Sierra

Unfortunately I have no experience with the Simplus mask, but perhaps others do. I have a recollection it is one of the older ones that are supposed to be capable of higher pressures. The Amara I recall got good reviews too. Mask are very individual, and the full face one seem to need lots of tweaking to make them work. I find it amazing that some people on a BiPAP uses these things right up to 25 cm of pressure...

At some point it would make some sense to stop and leave the pressure alone for a while. That could be at 14.5 to 16, or 15 to 16. The machine changes pressure instantly. The user does not adapt to it quite so quickly. The unfortunate part is that obstructive apnea is still showing up with pressures as high as 16. That indicates more pressure is needed. With no central apnea that is a good sign that it is not going to be a problem.

Hope that helps,

I checked out the website. Most of it does not work and just sends you in circles. From what little is there it appears the device is only intended to sanitize the CPAP machine and humidifier by forcing ozone through it backwards. Ozone and water can be very corrosive to metal parts. I would not use this device on my CPAP machine for that reason. From what I can see the device is being sold over the internet directly out of China. Sorry, but it seems pretty dodgy to me...

I clean my equipment the old fashioned way. I use vinegar, then soap and water, and after a final rinse, let it drip dry. I never try to clean the machine itself, only the humidifier reservoir.

A pressure setting of 11 is not that high. That is what I used with a P10 nasal pillow mask. I have now switched to a Swift FX nasal pillow which is very similar to the P10 but with better headgear. My wife uses a F&P Brevida nasal pillow up to 14 cm pressure. We both mouth tape however. She gets away with just mouth taping, and I have to mouth tape and use a chin strap. If you do go down the nasal pillow route, I would suggest using the 3M 2" Micropore tape. I am trying to get to the point I can use mouth taping only and ditch the chin strap.

Well the good news in this one is that your Periodic Breathing seems to be down, and there were zero central apnea events even though the pressure was higher. If you were disturbed with leaks all night that is probably the reason for feeling bad. Simply not enough sleep is the most likely problem.

I see from an earlier post you have a new mask (F30) on order. What mask are you using now? I don't have a lot of experience with full face masks but others here may. Perhaps they may have some suggestions on how to address leaks. From what I can see your mask leaks were much better later in the night, so perhaps you were making progress.

Probably about half of the obstructive events were happening at the 14.5 cm minimum. The next step would be to try a 15 cm minimum while leaving the max at 16. Probably going to make it harder from the leaks perspective though, so sooner or later you will have to solve that one. Perhaps the new mask will be better...

The other issue is that the obstructive events (not so much with the hypopnea) look like they are occurring in clusters. Bonjour has mentioned in another thread that sometimes it is a head positional issue that can be reduced by using a soft cervical collar. They are not too expensive, so at some point that may be worth a try.

A few posts back you asked this question:

"If it is RERA's that can't fit into the Apnea or Hypopnea categories, is this going to end up with neurology and taking a pill for life instead of APAP?"

Not a medical professional but I do get RERA indications on my ResMed AirSense 10 machine. This is how ResMed defines them:

"Respiratory Effort Related Arousals (RERAs) are periods of increased respiratory effort leading to an arousal. Increasing respiratory effort will be seen as airflow limitation. These flow-based RERA events are logged and stored as summary and detailed data..."

I am not totally sure how the machine can tell that an arousal occurs. When I look at the detailed data in SleepyHead when a RERA is flagged sometimes I see something that looks like an arousal (disruption in flow rate), and sometimes I do not. What I do see fairly consistently are indications of Flow Limitation.

In any case here is an example I found in my SleepyHead file of an event which includes both a RERA and an obstructive apnea. The RERA event (flagged as a RE) is associated with a quite significant (for me) Flow Limitation indication. This is followed by a fairly significant drop in Minute Ventilation which is amount of air being breathed in and out. Blood O2 levels tend to follow Minute Ventilation. The RERA event is fairly quickly followed by a non flagged obstructive event at 06:17:30. I can tell that by the blob of blue on the Mask Pressure. That is showing the machine is cycling the pressure up and down to sense whether the event is obstructive or central. It does not reach the 10 second of duration so is not flagged, but it occurred. When it ended there was a big spike up in Minute Ventilation showing over breathing to compensate for the period of reduced air flow.

