Sierra

I may not have explained the logic in setting the pressure support to zero, and potentially reducing EPAP pressure. The thinking is that the minimum of EPAP and IPAP can be responsible for obstructive apnea events. And at the same time the highest pressure of the IPAP can be responsible for creating central events. With a pressure split between the IPAP and EPAP you can get the worst of both worlds -- more obstructive events and more central events. I hope that makes some sense... If not just ask.

There are other reasons to have a larger split between IPAP and EPAP that might outweigh these issues in some individuals that are having trouble breathing. It does not look like that would be the case for you, so lets leave that aside for now.

You should first figure out what machine you really have. The model number and name should be underneath on the bottom of the machine. Dump the water out of the humidifier before you turn it over though! Here is a link that identifies the models. In short if number after the DSX is 200 it is the basic CPAP, 400 the CPAP Pro, and 500 the Auto machine.

There will be no point in using SleepyHead with the DSX200 as it does not save detailed data. I believe the other two models do save detailed data and should work fine with SleepyHead. Here are some links:

SleepyHead Download

SleepyHead Basic Manual

To use SleepyHead you need a PC or Mac and a SD card reader. If you do not have a reader, a portable one that plugs into the USB port are quite cheap at places like Walmart.

Getting AHI under 5 is the normal goal for good treatment. However, many get quite a bit lower than that.

Yes, that is about what I would have expected. Centrals are down, while obstructives are still not that bad. My comments would be the same. If it were me I would first try setting pressure support to zero. And if that is not enough then start lowering IPAP Max. I suspect with some adjustments a setup can be achieved that will work at both elevations.

Keep in mind I am not a medical professional. I have no sleep clinic to depend on, so what I know comes from what I have tried myself, and what worked for me.

That looks pretty good. I would suggest one more layout change. Slide the bar up on the right so the Pressure, Mask Pressure, Flow Rate, Minute Vent., Flow Limit., and Leak Rate show on the screen. You can change the order by left clicking on the title of the graph and then drag it up or down. Clicking and dragging on the gray dividing lines between the graphs can make individual graphs bigger or smaller.

From what I can see your leaks are fine, and your pressures are not all that high. Your obstructive apnea is low, suggesting you do not need more pressure. Your central apnea index is very high though, which suggests less pressure is needed. The machine as it is set up is not behaving much different than a AirSense 10 AutoSet with EPR turned on. The only difference is that your pressure support is 4 cm and the maximum EPR on an AutoSet is 3 cm. Pressure support and EPR are both simply the difference between inhale pressure (IPAP) and exhale pressure (EPAP).

Are you planning to try to adjust and improve the setup yourself, or are you going to ask the clinic to adjust it for you. My initial thought if you were going to adjust it yourself would be to set the pressure support to zero. That alone may help quite a bit. Central apnea often can be aggravated by higher pressure. Reducing pressure support should reduce pressure. If that helps but is not enough to bring down the centrals to an acceptable level, then I would next start to reduce the Maximum IPAP. While making these changes you will want to watch the obstructive apnea index. Reducing pressure support should not hurt it. But reducing IPAP may eventually cause it to come up, and there can be a trade off point where reduced centrals are being offset with increased obstructives.

If you are going to make these changes yourself here is a video on how to get into the clinical menu to do it. It is for an AirSense, but the AirCurve should be very similar. The menu choices will be slightly different. The only setting you would want to change initially would be Pressure Support, and then perhaps later Max IPAP if necessary.

If you are going to have a clinic do it, I would just ask if you can try no pressure support, and if that does not help, then reduced IPAP.

If you can post this same graph with the graphs I listed above showing, I can give you a better idea as to what the IPAP may have to be reduced to. While my AHI were not as high as yours, I live at 2000 feet, and I have had central apnea issues. I was able to improve AHI a lot by turning off EPR which is essentially the same as PS, and by reducing pressures, in my case from a maximum of 15 cm to around 11 cm. I have a feeling you may be able to reduce pressures down into the 8-9 cm range. But, the proof is always in the pudding. One has to try it to see what it actually does.

