Sierra

I have experienced a somewhat dizzy feeling an hour or after getting up in the morning, but no really issues with hearing. I do the HA thing now too. Nose plugged into a machine for 8 hours a day, and ears plugged into two more machines for the other 16 hours of the day.

The cause is most likely the pressure balance combined with a possible sinus infection? If it is recurrent I would think a visit to an ENT would be in order. If you are thinking about wearing ear plugs all night, I'm not sure that will work unless they seal perfectly. And that is unlikely.

CPAP's really only correct obstructive apnea, and it appears you have none. You are having more hypopnea than central apneas, but in the absence of any obstructive apnea or RERA, there is some possibility those hypopnea events are central in nature. In other words they are not a result of flow restriction, but the result of effort to breath restriction.

BiPap is not an obvious solution either. They (and APAP as well) use pressure to support the airway, and the pressure can have a side effect of increasing central apnea. Some BiPAP machine have a backup respiration rate. They cycle inhale and exhale pressure to give some forced ventilation, and can help with central apnea to some degree. The machine that is best designed to address central apnea is the ASV type. In the ResMed line the AirCurve 10 ASV is an example. The unfortunate part is that they are expensive. In Canada they run a little over $4000 the last time I checked. You also need a heart function test before they will be prescribed.

My thoughts would be to try and get an independent opinion from a sleep doctor that ideally is not in the business of selling sleep tests or machines.

Those are just my thoughts based on having significant issues with central apnea. Last night I has an AHI of 4.5 and it was nearly all central while using an APAP. I am not a medical professional though, and this is just an amateur opinion.

The other thought is that you could consider getting an opinion from a cardio vascular doctor. Central apnea can have origins in the heart and lung system.

I use the ResMed AirSense 10 AutoSet and have tried the Brevida, and also have a AirFit F20 full face mask. I found the Brevida did not work as well as the AirFit P10 nasal pillow, but my wife liked it so she took it over. I am back to using the P10 with the Swift FX headgear. I did my best to make the F20 mask work but I could not get it to seal with a reasonable tightness. It kind of works if you lie on your back, and never on your side. It seems as soon as you disturb it, it starts to leak. I managed 4-5 nights with it, and it now sits unused in my box of rejected CPAP stuff. The final straw was that it started to irritate the bridge of my nose. I probably had it too tight, but that was the only way I could get it to stop leaking. The AirTouch F20 is the identical mask with a memory foam seal. In fact the seals can be interchanged. Some report the memory foam to be better, but not very durable. Others report it leaks too. This said it is a very popular full face mask and many use it. Masks are very personal. Ones that work perfectly for some are hated by others... I find mouth taping with a nasal pillow mask to be far more comfortable than a full face mask.

I think if I was forced to use a full face mask I think I would try the Philips Respironics Amara View Full Face. I like the way it fits more under your nose rather than covering the whole nose. But, I have no personal experience with it.

That is kind of like Apple considering it illegal for anyone but them to work on their products. It seems to me that the machine only belongs to one person. If the user paid for it, it is their machine. Apple does not think that way however. Here is an interesting article about the "Apple Way".

I agree with most of this. EPR and PS on a ResMed is essentially the same thing, except EPR on an APAP is limited to 3 cm. I have to disagree with the ramp comment. ResMed and I think DreamStation machines have an Auto Ramp. The Auto Ramp is smart enough to end when you go to sleep. When you are awake you are highly unlikely to have an apnea event. For that reason using EPR during Auto Ramp is not an apnea risk. The bottom line is that you can use EPR during AutoRamp for comfort, with essentially zero risk of an apnea event.

This issue got thoroughly discussed over a year ago in this thread.

Mine is a year old now, and I have not really had the noise issue. I recall once or twice hearing something when the water reservoir was not fully inserted into the machine, so it was not sealing. The air comes from the machine to the water reservoir/humidifier, picks up some moisture, and then returns back to the machine where it goes to the mask hose connection. There are some silicone seals in there that you might want to check to see if they are damaged or out of position. See page 24 in this manual for a diagram on where these seals are.

As for the discoloured mark on the water reservoir, it may be due to running out of water during the night. I have had that happen a few time. The machine is supposed to have a high temperature cut out to shut the humidifier off if that happens. I have seen the discolouration on mine, but when I clean it thoroughly with vinegar it goes away.

Your machine is still on warranty, so you may also want to consider taking it back for servicing, if your vendor can do that.

