Sierra

It depends to some degree on the specific person and their apnea, but I would say in general most people are as likely to suffer from apnea on the inhale half of the breathing cycle as on the exhale half. So when you set an EPR of 3, then it reduces the exhale pressure by 3 cm. And in most it effectively reduces the treatment pressure. Apnea events are likely to then go up, and if there is room under the maximum then inhale pressure goes up. So it is kind of a vicious circle.

As an example say your minimum pressure is 8 cm and maximum is 15, and without EPR, say your normal treatment pressure is about 11 cm (inhale and exhale). Then you set your EPR to 3 cm. Now you are getting 11 cm on inhale and 8 cm on exhale. Sounds good but you probably will start to have apnea events at the 8 cm exhale pressure and the machine will crank up the pressure, probably close to 14 cm on inhale and 11 cm on exhale. Events are likely to be the same as 11 cm on inhale and exhale, but you have to put up with a 14 cm maximum pressure. It can be much harder to make the mask seal well at 14, and can feel uncomfortable.

In the AutoRamp mode you are awake and the pressure is fixed at your selected ramp start pressure of say 7 cm. It will cycle down to 4 cm the machine minimum on exhale. The extra pressure on inhale helps you breathe, and the lower pressure on exhale feels good to. And since you are awake you should not be having any apnea events. So, the pressures as low as 4 cm on exhale do you no harm.

Make sense?

The Phillips Alice Night One system that I used had not way that I know of to tell if I was asleep. It may have known when I was laying down, but I'm sure cannot distinguish between sleeping and not sleeping. They used time in bed for the denominator.

Yes, I would say you did it right. If I get up in the night, I leave my mask on my face, but I disconnect it from the machine and shut the machine off. Then when you go back to bed it will start the ramp again. I find it helpful to use the AutoRamp feature with a starting ramp pressure of 7 to 8 cm. I also turn EPR on at 3, and the EPR type set to Ramp Only. Setting EPR to ramp only can reduce the maximum pressure it goes to while you are sleeping.

When I went to bed last night I could not get the SmartStart feature to auto start the machine. I finally pushed in on the water reservoir and then it started. Suspect there was a significant leak between the machine and water reservoir. I think my seals are OK though. If you look at pages 24 to 27 in the manual at the link below it shows you how to take the machine apart to inspect the seals.

A10 Technical Manual

A few tips to clean up your format to show on line.

• Click on the black triangle beside the data to hide the full month calendar
• Use File, Preferences, Appearance, and uncheck the box that says to show the pie chart
• Drag the leak rate chart up so it shows

Yes for sure you should check the seals on the water tank. To post a screen shot from SleepyHead just press F12 (on a PC), take note of where the image file is saved. Use File Explorer to find the file, left click on it, and then drag it to the body of a message you are composing here. Are you sure the mask type is set properly in the machine?

The short story is that if the mask leaks are keeping you awake then it is a problem.

My suggestion would be the same. Make sure the machine mask type is set properly, and install SleepyHead to get a better view of what is going on.

As a shot in the dark, is there any possibility of a leak in the humidifier to unit seals? or in the hose or connections somewhere? I once had weird issues with my A10 when the humidifier reservoir was not fully pushed in.

That aside where are you getting the leak rate from? If you set the Essentials option to Plus in the Clinical Menu you can get an expanded sleep report in the user menu. It reports average leak rate over the night, or average over a number of nights.

The best way to track mask leaks is by using SleepyHead. It reports a % of time over the leak redline. It also displays the leak redline and graphs the real time leakage over the night. It would be interesting to see if it displays the same as what you are currently getting. From MyAir? Here is an example of the leak rate graph in sleepyhead for a bad night...

And, a good night:

SleepyHead would give you more information on when the leak is happening. This all said, if there really is no leak anywhere, you may have a defective machine. I take it your mask type is set to full face? If it is set to nasal pillow, it might be over reporting the leak as a full face uses a much larger purge flow than a nasal pillow.

I don't have any O2 monitoring, so I can only see Minute Ventilation (MV) which is really a measure of how much air (Oxygen) is being transferred into your lungs. If you look at the SleepyHead screen shot below, I zoomed in on an obstructive event that lasted 21 seconds. Prior to the event you can see a stable sleep period with uniform breathing and flow. MV was a pretty stable 7. However as the result of the 21 second obstructive event you can see it dip to about 1.7. It would be my expectation that oxygen desaturation would follow the MV but with a bit of a delay. With SH you can scroll through the night and see when MV is dipping down. What I like to see, but unfortunately do not see as much as I would like is a flat MV graph trace.

On a PC you can do a print screen by just pressing the F12 key, and watch for the pop up window that will tell you where the screen shot is stored. If you want to post it here, just use Windows Explorer to find the file, left click on it and then drag it into the body of a message.