The full units of pressure are cm of water. Many get lazy and just say cm. Google tells me that a professional trumpet player can blow about 130 cm of water pressure. An APAP like AirSense 10 produces a minimum of 4 cm of pressure to a maximum of 20. It is a very low pressure. Don't hire a trumpet player to fill in if your APAP breaks down...

It is recommended to clean your mask daily by just wiping with soap and water. ResMed sells special wipes, but I think they are unnecessary. I have a full container of them that came with my package and I have never used them. The hose, and humidifier is generally recommended to clean weekly, but I suspect many of us stretch that a bit.

The For Her version should be the same price as the standard AutoSet on line. I would look for a package that includes a heated ClimateLine hose. It is not essential, but nice to have. If you are going to set up your own machine I would highly recommend using SleepyHead to monitor your results. The initial settings are not that difficult. Out of the box it will be set to a minimum of 4 cm and max of 20 cm. Not a good idea to leave it with those settings. Based on your low AHI I would suggest a minimum of 6 cm and max of 10 cm, along with the comfort settings I gave you above. With a week or so of using it, you most likely could reduce that maximum pressure limit. Keep in mind that the machine will only go there if it sees apnea events. SleepyHead will tell you exactly where the machine takes the pressure through the night.

Based on all your symptoms, I hope you can get the For Her version of the AirSense 10. That mode could work well for you.

When you set the Ramp to Auto it essentially holds the pressure at the Start Pressure until it detects you have gone to sleep. When you go to sleep it then ramps up to the Minimum Pressure. One of your issue may be that you do not need a lot of pressure. You cannot set the Start Pressure any higher than the minimum pressure. I would discuss the setup with the clinic and try to get them to put the minimum at no less than 6 cm at least as a first try. If they put the minimum at 4 cm that can feel a little suffocating. When you use the Auto Ramp it also makes sense to turn the EPR on, set the type to Ramp Only, and set EPR to 3. That way it will cut the pressure back on exhale while you are awake. That makes breathing easier. For example with a start pressure of 6 cm it will cut back to the machine minimum of 4 cm on exhale, and still give you 6 cm on inhale. Hope that makes sense.

Cleaning is no big deal. I use pure household vinegar to clean the mask, hose, and humidifier tank. Then I follow that with Dawn dish detergent and water to get rid of all the vinegar. Last is a clear water rinse and then hang to dry, except for the humidifier, which you just need to refill with demineralized or distilled water.

As a matter of interest, I have the ResMed AirSense 10 AutoSet, with all the bells and whistles. However after 9 months of use I have found I can achieve better results in simple fixed pressure CPAP mode. That may not be true for everybody, but in my case with mixed central and obstructive apnea, the fixed mode seems to give better AHI and at a lower pressure. The only issue with your machine is that you cannot view the data to help optimize the results. About the only way, besides going back to the clinic for repeat titration sleep studies, is to just try it at a little lower pressure and then at a little higher to see what gives you the best AHI. If you do try that I would suggest a minimum of one week at each pressure your try (unless it is giving very bad results). AHI is always quite variable from night to night, so it can be very misleading to base any judgement on one or two nights results.

There are some comfort settings you can make that may help in getting used to the machine and getting to sleep each night. To do it all, you have to go into the Clinical Menu. Here is link to a video that shows you how to do it. Scroll down to the Comfort section and make these settings:

• Ramp Time: Auto
• Start Pressure: 7 cm
• EPR: On
• EPR Type: Ramp Only
• EPR Level: 3

These settings should give you a comfortable breathing pressure while you are awake and going to sleep. If you feel short of air, you can increase the Start Pressure some. However, you cannot set it above your therapy pressure of 12 cm. 7-8 cm should feel comfortable for most. The machine will stay at this pressure until you fall asleep. Then it will ramp up to your 12 cm pressure and discontinue the EPR. The EPR is good to have on when you are awake, but it can compromise treatment so it is better to have it off when you are sleeping.

I should have posted a "before" picture as well as a current one. Here is what my results looked like at about my 3rd week into this CPAP thing. This one is in auto mode with EPR on, and pressures running up to 15 cm. At least on this one leaks were good!