Sierra

I have not used the mini but yes there are some limitations to it. One I recall is that it does not collect detailed data for use in SleepyHead. So that makes it harder to troubleshoot problems -- such as what the pressure is doing during the night and when apnea events are occurring. I have used both the P10 and Brevida mask and don't recall any big differences. I have tried about 6 different masks now, so I kind of get them mixed up. I do recall that all the masks do not use exactly the same pressure when in auto. That may be because of differences in how the machine accounts for pressure drop in the hose and the mask. But, unless your min and max pressures are a limiting factor, the machine should adjust to compensate for those differences. If you are limiting pressure during the night with the max pressure setting, and you are getting higher obstructive events, you may want to increase it a bit. My recollection is that pressures between masks were only about a 1 cm variance. Another thing you could try if you are using SleepyHead on your AirSense is to look at what your pressures are doing during the night and how close to the pressure limits they are getting. That might give you an idea if a small pressure difference would necessitate a change in pressure on your AirMini.

The professional treatment standard is an AHI of less than 5. With centrals I struggle to keep mine under 3, while my wife who seldom has centrals easily gets under 1.

The settings look good, as does the results for the short period of time you had it on. Does SleepyHead indicate anything abnormal leading up to when you took the mask off?

One of the things I have found helpful is to avoid if at all possible any daytime napping. I try to focus on getting 7-8 hours of continuous sleep at night in one stretch. For me, less than 7 hours is not good in the longer term, and more than 8 hours is not good either. I think when one sleeps too much the quality of sleep deteriorates.

One thing to keep in mind about apnea treatment is that each night is always a bit different. It is a mistake to come to conclusions about a setting after only a few nights. I have found that it takes up to a month at the same settings to really see what is happening. Yes, early when you are first starting and making bigger changes less time is needed, but when you get to the refinement stage it just takes longer to see the real trend. the Statistics tab is useful for keeping track of the averages.

I am amazed that you got so many graphs in one image. Cut and paste? I actually don't find most of the graphs to be all that useful. I left click and drag on the graph title to bring the ones of interest to the top. My standard layout is in this order from top to bottom of the screen.

• Event Flags
• Pressure
• Mask Pressure
• Flow Rate
• Minute Vent. - I find this is a good indicator of central apnea probability, especially when you zoom in on the scale.
• Flow Limitation
• Leak Rate - On the Leak Rate graph I right click on the vertical scale numbers, select "Dotted Lines", and then check off "Leak Rate Upper Threshold". This will draw a red dotted line showing the upper limit as to where leakage should be. I don't worry about leaks if below that line.

The rest of the graphs I don't worry about much, and just scroll down occasionally to look at them, and wonder what they are good for...

On the For Her vs standard APAP, the For Her mode should respond quicker to hypopnea and possibly flow limitation, and if events occur in quick succession it can lock in at that as a new minimum pressure. That is good for preventing events, but it does not let the pressure come back down during the night. And, if your max pressure is set above 12 cm, it stops responding with more pressure to OA events when it gets to 12 cm. So it is not good for somebody with obsructive apnea needing higher pressures. That is not your case. In standard mode it will probably respond with more pressure slowly and ramp back down slowly if there are no more events. That can be good and bad. You can get into a cycle overnight where the machine is continually ramping up and down. Most prefer a more constant pressure even if it is at a higher pressure. I use a fixed pressure of 11 cm and find it just fine.

As far as your pressure settings a maximum of 9 looks about right. If it were me, I would move the minimum pressure up to 8 cm. While that might sound counter intuitive a higher minimum can avoid events, and avoid having the machine jack the pressure up. Overall you might end up with a lower Median pressure for the night. And once you see what that does, you may be able to slowly reduce maximum pressure down to say 8.8, and then 8.6 cm for example to see what that does to help avoid centrals.