Here is perhaps a better way to explain it. This is one of my SleepyHead reports from about a year ago when I had EPR set at 3 cm Full Time. My pressure was in Auto with a minimum of 10.4 cm and a maximum of 15 cm. The apnea event flagged as obstructive (OA) occurs when the inhale pressure was hitting about 12 cm on each breath. Then when the apnea event starts where the green cursor line is, the pressure is at about 9.4 cm. Flow stops, and then about 4 seconds later the machine starts to try to cycle the pressure and flow up and down to test if there is an obstruction. When there is the pressure goes up and down. Then it finally gets flagged as an OA. the point is that even though my pressure is going up to 12 cm, the obstructive event started at the lower 9.4 pressure. That is due to the EPR reducing pressure on exhale.

And another way to think about it is if you were prescribed an 8 cm pressure that was likely determined in the lab with no EPR on. So when you go home and start to use EPR then you are not getting the same pressure that was determined to be effective in the lab.

I copied my previous response to you on EPR below. I won't repeat that part again. What is new is your question about leaving EPR on full time. The problem with EPR is that it reduces your exhale pressure. Apnea can occur on inhale or exhale or the transition from one to the other. If for example you have a set pressure of 8 cm and an EPR of 3 then all night long the pressure will cycle from 8 cm to 5 cm on each inhale and exhale. If you are susceptable to apnea event on the transition or during exhale your effective treatment pressure is only 5 cm. But, you are having to endure a pressure of 8 cm on inhale. You may get almost the same benefit in apnea prevention by running a fixed 5 cm pressure.

The short story is that if you want to know what your effective treatment pressure is, then you have to subtract the EPR value from the set pressure. And if a set pressure of 8 cm and EPR of 3 works for you and feels comfortable then leave it that way. It indicates you really only need 5 cm, but that does not matter much. What works for you works for you.

" EPR stands for Expiratory Pressure Relief. It causes a reduction in the mask pressure when you breath out compared to when you breath in. The number is an approximate pressure reduction in cm of water pressure, often just called cm. Let me give an example:

If your therapy pressure is set at 8 cm, and you have EPR set at 3 cm and is turned on, then you will get 8 cm of pressure when you breath in. And you will get 5 cm (8 less 3) when you breath out. Now if you have a set pressure of 4 cm and and EPR of three, the EPR tries to reduce pressure to 1 cm on exhale. However, the machine is designed to never let pressure go below 4 cm. So in that situation the EPR does nothing. You will get 4 cm on inhale and exhale.

So if you set it up with the ramp in auto, a start pressure at 8 cm, and EPR at 3 for ramp only, it will go through this sequence. When you are still awake it will give you 8 cm on inhale, 5 cm on exhale. Most find that very comfortable. Then when you go to sleep, it will stop reducing the pressure on exhale. Most do not notice this change when they are asleep.

There is nothing magic about setting the ramp start pressure at 8 cm. If you find that too high, then try a ramp start pressure of 7 cm. Then it will do 7 cm on inhale, 4 cm on exhale, and then ramp up to a constant 8 cm when you go to sleep. The problem with setting the ramp start at 4 cm is that most people will find that too low, and feel like they are suffocating. I personally have a ramp start at 9 cm. I find that very comfortable, but everyone is different. Most with experience prefer a high pressure. A higher inhale pressure makes it easier to breathe.

Here is an example of how my machine works, as shown with SleepyHead. This is with an auto ramp, a ramp start of 9 cm, EPR at 3 cm, for ramp only, and a therapy pressure of a fixed 11 cm. You can see how mask pressure cycles between 9 cm and 6 cm for each inhale and exhale. Then when breathing becomes regular and it detects I am asleep (about where the green line is) the pressure ramps up from 9 cm to 11 cm, and then finally stops the reduction on exhale.

You asked whether 8 cm was a high pressure. My opinion is that it is a quite low pressure. Your machine has a maximum of 20 cm. Some machines go up to 25 cm. So if you think 8 cm is a lot, consider that some are using three times that amount."

Hope that helps some.

I am always suspicious of a company that provides no information as to where they are actually located. I searched but could not figure out their location. I did notice this though:

"How quickly will a doctor review my initial history? After your online visit a doctor will complete their initial review of your medical history within 24 hours. If you’ve been waiting longer than this, please email care@helloluna.co and we’ll take care of it."

If you are having issues at this point, it may be a major red flag indicating there are better alternatives...

I initially tried it and rejected it too. Then when I tried all the other alternatives, I came back to it, as the best choice for me. My wife was the same. She thought it was ridiculous, until she tried it for a few nights.