Sierra

During the study when they are not applying pressure to stop the OSA, yes you can get an apnea lasting that long.

If you can save it as a jpg file, then open a post hear. Left click on the jpg file and drag it into the post. It should then upload to the post. As you are a new user just drag one file into the post. That will reduce the odds it will get caught up in the spam filter.

As I responded in the other thread what is your ratio of central apnea to obstructive apnea? Central apnea is a very different problem and CPAP pressure alone does not help, and usually makes it worse. EPR while you are sleeping is most often not helpful. It tends to increase the pressure needed to treat obstructive apnea. I use EPR during ramp only, when I am still awake.

What is your ratio of central apnea to obstructive apnea? Pressure most often is not helpful in reducing central apnea.

Everyone is always afraid of over tightening your mask straps. However, I find with a nasal mask tightening it up some can help keep it located on your face and over your nose.

Yes for some reason the DreamStation machines include the purge flow of air out of the mask. In SleepyHead there are two curves for leak rate. I would ignore the higher one, as it is quite meaningless.

A minimum pressure of 4 cm in my opinion is almost always too low, unless you are getting central events at a very low pressure. If there is a normal setup for a ResMed AutoSense machine, I would suggest a minimum of 7 cm, with the AutoRamp turned on, EPR turned on and set at 3 cm, and EPR set for Ramp Only. This will maximize comfort for going to sleep.

Raising the minimum pressure can be effective for reducing AHI if it is obstructive in nature. A high minimum pressure will start preventing obstructive events earlier without waiting for them to occur first, and then letting the machine increase pressure.

Hope that helps some,

Depending on how the home study is done it can also UNDERestimate the AHI. Sometimes it includes all time in bed instead of just sleeping time. In any case an AHI of 15 with the machine is too high and needs attention. However it is critical to know how much of that AHI of 15 is obstructive and how much is central.

Edit: I said it backward. If they use all time in bed for the denominator it makes the AHI appear lower.

ResMed considers the leak redline to be 24 L/min, so you are not really that much above this number. One of the concerns I have seen reported is that the machine response to events may be suppressed when the leak rate is above the 24 L/min limit, and at the end of the leak period, pressure may be too low and you could get a burst of events.

The N20 seems well constructed with good solid headgear. I would think if it is adjust correctly it should be quite stable for side sleeping. A couple of the things I have found helpful is using a satin pillow protector. It lets my head and headgear slide around on the pillow easier and keeps the pillow from dragging the mask out of place. Another thing that I believe helps is a pillow that does not push back. I started out with a memory foam pillow but found it liked to push back and push the mask out of place. I have since switched to a down alternative pillow from Costco. It is not super soft, but it kind of stays put when you compress it -- no push back.

Another issue is whether or not you are getting the leaks from the mask being dislodged, or if you are opening your mouth in the night allowing air to escape out. Symptoms are a dry mouth in the morning. If yous use SleepyHead a mouth leak usually starts suddenly and has a flat top on the leak rate curve. Mouth taping is one solution, and using a chin strap is another to stop mouth leaks. I find mouth taping to be much more comfortable than using a chin strap.

Hope that helps some,

You mentioned in another post that the 93 AHI is a combination of central and obstructive. The obstructive will probably come down dramatically, but the central apnea does not respond positively to pressure, and more pressure can make it worse. Your machine AHI results will give you a more realistic picture of where things are at.