Converting the P10 headgear to the Swift FX is probably a good idea if you can't keep the mask on. It is much more secure and adjustable. Just keep in mind that the conversion is a one way trip as you have to cut the plastic prongs on the P10. This how I did it. The headgear only for the Swift FX is not that costly. And, I think I told you before, the other trick is to use a satin pillow protector to make the pillow more slippery, and less likely to drag the mask off your face.

I also think much of your problem is still in getting used to wearing this contraption while sleeping. It takes a while. 9 cm of pressure is not very high, and should be quite comfortable. I suspect that amount of pressure alone is not the root cause of waking up.

Hope that helps some.

I hope you get some responses from those that have used an ASV. I have not, but have thought about it. I generally average around 2.5 for AHI, with the majority being centrals, while using a lower fixed pressure of 11 cm. Seems not worth it to consider an ASV for now for myself.

I can't remember off hand what kind of pressures you are using. If you don't need higher pressures (over 20 cm) you most likely would benefit from an ASV. However that said since you have an VAuto I wonder if you could improve some with tweaks to your VAuto such as Trigger and Cycling Sensitivity and TiControl. See pages 5-6 in this VAuto Clinical Manual. I am afraid I have no experience here in making any suggestions in what to do. Perhaps others do?

First I would suggest you do your research on the pricing of various machines. The last time I looked the ResMed fixed pressure Elite machine is only about $80 cheaper than the Automatic AutoSet machine. And the For Her version is priced the same as the standard one. The For Her version gives you an extra mode, that you might find works or not, but it is at no extra cost. The DreamStation machines are a bit cheaper, but not a lot. I don't think it is bad if it comes down to paying the extra.

Many insurance companies will prefer the Automatic machines over the fixed pressure CPAP machines. The reason is that you can go straight from a diagnosis of apnea to using a machine without an overnight titration test -- which probably costs more money than the price of the whole machine.

And assuming you can talk to your insurance company you can feel them out ahead of time. If they say yes to an automatic machine with it saving money you can tell your doctor that they are ok with it.

Oh, and there should be no difference in the pressure setting for the standard AutoSet mode compared to the For Her mode. Just check that nothing changes for settings when you switch the mode.

You can read the Clinical Manual but my recollection is that one of the "features" of the For Her mode is that if a certain number of event happen within specified time period, then the pressure does not come back down. There are some pros and cons to that. It can prevent more events, but it also can keep pressure up higher longer than necessary.

My thoughts based on the limited data so far is that it could be of benefit to lower max pressure to as low as 9 cm and then perhaps lower. Where you are at now is that CA events are dominating, and OA and even H events are not a problem. That suggests you do not need as much pressure.

My suggestion at this point would be to reduce max pressure to 9 cm, and increase minimum to 7 cm. Reducing max may prevent CA events, and increasing min can avoid H events which prompts the machine to increase pressure.

I believe in the setup section you can adjust the time the day starts, and by default it is usually 12 noon to 12 noon the next day, and all sessions within that time window get assigned to the day starting at 12 noon. So, you may be just looking at session times vs the nominal day. Again, if you click on that black triangle beside the current date it will suppress the whole month view and give you more room on the left to include most of the detail as well as the session data. You can also suppress a session you don't want to see or be included in the day statistics, like a mask fitting session, by clicking on the switch beside the session to turn it red for off.

Yes, in general it is a good idea to work up the minimum pressure as you become more used to the machine. About the only thing I see a little concerning on these charts is that it appears a hypopnea brought the pressure up and right after that you had a series of CA events. You will want to keep an eye on that. If this becomes a pattern, you may want to limit the maximum pressure the machine can go to. It could avoid some of those CA events.

Also after you get more data and a better idea of how the machine is behaving it may be worth a trial using the standard AutoSet mode instead of the For Her version, just to see which one is better for you. And also at some point it may be worth considering a fixed CPAP mode and a fixed pressure. You could do well with a fixed pressure of about 8 cm if it is high enough to avoid the OA and H events, but not too high to initiate CA events. But, too soon for that stuff. For now I would concentrate on getting used to the machine so you can get through the night with a good sleep.