Sierra

"As for the Centrals...nothing shows up to give me details about that. Could just be the way I had the mask on that confused the machine or something. I don't see any Centrals in sleepy."

RedMed/SleepyHead calls central apnea events "clear airway events", or CA. Essentially the same thing.

The number in brackets after the event is the length of it in seconds. It does not get flagged as an event until it is 10 seconds or longer.

There are a few things you can do to make better use of your screen though. The F10 will get rid of that kind of useless Navigation menu block on the right. If you click on the black triangle beside the date you can hide the full month calendar. The pie chart is kind of redundant and takes up a lot of space. If you go to File, Preferences, Appearance you can uncheck the box that says show the event pie chart. The bars above it give the data too, so nothing is lost.

As far as your data nothing jumps out. The only obstructive event was at 8 cm pressure, and it looks like it woke you up. It may have been that you were waking up already for some reason. Your central events seem to have occurred at a pressure of 8 or less except for one. It is not obvious why there was a pressure increase around 10:00 other than what appears to be a single hypopnea event. But not much to worry about for now. You need more data to come to any conclusions.

One option you could consider is to not use the pre warming feature. I do it when I remember it, but don't sweat it when I forget. My feelings are that the most critical part of the sleep is getting to sleep. I consider it a good night when I can get to sleep in about 10 minutes.

This issue I have found with leaving the excess hose off the bed is that the weight of it pulls on the mask. However, if you anchor it under your pillow that should not be a problem.

On the central concern SleepyHead will be enlightening. You will see every one, and even the ones that do not last long enough to be flagged. For now, I would not sweat it. You seem to be adapting to using the machine very well. I think you were questioning whether or not you needed a machine. The pressures you are seeing suggest you do need one.

Yes, one of the underappreciated good features of the ResMed and Dreamstation machines is that they have the ability to differentiate between obstructive and central events, and then take the appropriate action for a central, which is do nothing. Some machines like the Fisher & Paykel cannot differentiate and actually increase pressure in response to a central. For someone that is sensitive to pressure that causes centrals that is a bit of a disaster. You get a central, pressure increases, and you get more centrals. The basic principle of a CPAP is to increase pressure to open the airway. With a central the airway is not the problem.

A CPAP is not the cure all for everything. They certainly can reduce the number of obstructive apnea and hypopnea events. Now does that translate into better sleep, and feeling more rested, with more energy? Yes in most, but potentially not in everyone. I think the main thing for a new user to concentrate on at first is getting comfortable with the machine. The irritation effect of the machine can nullify some benefits. One needs to make friends with the machine to reduce that effect, and let the benefits take over. I now look forward to going to bed and having that warm moist pressurized air making it so easy to breath and get to sleep.

On the mask coming off, that is one of the issues with the flimsy headgear on the P10. One of the things I found helpful is using a satin pillow protector instead of the usual pillow case material. My theory is that my head and the headgear slips around better on the pillow without dislodging it. At some point I also cut and sewed the straps back up so they were shorter. And as you know my final solution (hopefully) is to convert it to use the Swift FX headgear. It is much more stable. One of the other somewhat goofy solutions I tried was wearing a Speedo lycra skull cap over top of the headgear. It actually worked quite well, but left a significant mark on my forehead by morning. I suspect it was too small, but I couldn't find a larger one...

As for typical AHI and types of events, I would say that there is quite a wide variation in what is normal. My wife was diagnosed with an AHI in the 80+ range. Her AHI now averages under 1, with about 0.1 of it being central. I was diagnosed with an AHI of 37, and now average about 2.7 with half of it being central events. Hypopnea is also high at about 1, which leave my obstructive index quite low at 0.4. So, I'm not sure there is a typical. Your numbers however are very good. I don't see any indication that the pressure is causing central events. However that is much better determined with SleepyHead. When you look at the daily report you can make a correlation between when you have central events, and what the pressure is at that time. If you consistently see the centrals at the higher pressures, then there might be a bit of an issue. It can be fairly easily controlled though, but lowering maximum pressure more, if that is the case.

Hope that helps some

I have no experience with using a timed backup rate pressure support machine. I am aware that ResMed makes a AirCurve 10 ASV machine that automatically follows the breathing pattern and provides breathing support on a breath by breath basis, rather than at a fixed rate. You could ask his doctor if that type of machine might be a more suitable solution. The AirCurve 10 ASV I believe is limited to 20 cm pressure, so the requirements would have to be under that. Other BiLevel machines can go up to 25 cm.

I can't remember if I gave you this link before. It is to the ResMed AirSense 10 Clinical Guide. This gives you some written guidance on the settings. Pages 4-11 are a good read if you want to understand better what the machine is doing and how it works.

Your readings and settings look pretty good. This is the definition of the pressure you see on the Sleep Report:

Pressure - Average pressure during the selected period (95th percentile for each day; average of the 95th percentile values for periods >1 day).

In other words for the night 95% of the time the treatment pressure was less than that number. In your case 9.7 cm. So, it may have reached the maximum pressure of 10 that you set. All this is far easier to see on SleepyHead, as you will see the actual pressure throughout the whole night. It gives you a much better idea of what the machine is trying to do. Just a comment, but I am surprised that it is reaching 10 cm. I would have expected your pressure to stay lower than that. On the plus side, the fact it is going that high suggests the APAP is of value to you.

On the ramp start pressure what I do is breathe in quite deeply and quickly. What I am looking for is a pressure where the in-flow feels free and unrestricted like I am not wearing a mask at all. Most people breathe more heavily and deeply when they first go to bed. Under those circumstances you do not want to feel like you are suffocating. If 5.6 works for you, that is fine. You may find as you get more used to the machine you will like more.

