Sierra

Just as an update I tried the 3M 2" Micropore tape for two nights now. The first night I used it with my BreatheWear Chin Strap. I got very low leakage. Last night I tried it without the chin strap, and it wasn't so good. It was 2.7% over the leak redline, which isn't a disaster, but not great either. Much of the night was spend just under the leak redline. I am not going to give up on using it alone yet, but it is looking like a chin strap may still be in my future. In any case the 2" tape is better than the 1" I was getting at Walmart, and is nearly the same price. As a mouth tape I recommend it. It does not seem to be available at Walmart or the other larger drug stores, but we found a medical supply place locally that has it by the boxes.

The one I found using Google looks a lot like something one would wear when taking a long term "sleep" under a nice Egyptian pyramid!

Good one!

Is it possible that the pink For Her strap might be shorter? They sell it in two versions and some think the only difference is the colour. It would seem to make some sense to make the For Her version smaller.

That looks better. Your CA event frequency is very low and the residual is mainly OA and H. The machine did not attempt to go over 15 cm even though you had the max at 16 cm. What seems to be happening is that the machine algorithm is getting caught with the pressure too low, events happen, and it jumps up, and then fairly quickly the machine wants to reduce pressure. The set minimum of 14 cm is likely preventing it from going even lower and making things worse. Unfortunately this quick spiking up and down is a characteristic of the Respironics algorithm. My first thought would be bump the minimum pressure up to 14.5 and try that. If that helps, but there is still high OA, then the next step may be to go to a fixed 15 cm. I wouldn't jump into that yet, as you want to see where the machine wants to take pressure in limited auto control.

On the CSR I would not get too hung up on whether it is or it isn't. I think there is enough there to say there is an issue that should be raised with your GP doctor or cardiologist. Remember that Respironics does not say it is CSR, they just report periodic breathing probably on a basis that may be unique to Respironics. ResMed does report CSR, but again they are probably not all that transparent as to how they do it. This periodic breathing issue may have been there before you went on PAP treatment, and now the only difference is that you have a PAP machine reporting it to you, compliments of SleepyHead. Or, it may not have been there before, and the PAP treatment in the pressure range you have of about 15 cm is causing it, or aggravating it. That is of bigger concern, and again I would recommend discussion with the appropriate medical professional, like a cardiologist.

If they feel it is something that should be addressed, then that drug (Acetazolamide) I mentioned before may be of some help. Another approach that is used is to switch machines from the standard APAP you are using now to an ASV machine. There are risks associated with that too, and while it probably will reduce CSR and central apnea, it may or may not improve outcomes. That is something to be discussed fully with your health care professionals. Here is another reference you may find of interest.

Cheyne Stokes Respirations

This all said I would think that your elevation of 5000 feet is a factor in this, and it may not be fair to assume this is a heart issue. There can be other causes, and that drug for elevation sickness may have some benefits. And, I also think with a few more tweaks you may be able to get your AHI under the treatment guideline of 5.

Keep posting. I think you are making good progress.

Unfortunately I think most pharmacological solutions tend to be addressing the symptoms or outcomes of a disease, but not actually curing or reversing it. There are some that perhaps may be partial corrections, and even have preventative benefits, but not a lot. This is the way I see the prescription drugs that I take:

Metformin - This does not really correct anything, but it does help with type 2 diabetes by making the body more sensitive to insulin, slows the dump of glucose from the liver, and slows the rate of digestion of carbohydrates. Not a cure though.

Insulin - Again not a cure, but it does compensate for lack of insulin in the body. It is more effective, and essential for type 1 diabetics.

Statin - Reduces cholesterol, and if you believe some of the studies it has long term preventative benefits by reducing the build up of plaque in the blood vessels. Those at high risk like diabetics have lower standards for LDL cholesterol, but not all doctors seem to know that. While it is widely prescribed often the most at risk in the population may be under treated. It is nearly impossible to get to the lower standard without the assistance of a statin. The real long term benefits will need to be proven with time however. If it is, this drug may actually have some corrective health benefits.

ACE Inhibitor - This is claimed to reduce the impact of high blood glucose on the elasticity of the artery walls, and is often prescribed as a preventative basis for diabetics. It is also said to help prevent high glucose damage to the kidney. And of course it reduces blood pressure, and while not correcting the underlying cause, it should improve long term outcomes.

Beta Blocker - Again reduces blood pressure and heart rate, but is not really a cure for the underlying issues. Lower blood pressure however should have benefits.

