Sierra

Here is a link to a study that looked at a number of people who were diagnosed with a full in clinic study, and then estimated what the AHI would be if Time in Bed (TIB) was used instead of Total Sleep Time (TST). It not unexpectedly showed that many who were diagnosed with mild sleep apnea (AHI 5-15), would have been missed and diagnosed with normal apnea levels (AHI 0-5). They reported it in a pretty complicated way, but the conclusion is obvious. The more differential there is between TIB and TST the greater the error in reported AHI.

Potential Underestimation of Sleep Apnea Severity with At Home Kits

My opinion is that there is not much wrong with a home test, as long as one understands the limitations. And with respect to RERA events even though they are likely to measure them with an in lab test, the large majority of of insurance companies will not count them in determine eligibility for coverage. For example AHI - 4, and RDI - 15, no coverage!

Yes, I think snoring does reduce the quality of your sleep. So does flow limitation and it is typically not reported other than when it makes the 10 second flow reduction to qualify as a hypopnea event. Here is an example of a RERA event I posted in another thread. It is from my data and it preceded a full obstructive apnea event. In this graph you can also see Minute Ventilation which is just a measure of the air (oxygen) being exchanged with your lungs. The reduction in air exchange was more significant in response to the RERA event (RE) than it was to the obstructive event (OA). So they do count as a factor in the quality of sleep.

Not sure how the PAP prescription process goes in your area, but here (Alberta, Canada) after a home sleep test which is positive for apnea, it is pretty standard to prescribe a free trial of a APAP machine, and after that if it is successful you can buy it from the clinic ($$$) or elsewhere on line ($). The good part about a trial is that you get to try one or more masks which is most difficult part in gaining comfort, and you also find out what the machine does for you.

The industry standard is to treat AHI>5. One issue with a home sleep test is that they base the AHI average on machine operating time, or possibly body in position (lying down) time. There are no electrodes attached to your head so they can't tell when you are asleep or not. The more time you spend lying down during the test but not sleeping, the more the home test underestimates the real rate of apnea and hypopnea. Your in lab test is most likely to report a higher AHI than 8 because of that factor.

It is often rumored that the AirFit P10 mask was designed to replace the older Swift FX nasal pillow mask. The P10 has been on the market for about 5 years or so, but has not pushed the much older FX out of the market. If you believe the CPAP.com sales volume sort of nasal masks, the P10 is currently the most popular, and the FX remains right up there in second place. The FX even enjoys a slightly higher user rating at the site. So how do they compare? I have used the P10 for about 9 months, and now the FX for about a week.

First the Obvious

• The P10 headgear is simply flimsy and in my opinion poorly designed. They include some mickey mouse clips that are intended to be used to tighten up the mask, but they create bumps that catch on the pillow and make the issue of the mask headgear slipping around even worse. I threw them away, cut the straps and sewed them up about an inch tighter and that helped a lot. Some report that washing the headgear makes it shrink, but I have not noticed that. It has been washed many times, so perhaps I used up that benefit before I cut and sewed them.
• The FX headgear is more conventional and substantial. I would expect it will last a long time. Silicone would not have been my first choice for a material to use, but I guess it is durable. Some have reported that the back strap tends to slip up during the night. I have not noticed that. Some have reported that sewing the hook side of a velcro strip inside the back strap helps with the slipping. Probably would help, but not sure what that would do for those of us trying to save the last few hairs on their head!

• The clear winner in the headgear department is the FX.

• The outstanding component of the P10 mask is the air vent. The large mesh design on the P10 diffuses the air stream making it very quiet and non disturbing regardless of the position you are in. I can't think of a way to improve it.

• The vent design on the FX is somewhat of a disaster. It consists of perfectly round holes cut at about a 45 deg. angle down from the mask. The angle does divert air away from the face, but it directs it onto your bed covers or your arm or hand. The velocity of the air is very high and some have compared it to the exhaust of a jet engine. The amazing part is that while it has the velocity of a jet engine, it is pretty quiet, until it hits something. Then it makes lots of noise. After a week I seem to be sleep learning how to position the mask and it is an issue that is going away. Some route their hose back over their face and up to a hose hanger to get around it. I have not done that yet!

• The clear winner of the air vent design is the P10. It is perfection in design.

Now the less Obvious

• I have not come to any firm conclusion on leaks. I mouth tape, and use a chin strap with the P10. It is about the only way I can keep it on my head for the whole night with those flimsy straps. I thought with the better headgear I might get away with using 2" mouth tape only and no chin strap. However, it looks like that is pretty marginal at best. I like to get zero leaks over the leak redline and this method does not quite achieve it. It seems I have to go back to both the mouth tape and BreatheWear Halo chin strap for the FX as well. No clear winner here.
• On comfort, the shape of the nose cones appears very similar. I used the Large with the P10 and have only tried the Large with the FX. Both masks irritated my nose for about a week and then it went away. I suspect while they are similar they are not identical. But again no clear winner, and it probably is just a personal nose shape issue.

