Sierra

There are some areas to explore, but this is looking more and more like a situation that needs an ASV instead of a APAP. I exchanged a number of posts with an individual who lived in Canada at 500 feet but vacationed at Lake Chapala in Mexico at 5,500 feet. I recall him having similar issues. I think we found some settings that worked to some degree but it required two different setups for the two different elevations. He was on a BiPAP so the terminology is slightly different. You can find the posts at this link if you want to explore them.

https://myapnea.org/members/lakechapala/posts

In the end he got an ASV and brought AHI down to very low levels. So, while I would not give up on your APAP just yet, but an ASV may be the final best solution. See this information on the ResMed version of one. They are not cheap and are in the $5,000 range.

AirCurve 10 ASV

An ASV looks at your breathing pattern and adjusts pressure on a breath by breath basis to essentially force you to take a breath even when you do not initiate it.

Yes, you did not respond well to the full time 3 cm EPR, other than hypopnea seems significantly reduced. For sure go back to having it on ramp only. You may want to revisit it later at a lower level than 3 cm. The concerning part is how much OA you are getting with pressure at the max of 17 cm. It is also concerning that the CA events seem to be happening at a lower pressure. I would go back to ramp only EPR for a couple of nights with max pressure the same at 17 cm to see if the OA events come back down.

Just use distilled water then. It is all the same.

I think that terms get used loosely at times. Perhaps this may help some:

• Demineralized water - Water that has the minerals removed
• Distilled water - Water that has had the minerals removed by boiling it and condensing the water to leave the minerals behind. Volatile organic compounds, (VOC's) tend to carry over however, so it is not the purest of waters.
• Deionized water - Ion exchange resin is used to remove the ionized portion of the water. It is usually preceded by carbon filtration
• Reverse osmosis (RO) water - Water that has been "squeezed" through a plastic membrane to remove minerals and VOCs. It also is typically preceded by a carbon filter.
• Ultra Pure Water - Water typically used by the semiconductor and IC manufacturing companies. It is typically produced by putting the water through a reverse osmosis unit followed by ion exchange resin and a degasifier. This would be about the purest water available.

All of these types of water are just fine in a CPAP. I suspect the large majority of people just buy what is convenient and least expensive in the grocery store or drug store. No brand has any advantage over another, but if you really wanted to be super paranoid about it you could buy a water conductivity meter at Amazon. You would want one that measures down to 1 micromhos/microsiemens. Then you could buy a gallon of each brand and type of water to test to see which is the best. Lower is better.

But before you do that, you may want to speak to your doctor about the possibility of having OCD. The reality is that in a pinch even tap water works. It just takes a little more vinegar to clean out the reservoir.

Now that I see the data better, it seems most of the CA events are happening at higher pressures. You may want to make your first max pressure reduction down to 14 cm max, and then do 1 cm at a time to get to the ideal pressure sooner. And to help a little bit to avoid OA events you may want to make these changes.

1. Increase the minimum pressure to 7 cm
2. Switch the Ramp time to Auto
3. Increase the Ramp start pressure to 7 cm

This will get your pressure up a little quicker and potentially avoid some of the early OA events.

It also appears that flow limitations are driving your pressure up. Putting the EPR to full time at 3 cm could help reduce them.

For what it is worth I had similar issues and when I finally got the max pressure about right, I had it at 11 cm. And, then at that point I found I got the best results by switching from the APAP mode to a fixed pressure CPAP mode, with the pressure set at 11. Leave that to the end, after you get into the correct pressure range.

Oh, and when you post a graphic, it helps to open a new full width window by using the orange Write a Reply button in the bottom left of the screen. Another quirk of this site is that it keeps making each response window narrower and narrower!

For some reason these posts with the OSCAR graphs did not show up until today. This site is quirky and seems to delay posts with graphics in them especially for new users.

I am having trouble seeing all the detail and if there is any way you can increase the width of the left hand window it would be helpful to read the numbers. You may also want to increase the height of the individual graphs by clicking and dragging on the dividers. The important ones are the Event Flags which I pin to the top position. Then Mask Pressure, Flow Rate, Pressure, Minute Ventilation, and Flow Limitations are the most important. If you click on the title of each you drag the graphs up to get these to display. It is OK if the rest slip down to the bottom and don't display.

In any case, what I am seeing is that most of your AHI is hypopnea, and next is central apnea events, with zero or near zero obstructive apnea events. First, assuming you are in Colorado, what elevation are you at? Denver? It is nearly a mile above sea level, and the altitude can aggravate the central apnea issue. And, more pressure can make central apnea worse, not better. EPR can help reduce hypopnea in some cases. I see you have EPR turned on only during the ramp. Here are some suggested changes you could try. I would try one at a time to see what impact each has. If things improve, keep it, and move on to the next change.

1. Switch EPR to Full Time, and increase it to 3 cm. The hope would be that it reduces the frequency of hypopnea events.
2. Reduce your maximum pressure setting 1 cm at a time to see if that reduces the frequency of CA events. At some point you may see OA events start to increase. When that happens you may be approaching a more ideal maximum pressure. In the end it can be a compromise between reduced CA, and increased OA.

When you have tried these, then check back in. You may need an ASV machine instead of an APAP. It can deal with the CA events better, if they continue to be a problem, especially if you are at a high elevation. Another alternative is that a drug used for elevation sickness is sometimes used to reduce CA events if you are at a high elevation. You of course would need a doctor prescription to try it. But, try the changes above to see if they help first.

Your data suggests that you have Complex Sleep Apnea. Here is a link to a detailed article about the condition. Near the bottom of the article it mentions the off label use of acetazolamide which is the drug for altitude sickness.

https://myapnea.org/blog/complex-sleep-apnea

I tried the Primo Water dispenser today at our Walmart. The service basically works, but is a little less convenient than the closer Canadian Tire that I have been using. The price is basically the same at $2.97 for 5 gallons. Your have to pay for it in advance which is a bit more awkward. This Walmart only has one machine and I fill two 5 gallon containers each trip that I make, so I have to do one after another. At Canadian Tire they have at least 3 machines so I can usually fill the two jugs at the same time. All in all, it is an option, but I will continue to go to the Canadian Tire as it is more convenient for me.

Yes, ResMed likes to keep the Clinical Menu access a secret. Here is a link to the manual that describes all the Clinical Menu options. But, be careful. You can change important settings with this menu!

https://www.respshop.com/manuals/ResMed-AirSense-10-for%20her.pdf

Your machine may be set in a more limited visibility of options mode. To fix:

1. Hold down the rectangular home button and round settings button at the same time for 5 seconds to enter the Clinical Menu mode.
2. In the Clinical Menu rotate the settings button to scroll down to Options, Essentials, and then set it to Plus. This should give you the additional visibility. It also gives you access to an advanced sleep report.
3. Exit out to the User Menu.

Are you really connecting at 5G? You should be able to go into the "My Options" menu, and right at the bottom "About", and at the bottom again "Provider". There it will list who you are connecting to and at what speed.