Sierra

First the easy answer. While I do not subscribe to it, ResMed offers what they call MyAir service. Each morning the basic summary data is uploaded automatically to the ResMed cloud. If you sign up for the service (no cost) you can access your own personal data which I suspect is tracked to the serial number of the machine. It is very high level stuff that is provided to mainly encourage you to keep using the device. For example you could get a poor AHI score but if you used the machine for 8 hours you would be given a very high overall score. This service is very difficult to turn off, and for some it raises privacy issues. Technically they could track from the cell service where you actually are located.

Next the more complicated. Your provider can access the data too. Whether or not they actually monitor it is something I am suspicious of, but I don't really know. I suspect because they have thousands of clients they really do not monitor results. Is there a flagging system that identifies those with bad AHI? Perhaps, but I doubt it. Second hand information but I do understand the DME system and insurance providers in the US may track compliance and take the machine away if they have paid for it, and you are not using it.

The clinic does not get the detailed data unless you as the patient bring the SD card in to them. They have software similar to SleepyHead which they can display the detailed data. Perhaps someone that is going back to their clinic on a regular basis may bring their card and ask them to look at it. However, the problem is that it takes quite a bit of time to review detailed data. I'm skeptical that it is really done much.

You have to understand there are two basic ways in which people get machines, and it varies from area to area. Some have the DME or insurance provider pay for it in a kind of a full meal deal arrangement. The cost can be in the order of $2400-2800 in addition to the cost of the sleep studies. Other people like myself without insurance can just get a prescription and buy the machine from an on line provider for $800-900. Most of these are quite clear that they provide no monitoring. The full meal deal providers should, and should answer any questions you have. Do they though....

There is lots of information and help on line if the patient wants to make the effort that will assist them in understanding the results. The basics are quite simple. The guidelines are to achieve an AHI of <5. The more difficult stuff comes in when one cannot do that. Then what do you do? And the obvious simple answer is go back to your sleep clinic that did the sleep study.

The popular ResMed and Repironics machines are essentially all supported by SleepyHead. An informed buyer of a CPAP will make sure it is supported before they buy. There is not much hassle to install it, unless you are trying to get by with using a tablet or phone instead of a real computer.

My thoughts are that clinics make money by doing sleep studies, selling the machine, but not much in supporting the user after that. Some would prefer you come back for another sleep study, rather than just look at your data and make a change to the settings. Other clinics are not in that business, and will tell you about using SleepyHead.

My preference is to stay out of it.

Not likely to work. The machine is designed to compensate for quite large leaks.

I don't think it is dead. However I believe there has been an ongoing dispute over control of the project for some time now. Mark Watkins, who was the originator of the software has said he wants nothing to do with it any longer as a result of the dispute. It is an unfortunate situation, but I sure hope the product continues in some form.

There is an easy way to reduce pressure to zero. Just don't use the machine! The machines I know about all have a minimum limit of 4 cm. Not totally sure why they do that, but they may want to ensure there is always flow and no reverse flow. Also when taking deep breaths the machine always lags behind the demand for air. They perhaps do not want to see the pressure go negative. ResMed machines show mask pressure which is an estimate of the actual pressure at the mask. When you zoom in with SleepyHead you can see how much pressure fluctuates when it is set for a constant value. It can be significant.

There is one possible way you could get a lower pressure, but I don't know how safe it would be. The machine measures pressure at the machine and estimates pressure in the mask using pressure drop flow calculations. If you were to use a longer and/or smaller hose the pressure drop would increase and as a result you would get lower pressure at the mask. Not sure about the Respironics machines but the ResMed ones have a setting for the hose type. If your machine has that, you could perhaps set it for a larger hose than the one you really have. Your indicated pressure would then be no longer correct, and would be lower than indicated.

My suggestion is to ensure you have a SD card in your machine and then download SleepyHead to view the data. Here is a link to a basic manual.

If you still have the SD card from your S9 machine it should have some data on it. It wouldn't hurt to transfer that data to SleepyHead first and then transfer the data from the newer A10 machine next. That way you will see how your old machine was set up in comparison to your new machine. The A10 can do anything the S9 could do, and if set up the same should perform the same.

There may be a slight difference in pressure requirements for a nasal mask vs a full face mask, but it is unlikely to be significant, and I couldn't even guess which one might be higher. It may depend on the machine and the mask model. These machines do not measure the pressure right at the mask. They measure the pressure at the machine, and use algorithms to estimate the pressure at the mask, considering the hose type used, and intentional vent air required by the mask. If there are differences in pressures need due to the mask it is most likely due to errors in the estimation of the mask pressure.

The real pressure requirement is determined by the degree and type of apnea you are suffering from, and should be quite independent of the mask type. The most common mistake in setting the machine up is to have the pressure too low at the start of the ramp up. The DreamStation has a SmartRamp feature which will hold the pressure at a comfortable level until you go to sleep. I would ask your supplier to set it up for you with a ramp start pressure of about 7-8 cm. They should know how to do that.

How do you get the data of your machine?

Most new machines use the cell phone network to send information to the machine provider and to the machine company cloud storage (ResMed for example). The data is very limited and mainly intended to monitor and encourage compliance (with using it). The real detailed data is only stored on the machine SD card. This is an example of what is stored where with a ResMed machine.

Why do you need it? Curiosity? Insurance? Do you give it to your doctor? Or use it yourself (it seems bloody complex!)?

Those who monitor their apnea closely need the data to see how well the machine is working and if there are any opportunities for improvement. Some insurance companies use the compliance data to determine if they will take the machine away if compliance is low. No I don't give the data to my doctor. It takes quite a bit of time to review the detailed data, so I expect most doctors just want to look at the summary data. Yes, I look at my detailed data daily to see how well I am doing, what type of apnea I am having, how well my mask is working for leaks. I can also tell if I am opening my mouth in the night causing leaks. The machine will also tell you if anything out of the ordinary is happening -- like Cheyne-Stokes respiration.

And finally is the data you are getting enough?

Yes, when one uses an applications like SleepyHead you can pretty much see all the data you want. If you just use a lightweight application like MyAir, you are pretty much in the dark. But if the AHI is good, and the machine is comfortable, then perhaps that is good enough. For some PAP treatment works very well, and is easy to maintain. For others it can be difficult, and requires pretty constant monitoring..

The main reason for confusion on the part of users is that many sleep clinics try to keep the data from the user, and are not very forthcoming on how it should be set up for comfort. Some even pull the SD card out of the machine before the patient is sent home with the machine. I suspect most sleep clinic technicians do not suffer from sleep apnea and don't use a PAP machine personally. Just my opinion...

Mouth breathing is quite common, and considered by some to have detrimental effects on your sleep. See this video which is directed at the general population.

How to mouth tape for a better sleep