Sierra

About all I can think of is that EPR is on, which causes pressure to cycle down during exhale and up on inhale. However, I see that you are reporting that EPR is off.

If you push the round button when the machine is running it should display current pressure. One check would be to see if it is cycling up and down.

I have no experience with OSCAR, but I believe it is the same open source software, but with some minor improvements. There was a disagreement between Mark Watkins the original developer of SleepyHead, and some others who were assisting with the development. Mark has decided to step back. The remaining team is now developing the software. I suspect either OSCAR or the older SleepyHead will work fine for you. SleepyHead does have a few minor bugs, but I find it quite acceptable to use.

I don't know much about dental appliances. I don't believe they do anything for central apnea. So if you go down that road, make sure your issue is obstructive apnea, not central apnea.

One thing to keep in mind is that when a lab sleep test is being done you are not being "treated" with pressure. They are just monitoring your breathing etc and looking for apnea and hypopnea events. The other lab test is a titration test where they do essentially put a CPAP machine on you and use pressure to determine how much you need to stop obstructive apnea without causing central apnea. Not 100% sure but I believe they can start with a higher pressure to see if that prevents sleep onset apnea.

Also it is kind of the same with a home APAP. You can start with any pressure up to your minimum set pressure. or fixed CPAP pressure. If that pressure is effective, you will not experience sleep onset apnea. And with SleepyHead you will see if there is an apnea event or not. Same with an in lab titration test. The graph below is an example of my SleepyHead report from a few nights ago. You can see each breath, with the mask pressure cycling up and down with each breath (9cm on inhale, and 6 cm on exhale), until the machine detects I am asleep, and then it ramps up to my fixed CPAP set pressure of 11 cm on inhale and exhale. There is a bit of a disturbance in flow rate just after it switches to the fixed 11 cm where the green vertical line is, but no real apnea. If there was, you would see it. An apnea is 10 seconds or more with no flow.

In the US there seems to be a progressive route that is prescribed I think mainly by medicaid and insurance companies. They like to give you a fixed pressure CPAP, and if that does not work, then an APAP, and if that does not work then a BiPAP. For the most problematic cases of central apnea an ASV machine is prescribed. My thoughts are that the only machine that has real significant treatment benefits for central apnea is the ASV. The others are pretty much the same, although certain types of BiPAP machines may behave a bit more like an ASV.

The basic treatment for central apnea is to avoid pressure. For someone that has both obstructive apnea and central apnea that is a problem, because of course obstructive apnea is corrected by pressure and centrals are aggravated by pressure. So where many end up is with a compromise pressure that is high enough to reduce obstructive, but low enough to minimize the centrals. I have a ResMed APAP machine, but I have found that I can control that compromise pressure best by setting it to fixed CPAP mode. For that reason I don't think an APAP is an obvious advantage. However it covers all bases as you can use it in either mode, and starting out in auto mode can help you find the compromise pressure sooner.

Essentially all the BiPAP does is increase the differential between inhale and exhale pressure. The CPAP and APAP are limited to 3 cm differential, but BiPAPs can go up to 10 or more. The problem is that this differential is a double edged sword. It makes the overall pressure higher, and can aggravate centrals, but at the same time it can simulate a breathing assistance effect which can reduce centrals. Certain machines can detect lack of effort to breathe and will trigger a backup cycle rate to assist breathing.

The ASV monitors every breath, and helps assist breathing on a breath by breath basis. It is the most sophisticated of them all, and often is the most effective with problematic central apnea.

This all said, you may not have central apnea at all. The normal way to measure it is in a lab sleep test. A trial APAP machine that detects central and obstructive apnea is often used as a confirmation method.

If you do a search here for sleep onset apnea, I suspect you will find a few threads. I recall it being discussed some time ago, but not recently until you posted. Many people post a few times but then do not come back to update. It is the nature of forums...

I am not sure that there is any official designation of sleep onset apnea being a condition independent from sleep apnea. That said there can be issues with the handoff of breathing control from a semi manual to the automatic control during sleep. You are correct in that it could be central or obstructive. I suffer from both, but they certainly do not occur in any significance when going to sleep. Centrals tend to be more likely toward the morning. And, just personal experience but I find central apneas end smoothly with breathing starting again, not with gasping for air and arousal. I am just judging that based on observing data from my CPAP using SleepyHead software.

Yes an automatic CPAP would be the better choice. Just make sure you get one that distinguishes between central apnea events and obstructive apnea. If you had one, or could trial one, and viewed the data in SleepyHead you would likely find out what type of apnea you have, or what is causing the issue when you fall asleep. Both the ResMed and Phillips DreamStation machines can distinguish between the types of apnea. The unfortunate part is that a CPAP can really only correct obstructive apnea. The ResMed does have an EPR function which cycles the pressure higher on inhale and lower on exhale. That can to a very limited degree help with breathing effort when the body is not (during a central event). It might be enough to avoid a central during the transition from being awake to sleeping. If the events are obstructive in nature, then the pressure alone will be helpful in preventing any apnea.

Hope that helps some,

If you have been diagnosed with mild sleep apnea you may want to consider getting a CPAP. Some countries and jurisdictions treat mild apnea and others do not. If you are having sleep issues related to apnea then getting it treated may be the better choice. A CPAP machine can be set up to deliver a fixed amount of pressure while you are awake, and then ramp to an automatic pressure control after you go to sleep. This should prevent any obstructive apnea during the transition period of falling asleep.

Can you do an F12 of the Daily report that shows mask pressure as one of the graphs? Note where it gets saved, and then drag the image file into a message here. It might show something.

Edit: To explain a little more, the Pressure graph shows the set pressure (it should not change), not the actual Mask Pressure. Also what is the make and model of your mask? Could flow be restricted somehow?

Here is a link to a user manual for the machine.

RemstarPro M Series Manual