start higher helps avoid early in the sleep apnea incidents which might wake you up just after going to sleep.

As far as settings go, it sounds like you are doing well with either a fixed pressure or auto pressure range. If you download SleepyHead and view your detailed data which should be on the SD card in your machine, you will see what has been going on, and what pressure range may be idea. The software is free. It is no longer being developed but works with the AirSense machines. You need a computer to run the software and a SD card reader to get the data from your machine into the program. If you post the Daily report here of a night when it is in AutoSet mode I can give you my comments. My thoughts based on what you have said in your post would be to move your start pressure up from 4 cm to 7 cm, set EPR to 3 and for Ramp Only, and increase your minimum pressure to 8 cm. What that will do is give you 7 cm on inhale and 4 cm on exhale while you are awake in the AutoRamp mode. I find a start pressure of 4 cm is far too low and can feel somewhat suffocating, but it is a personal thing. Then when you go to sleep, the pressure will ramp up to 8 cm and the EPR will stop. After that the pressure will adjust up and down between the limits of 8 cm and 10 cm. Once you see what it is doing, some further refinement of the min and max pressures may be possible.

I just clean my equipment with pure vinegar, then dish soap and water, and finally a rinse with water. I try to do it first thing in the morning so it drip dries before bedtime. Not a believer in the need for the SoClean.

Ozone is very reactive and is not going to last as ozone very long. I would do your cleaning first thing in the AM and let it air out during the day.

I doubt that the tongue issue is caused by the apnea, but it could be the other way around. The tongue issue may cause the sleep apnea. Obstructive sleep apnea is most often caused by a tongue that falls back and obstructs the air flow when you are sleeping.

I use the 10 cm wide MeFix tape, and use a paper cutter to chop 6 cm pieces off it. The NexCare tape is 1" wide. You can get it at Walmart, but it is probably cheaper at a medical supply place that handles the MeFix tape (which you will not likely find at Walmart).

I expect the main determinant of power required is the pressure you run, whether or not you use the humidifier, and if you use the heated hose. The ASV should be quite similar in power consumption to the APAP's if those other things are the same.

My guesstimate would be that 4 cm does provide some therapeutic value. How much is the question I can't answer, but it should not be a lot.

My suggestion would be to run the APAP in Auto mode for a few nights with the Tap 3 device in, and then do it again with the Tap 3 out. Then observe the average median pressure in OSCAR under each mode of Tap in and out. This should be displayed in the statistics page. That should give you an estimate as to how much the Tap 3 device is reducing AHI. The higher the difference the more effective it is. With what you have done so far it would seem like the Tap 3 alone is giving you an AHI greater than 3.

Let me try to help a bit. First off, I am not sure how one could get a battery arrangement for a full sized home machine on an airplane. Not optimistic there is a solution, with regulations today, but their might be. I believe some planes do have 110 volt ac on them and if you had that, then you could just plug in your normal power supply. There may be a current limit, but if you turned the humidifier off and heated hose off, you could be within that limit.

In a home or camping battery situation, the most straightforward way would be to get a 12 volt deep cycle battery at Canadian tire. They have their own standard lead acid brand, or you could go for an AGM type for more reliability and less chance of spilling acid at an extra (2-3 times more...) cost. If you use a 12 volt to 24 volt converter from ResMed that is the most energy efficient way to get the needed 24 volts. They are about $130, but you should check with ResMed or the dealer that they will fit your ASV machine. The other way is to just use a 300 watt inverter available at Canadian Tire. They are cheaper but not as efficient. As far as battery size have a look at this table.

The top situation is without a heated hose and the humidifier turned off. At a 16 cm IPAP it suggests that current draw (at 12 volts) would be 1.23 amps and a 15 amp hour battery is recommended. That is a fairly small battery and a lawn tractor or motorcycle battery might work. However they are not deep cycle and can be expensive. A full sized 24 or 27 deep cycle battery may be more practical, but much heavier. If you take the more normal second last case in this table with the heated hose and humidifier on in Auto, and a 16 cm IPAP, it says 4.21 amps and a 51 amp hour battery. That is pretty close to a normal size 24 battery like this one at Canadian Tire, which is rated at 65 amp hours.

Based on our camping experience, I would suggest a 100 watt solar panel is about the size needed to recover each day from the night before.

Hopefully that helps some.

My routine when I remember it is to wash the mask, hose, and humidifier reservoir weekly. My first wash is with pure vinegar. Full strength vinegar is a disinfectant. It also is very effective in removing mineral deposits in the reservoir. I occasionally use tap water when I don't have any demin water. I just use my fingers in the reservoir to ensure the vinegar removes all the deposits. The vinegar rinse is followed by a tap water and Dawn dish soap wash, and then a final rinse with tap water. I hang the mask and hose up from the shower head in the bath room and let it drip dry all day.

I use a ResMed AirFit P10 and the tape does not interfere with it. My wife uses a F&P Brevida and taping does not interfere with it either. She gets away with just the 1" paper tape. I have to add the second larger layer of MeFix.