Sierra

Let me try and explain again. 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 considered that it might have been an April 1 joke, but decided that in down under time the window for that was over for another year...

My experience with the nasal mask is that if it leaks too much all the time (from SleepyHead graphs) then it may be too tight. It also tends to be noisy. However, if it leaks tend to start gradually and are intermittent during the night, it tends to be because the mask is too loose. And, of course if the leaks start and stop suddenly and the leak rate has a flat top, then it is most likely due to opening the mouth.

It is not the mask adjustment. The Mirage FX has a terrible air vent design problem. The air vent which is design to keep the air fresh in the mask consists of angle drilled holes. They create a very high velocity that is quite directional. If it is away from you or the covers it is fine. But when it blows on you it is terrible. I used one of these masks for a week or two, and tried many different things to control the flow. I have read that some people use a hose hanger back behind their head and route the hose up to the top of their head and then up to the hose hanger. That does not work for me.

The ResMed AirFit P10 nasal mask has a nasal insert almost identical to the Mirage FX, but the mask vent is very different. It is like a plastic mesh and diffuses the vent air flow. The flow, no matter which way the mask and hose is oriented does not cause a problem. The problem however is that the headgear on the P10 is flimsy. For many people it comes off during the night, or slips to the point that the mask seal leaks.

Since I had one of each of these masks I used the headgear from the Mirage FX, which is excellent, and fitted it to the nasal mask and hose from the AirFit P10. It is not really that hard. Just read the post I made in detail. You do not have to buy a complete P10 mask, just the nasal part and the hose. Then you can fit your Mirage FX headgear to it. Here is a link to the mask/hose part of the P10 mask. Order the same size insert as you are using on the FX mask.

P10 Mask/hose assembly

I believe you are using an AirSense 10 AutoSet with a maximum pressure of 15 cm. Is that correct?

About the only realistic way to determine if pressure is correct is to view the data using SleepyHead. Then you can compare when you are having apnea incidents to what the treatment pressure was at that point during the night. You can also determine if the machine may be raising the air pressure unnecessarily. If you copy the data from your SD card to SleepyHead and do a screen capture of the daily report, then post it here, then we can give you an opinion on what may be going on.

Also if you have EPR set to full time, the pressure may be going higher than it needs to.

The standard practice is to do the Stop-Bang and Epworth quiz tests first to establish your risk level for apnea. If it is well elevated, then the next step is a sleep test. If there are no other medical complications it is becoming more common to do the at home test. That is what was prescribed for me. My equipment was a Phillips Alice NightOne. I have no experience with the ResMed, but I would expect it is good. Phillips and ResMed are the market leaders in CPAP equipment. One thing you might want to check on is if you will get a valid prescription out of it if you test positive. On line CPAP supply companies like CPAP.com give advice on what they will accept. A prescription is required for new CPAP equipment and the masks in the US. If you are going to try to recover anything from your insurance company you may want to check and see what they accept too.

AHI for diagnosis is basically apnea + hypopnea events divided by the time of the sleep. However, most at home tests only measure time in position or time with the test machine turned on. For that reason they tend to underestimate the AHI value because you are dividing by a number that is higher than your actual sleep time. Some equipment may have a method to better estimate sleep time. The Alice NightOne equipment I used, did not.

Hope that helps some,

Here is the solution:

Swift FX - P10 Hybrid Mask

Sounds complicated. You are correct though about smoke being a particulate and a fine filter will take it out. I think I would just buy the Hypoallergenic filters that ResMed makes for the machine. See this link for a supplier in Canada. I have dealt with them and they are very good. You probably would have to replace them more often than the standard filters. And if you think it is bad on Vancouver Island, you should try it in Alberta. We are downwind of all that smoke!

The settings I suggested you change are comfort settings. The main therapy pressure of 8 cm is your treatment pressure. You should consult your doctor before changing the therapy pressure. The unfortunate part is that the doctors and technicians focus on the treatment pressure and often do not set up the comfort settings properly. You really should turn your ramp back on to Auto, the EPR on to 3, and Ramp only. And most important the ramp start pressure to 8 cm. Having a ramp start of 4 cm would be very uncomfortable. That is an example of how machines are given to users without the proper comfort setup.

Do you own the machine, or does it belong to your doctor? I guess if it belongs to the doctor, I would be a little more careful with it...

I have a bit of a groove across my cheeks when I get up in the morning from the strap to my nasal pillow. It goes away in about an hour. As for ruts on the back of my head, I don't seem to have that. In a way, I would think they might be helpful in keeping the headgear in place over the night. I was worried that the Swift FX headgear might slip up on me, as some report that issue. It has not, but I had a plan in mind to sew some non slip material on the back strap to prevent it. I read that someone had sewn some hook half of a Velcro strip on the back strap. Has not turned out to be necessary. Perhaps there is a rut back there working for me!