Sierra

My very first CPAP mask about 5 years ago was the ResMed AirFit P10 Nasal Pillow type. I really liked that it was so quiet and minimal in shape. However, I found the headgear was terrible. It would not stay on my head. It was hard to adjust. And it leaked a lot. After trying different masks I could not find one as good, and I finally modified my P10 by fitting it with a Swift FX Headgear as described here. That worked much better and it served me well for nearly 5 years. But, my original P10 mask was starting to get tired, and it even plugged up as described here. So, I decided it was finally time to get a new mask. I bought the new complete P10 with the new improved QuickFit headgear. While it was tempting to modify it to be used with my Swift FX headgear, I decided to try it as is first to see how good the new headgear was.

I have used it just as it came out of the box for two nights now, and so far this is a major improvement over the original headgear. It stays on my head, and my leaks so far have been lower than I was getting with my modified headgear. See the OSCAR screenshot from last night below. The hose did pull apart once at the connection to the heated hose. I had that issue before with the old mask, and had put a few wraps of Scotch Magic tape to build up the diameter of the hose fitting. If this keeps happening I will have to do that with the new one.

In any case I can now fully recommend this mask. In the past I have always said it was a great mask but had terrible headgear. Now they have improved the headgear it is a complete all around good mask. You do have to keep the vent screen clean though. I have retired my P10-Swift combo mask now but will keep it as a spare just in case....

I do not have experience with that particular mask. However, it sounds like you have switched masks with no change to the sound. It would seem possible the sound is coming from somewhere else other than the mask. A leak in the hose? From the A10 machine? Have you changed the inlet filter in the machine lately? Are the seals between the water reservoir and the machine in good condition? I have found that the water reservoir has to be firmly pushed into the machine to make it seal. Do you have an older machine to try instead of the A10?

My thoughts would be to try to get the DreamStation working better in APAP mode first to figure out what pressures may be best to try in fixed pressure CPAP mode. I am more familiar with the ResMed than the DreamStation but with the ResMed you just set the mode to CPAP and then it operates with a fixed pressure. But yes setting the machine in APAP mode would just mean setting the min and max pressures the same or very close. I would try 3 cm with Flex first and see how that works. But, at the end of the day it is hard to predict what works, and it is really a trial and error thing. But, I would only change one thing at a time and it takes probably a minimum of a week to see what the outcome is. That is why I went down the road of narrowing down the pressure in APAP mode first and then going to fixed CPAP. OSCAR is extremely helpful in determining how things are working.

You would be best to look at your detailed data with OSCAR. The rules of thumb you mention are generally right. I have found to avoid central apnea events I keep the pressure as low as possible without seeing a sharp increase in obstructive events. I get both but my central events are still two thirds of the total. I have switched to fixed CPAP pressure at 11 cm after experimenting with different pressures. I have also found that increasing my EPR on a ResMed has reduced my hypopnea events significantly. I used to average over 2 for AHI but now average less than 1.

If your pressure support was only set at 2 cm, and your IPAP pressures are less than 20 cm, then a standard APAP should be able to do just as well as a BiPAP. The main differences between a BiPAP and an APAP is that the BiPAP can go higher than 3 cm for pressure support (EPR or FLEX), and they can go up to 25 cm of IPAP pressure.

This said a DreamStation will be a bit different than a ResMed. If you download OSCAR, to view your readings on the SD card you will be able to see what the DreamStation is doing during the night.

BiPaps use a bit different terminology than an APAP. EPAP is an exhale pressure and pressure support is the amount that inhale or IPAP is higher than exhale. With an APAP you set the IPAP and then Flex determines how much the exhale is reduced. So you may want to try the DreamSation set at 13 and 17 cm with Flex at 2 cm.

Another option would be to find a mask that does not use magnetic closures.

You may want to try a nasal pillow type mask if you are able to use that type. Also check to see if your EPR (ResMed) or Flex (DreamStation) is on and set to 3 cm.

What brand and model of mask do you have. I was not aware of a mask that has a flap in the mask that regulates air flow.

It is surprising that the Hypopnea Index is so high. I think that would suggest there may be a flow resistance issue. BiLevels can treat that, but not the Central Apnea.