While it is kind of depressing to some degree to think one may have to take these kind of drugs for a lifetime, it is probably better than the alternative. Every once in a while I hear about somebody going to a new doctor or alternative medicine doctor and they get taken off "all those pills". The insinuation is that "all those pills" are part of the problem, and I guess in some cases that might be partly true. However, the next thing I usually hear is that the individual has passed and there is a funeral to attend.

Our publicly funded broadcasting outlet in Canada, CBC, has started a short series of more in depth coverage of sleep disorders. You can see them for a limited time on line. They did the second in the series last night and the first the night before. In the first one they covered the impact of sleep on memory. In the second they got into the issue of apnea and diagnosis. Kind of light and fluffy stuff, but perhaps of interest to those like us that are suffering from the disorders. Here is the link to the site where you can view the material. You may have to hunt around for it a bit, as it is only about 10-15 minutes out of the one hour National News program. I believe it starts at about the 30 minute mark. However, there seems to be no way around being bombarded by several commercials... The ones from Jan 21 and 22 have the content. There is supposed to be another tonight.

CBC The National

Interesting. I was just about to compose a post comparing the ResMed AirFit P10 to the ResMed Swift FX nasal pillow mask. I have used the P10 for about 9 months and also dislike the headgear. The rest of the mask is great. With that amount of use perhaps I have not had it long enough to plug up the vent screen. I just rinse it under the tap. I have managed the headgear problem in two ways. I cut the straps, overlapped them about an inch, and sewed them back together again. That helped a lot. However, I still was using a BreatheWear Halo chin strap for two purposes. One was to hold that flimsy headgear of the P10 in place. The other was to keep my mouth closed. It worked, but all that stuff is not that comfortable.

It was about time to replace the mask, and I decided to try the predecessor of the F10 which is the Swift FX. I think it dates back to 2010 or so. The P10 was supposed to replace it, but it really hasn't. I've now had two nights with the Swift FX. The headgear is much better, and it stays in place for me without needing the chin strap. The nose portion is almost identical. It seems to stay in place quite well when you side sleep. The only issue with the Swift FX that I don't particularly like is the vent on the elbow. It is a series of holes at a 45 degree angle, that are designed to blow air down toward the hose rather than straight out. I had read that the mask was more noisy than the P10. I did not find that to be the case, or perhaps I am going deaf! What I did find is that while the P10 diffuses the air so there is no real velocity to it, the Swift puts it into a high velocity stream, like a garden hose set for distance. The problem comes in when that high velocity stream of air hits the bed covers, or your hands or arms, it makes noise, and a fair bit of it. The first night I used it, I was quite bothered by it, and did not get a great sleep. Last night it worked much better, as I did what I could to keep everything away from air stream. It was much better, and I got a reasonable sleep. Short story is that it is essentially the same mask as the P10, with a much better headgear, but a poorer vent diffuser system -- but I hope manageable.

The other nasal mask I have tried is the F&P Brevida. It has headgear that is better than the P10, but not as good as the Swift. It has a similar vent location as the Swift on the elbow, but it has a detachable diffuser that goes over the vent holes. Not perfect but is better than the Swift, and not as good as the P10 vent. The Brevida however bothered my nose more than the P10, and is larger and seems much easier to dislodge from your nose when you side sleep.

Hope that helps some,

Ben, I looked into this a while back, with respect to building my own 12 to 24 volt converter. You can get them with enough capacity quite cheap on eBay. I finally got cold feet and just bought the ResMed 12 to 24 volt converter. They are more efficient and waste less energy than using a 12 to 110 volt inverter. The main thing that made me back out was the electrical connections. I concluded they were propitiatory and I was unlikely to find plug and sockets that were compatible. We also use two machines, one is the S9, and the other the A10. The S9 uses an unusual shielded connection and three pins inside. Not sure what the third pin is for... The A10 uses a single pin and outer shielding like a coaxial TV cable. Unusual too. They must be concerned about noise on the 24 volt power supply.

I believe Respironics have the right idea. I recall their machines run on 12 volts, and you only need a simple cable.

That is an interesting article, and I have saved the link. I do think it shows one has to be careful not to throw the baby out with the bathwater. The article raises many issues about the quality and ownership of the data, but seems to somewhat overlook that the apnea sufferer just wants a good night's sleep. I may be wrong in this, but my understanding of the ResMed system of handling data is that they only get the basic summary/compliance data wirelessly and only on the newer A10 series of machines. The detailed data is only stored on the SD card. They can read it with their Rescan software, if you bring the card in. Not sure if they can read it remotely over the internet. The point is that they are not seeing much. And the worst thing is that on the S9 for example it only saves a week or two of detailed data and then it starts to overwrite, so it is gone, gone, lost forever. The A10 keeps the data longer, but if you were to lose or format the SD card, then it would be toast too.