The Winner?

For me, I will certainly use up the life of the FX, and assuming nothing changes my next mask is likely to be a FX too. The P10 will go in the closet with my F20 as a spare that I hope not to use. Others who have less of an issue with the headgear of the P10 may be much happier with it.

The Question?

This leaves me with one obvious question directed at ResMed. If you wanted to make a mask to replace the Swift FX that was an improvement, WHY ON EARTH DID YOU NOT JUST PUT THE P10 NOSE INSERT AND VENT ON THE FX HEADGEAR??? If they did that I would buy it tomorrow! It really would be the perfect nasal pillow mask.

Welcome to the forum. I was diagnosed with a home sleep study as well. The machine I used was a Phillips Alice NightOne. You probably had the same. I went straight from the home study to an APAP machine, but my diagnosis was much higher at 37.

Treating a low AHI is always a dilemma. I can't say there is no discomfort to wearing a mask and using a machine. Some don't find it no problem at all, and others it bothers more. At least initially it is likely to disturb your sleep some. With a low AHI the pressure is also most likely to be lower, and that tends to make for more comfort. On the benefits side, it is much harder to predict. Reducing AHI from 8 to say 1 may not be that great. However, if there are other underlying issues such as RERA, snoring, and flow limitation events which don't get counted in the AHI the benefits may be higher than the AHI would suggest. I don't believe the Phillips machine reports RERA events, or at least my sleep report did not include them. Snoring should be measured though. An in lab test should measure RERA and they get added to the AHI to form the RDI index, which could be higher.

If you go ahead with the in clinic sleep test, you will know more and be able to make a better decision at that point. If things stay pretty much the same you would have the choice of going with a dental appliance or a PAP machine. The dental appliance is more expensive, but may be covered under your health insurance rather than dental insurance, and could end up less costly. If you go the PAP route, which is likely to have the best outcome in AHI, but not necessarily in comfort, I would resist doing a separate additional titration study and just ask for an automatic PAP machine. With your low AHI a ResMed AirSense 10 AutoSet For Her would be probably the best choice if you can wangle it. It is designed for women but can work for men with a lower AHI and less need for pressure. It is the same cost as the standard machine, and can be set to the standard mode if the For Her mode does not work. It just gives you more options.

Hope that helps some,

If you did not drain the humidifier reservoir is is the most likely to have some issues. I would inspect the reservoir, the hose including inside as far as you can see with a flashlight, and the mask. If you see no visible mold, I would do a normal clean. For me that would be to use pure vinegar first, followed by a warm water and Dawn dish soap clean, and last a tap water rinse to get rid of all the soapy water and residue. Hang to dry for a 16 hours or so. As for the filter on the inlet of the machine, I would inspect it and if it looks clean then just wash it under the water tap. At least the ResMed ones are water resistant and are quite easy to clean after you blow the dust off.

Here is a link to an article based on the TV segment about sleep disorders. Hopefully the link works. The claim is made, without backup that I could fine, that 80% of those with sleep apnea in Canada are undiagnosed. The video segments are embedded in the article, but they may not play outside of Canada...

I believe flow limitation and apnea can happen on inspiration and expiration. That is why there is a benefit to turning off EPR and Flex on a PAP device. That prevents a reduction in pressure on the expiration.

Hi Matt,

Here is how to do it with a PC. With the Daily Detail showing in SleepyHead use the F12 key to save the screen shot as an image file. A window will pop up in the lower right side with the file location. Start a new message with the orange Write a Reply button here. With Windows Explorer locate your saved file, left click on it, and drag it to the body of the new message you opened up. The image will be uploaded to the site and will be part of your new message. You can include text in the same message with your questions or concerns.

To get the most out of the screen space it is a good idea to clean up the SleepyHead layout before you start as follows (instructions for a PC)

• Use the F10 key to hide the navigation screen bar on the right
• Use File, Preferences, Appearance, and uncheck the box that says "Show event breakdown pie chart"
• Click on the black triangle beside the current date to hide the full month calendar

I depends on the data. Here is what I found in the S9 Clinical Manual. Looks like the high resolution flow data is 7 days, and other detailed data 30 days.

The AirSense 10 is quite a bit more and seems to be limited by SD card storage only.

Yes, I might consider testing. I use a home assembled PC. Some details below.