Things kind of settle out for a while after that, but at about 6:21:30 an obstructive apnea is detected and flagged this time. The blue blob is longer and the event met the minimum of 10 seconds criteria to flag it as an OA. You can see it had essentially the same impact on Minute Ventilation reduction as the RERA did, so probably the same impact on oxygen desaturation. If anything the Minute Ventilation was reduced for long as a result of the RERA than it did for the OA event.

Sorry for the long drawn out explanation, but the point is that RERA is not a lot different than a full obstructive apnea when you consider the impact it may have on Minute Ventilation, and as a result blood oxygen, and sleep quality. Also, from what I can see in my personal results a RERA is not really associated with a central (open airway) issue and is more obstructive in nature. For that reason a PAP device is likely to treat it sucessfully with pressure. My machine is set to a fixed pressure and did not respond. In Auto mode it would have responded to the Flow Limitation and bumped pressure up. And, the For Her algorithm would have bumped it up even more. That in turn could have prevented the OA event that followed. Hope that makes some sense. Any questions, just ask...

Sounds like not much opportunity to improve in the weight department. Your weight and neck size may indicate why you are scoring so low in the pure AHI value.

I watched a program on our Canadian public news network last night where they asked a panel of doctors various questions about sleep disorders. Marijuana (not CBD Oil) was raised. I recall they lumped it in with alcohol and when used before bedtime it could help you go to sleep, but when the effect wears off you wake up and then have even more difficulty going back to sleep.

My thoughts on central apnea is that there are a number of root causes, but they can generally be lumped into an umbrella category of a breathing system control instability. It is like a defective cruise control in a car, that cannot maintain a constant speed. Elevation makes it worse, air pressure from PAP devices can make it worse, and in general sedatives and in particular opiods which suppress the nervous system can make it worse. It is hard to guess how something like CBD Oil would or could improve the situation.

Now that marijuana is legalized in Canada for recreation use, I would assume people will now start being more open about how it affects apnea treatment. I have no personal experience, and don't plan to, so I can't help you there.

As far as PAP treatment for central apnea, I think there are three routes to go. First is to use a CPAP or APAP and do everything you can to minimize the pressure used for treatment. The second approach is to go to a BiPAP device and use lots of pressure support (difference between EPAP and IPAP) to help the breathing effect and hopefully prevent some of the full stoppage in breathing effort (central apnea). It is pretty blunt tool however, and statistics I have seen show that BiPAP is more likely to make total apnea worse instead of better. The third solution is to use an ASV device like the AirCurve 10 ASV from ResMed. It follows breathing on a breath by breath basis and cuts back or increases pressure support on a breath by breath basis. It can have quite a dramatic improvement in central apnea contribution to AHI. On the negative side it can only be used when heart function meets a minimum standard. And, there are no studies to date that it improves long term life expectancy. It other words, it may be just masking the issue.

It has been a journey for me. Many small steps have got me to a pretty good state of acceptance of the treatment. I am sleeping better now that the benefits outweigh the discomfort of wearing the mask. I'm sure my wife appreciates the lack of snoring. I appreciate the lack of her snoring as she used the PAP treatment too. My issue now is trying to limit the amount of time I sleep per night. I average just over 8 hours per night, and I would prefer to be between 7 and 8. I think the quality of sleep trumps quantity as long as you are getting about 7 hours minimum on average. I also think about the long term health benefits of using PAP treatment. I have diabetes, and some blood pressure issues, and I think PAP treatment can reduce the impacts of that to some degree. I think of people like my father in law who passed a few years ago that never had the option of treatment with a PAP machine. I suspect he would have had a longer quality of life if he had the treatment.

It is not unlike type II diabetes. More people undiagnosed than diagnosed. And if you include those in the Pre-Diabetes category it gets much worse. I think to some degree it is a truce of comfort between doctors, patients, and insurance companies. Many doctors don't really want to deal with it. Most insurance companies don't want to pay for it, and many patients don't really want to know they have it.

Hi Jeanette,

I think I saw a post you made in the Introduce yourself thread. Have you heard of SleepyHead software? It enables you to see the detailed data on your machine. It is not the greatest idea to just reduce the pressure of your machine without having any way to monitor what it is doing. If you need help using SleepyHead perhaps just post in the new thread...