ResMed does not disclose how they determine when you are asleep. However I suspect they base it on a very uniform breathing pattern that is not deep and irregular like it is when you first go to bed.

Pressure settings - For now I would leave Maximum at 10. Your AHI is very good. The 95% pressure of 9.7 kind of suggests the maximum should be higher, not lower. But your good AHI suggests it is high enough. You only have a few hours of data, so too early to make a change. As far as the minimum pressure goes, it potentially could be higher, but since you are just starting out and your AHI is good, I would leave it where it is. If your AHI was high it can often be reduced by increasing the minimum pressure. What it does is get pressure up sooner so events are avoided instead of responded to. In other words the machine gets out ahead of the potential problem.

When dumping your water and refilling it, I would just shake the reservoir up to dissolve any sediment, dump it, and refill with distilled. I have to admit that I don't dump the water every night, just about once a week. On the weekly clean I rinse it out with pure vinegar, then tap water with Dawn dish soap, and finally just a rinse with tap water. I do the same with the heated hose, and mask. Best to do it in the morning and then hang them up to dry during the day. I don't bother drying the reservoir though.

Opening your mouth and letting air escape can be a problem with a nasal mask. The usual sign of it is a dry mouth in the morning and a high leakage rate. Your leakage rate is pretty good, so I wouldn't immediately suspect it is a problem.

Good luck tonight!

"I don't understand why it doesn't ramp when I stop breathing on purpose to test it, for instance. 6 starting, minimum set at 6 and max at 9. If I'm up and awake and wearing it...breathing normally and then I stop, I expect it to ramp to up to 9 to clear what it should think is an obstruction. Does it wait x minutes before the ramp takes effect when set to Auto?"

The machine suppresses reporting of apnea events and response to apnea events when it is in ramp mode. This is because they are unlikely to be real when you are not sleeping. The ramp period automatically ends when it detects you are sleeping, or after 30 minutes, whichever comes first. So, you would have to wear it at least 30 minutes before trying to trick it into increasing pressure.

The AHI of 0.8 and leak rate of 10 both sound good. I think most of the issues you are having are normal for someone just starting on CPAP, and you will likely adjust to it quite quickly. I did not adapt all that well to wearing a mask, especially a full face mask, but I have always used the machine for the full night since the first day I got it. The worst experience was when trying a full face mask, and I gave up in the middle of the night and switched back to the P10 for the rest of the night.

Hope that helps some,

Based on your comments I am not totally sure you have the machine set up correctly. When you enable the SmartStart option it should just start with a smooth even pressure buildup when you put the mask on. It may take a breath or two, but it should just start. Then you will see the pressure ramp up to your minimum slowly. Keep in mind that the minimum pressure setting is independent from the ramp start pressure. If you want to lower them below the 7 cm I suggested you have to adjust them both down. The ramp start cannot be lower than the minimum pressure. When you start the machine it should go to either the ramp start pressure if it is lower than the minimum, or if they are the same then to that pressure.

The machine tries to maintain a set pressure, so if you turn the machine on without you having the mask on, then there will be a big rush of air as it is trying to build up pressure with no resistance to flow. I just use the SmartStart option and I just have to put the mask on to start the machine for the night. When I take it off, I usually push the machine off button just before I take the mask off. It stops that big rush of air. However if you just take the mask off there will be a big rush of air and then the machine will stop from the SmartStart control. The machine is set to maintain a small air flow after you shut it off to let it cool down and purge moisture. You should see a little icon on the screen indicating it is cooling down.

As far as maximum pressure of 12 or 10, that setting should not have a big impact on the pressure you are getting as it will only go up to that pressure if it detects apnea or hypopnea. It is simply a maximum, and I would expect in your case it will not go that high. If you wake up in the night and press the round button it should display your current pressure that it is controlling to in automatic. However, SleepyHead is the best way to see what goes on during the night.

I believe when you do the mask fit test it goes to the maximum set pressure for the test. However, in auto it will not go there unless it has to.

With the EPR set to ramp only and set at 3 cm. It will always be trying to reduce the exhale pressure by 3 cm. However the machine will not go below 4 cm no matter how you set it. So if you have a ramp start of 5 cm, it will reduce to 4, and with a ramp start of 6 it reduces to 4 and so on. Only if you have a ramp start higher will the exhale pressure be above 4 cm. For example I use a ramp start of 9 cm because that is what feels right to me. During the ramp I get 9 cm on inhale and 6 cm on exhale. As far as it feeling hard to exhale that is something you get used to. After my ramp is over the machine goes to 11 cm on inhale and exhale. I have no difficulty exhaling against that pressure or even higher. Some people exhale against as much as 25 cm on a bipap machine. '

Hope that helps some. One other feature I may not have mentioned that can improve comfort some is the prewarming of the humidifier. You can turn it on manually with the menu item that I recall is just below the mask fit option. It warms up automatically and there will be a small air flow during the warming. It takes about 15 minutes to fully warm up, and then it sits on hold. I usually turn it on when I first start getting prepared for bed, and then use the machine regardless of whether or not it is fully warmed up or not. The machine will still start as soon as you put the mask on and take a couple of breaths.

Any other questions, or if I missed something just ask. You will find SleepyHead very enlightening as to how the machine is performing. All of those pressure changes when going through the ramp can be seen in SleepyHead. If you zoom in using the arrow keys you can see each breath and how much the pressure is going up and down during the ramp. It is a good way to confirm that the machine is performing as you expect it to. An most important it will show what the machine does with pressure after you go to sleep, and whether or not you are having any events. Here is what my machine mask pressure looks like during ramp. This is with a ramp start of 9 cm, EPR of 3, and then a pressure of 11 cm when the ramp ends.