Sierra

It is a very interesting OSCAR report, but I am afraid that I do not have the experience with an ASV to make any suggestions. The machine is obviously working very actively to promote regular breathing by taking pressure on inhale right up to the maximum the machine is capable of 25 cm.

Hopefully they will provide you with follow up with a sleep tech experienced in adjusting an ASV machine.

On the leaks if you are opening your mouth during sleep you can get a dry mouth if you use a full face mask. Using a nasal pillow mask and mouth taping is the best way to stop mouth breathing. The second chart you posted, right at the end of the night could be mouth breathing.

If anything a CPAP should exercise the diaphragm more as you are breathing out against a higher pressure than normal.

I have to say off the top that I am not really sure you need or will benefit from an APAP. But, since you have one, you could try these settings to see if it can be made more comfortable and possibly helpful.

Minimum Pressure at 6 cm Maximum Pressure at 7 cm Ramp Start pressure at 6 cm

I would leave the rest of the settings the same including EPR at 3 cm. These settings will reduce the pressure you are getting, and more does not appear to be needed as your main component are CA or central events where pressure is of no benefit in preventing. In fact higher pressure can cause CA events. CA events can also be restless sleep.

This is quite a low maximum pressure, but unless you start to see obstructive events showing up, there is no need for a higher pressure. Are there nights when pressure goes higher than the 8.6 cm for this night? Since it is an AirSense 11 it should have the option of the "For Her" mode. You may want to try that mode to see if makes any difference. But, don't change it at the same time as the pressure settings suggested above. You need a few nights with those settings first to get a baseline.

An ASV is the best way to treat central sleep apnea. About 2/3's of my apnea events are central but I manage to control them to a reasonable number by minimizing the pressure and putting the machine in fixed pressure mode. This keeps me at a total AHI of 0.8. I initially though I would need an ASV, but so far have made do with a APAP in CPAP mode.

From what you describe it would appear to be a defect with the machine. Flex like EPR on the ResMed machines should reduce pressure on the exhale. A higher setting means more of a reduction. A three setting should be a reduction of 3 cm of pressure on exhale.

Machines are in short supply. You may want to check into getting a special model of the AirSense 10 AutoSet. I believe it is called the C2C model and does NOT include a wireless modem so it cannot transmit data to the cloud. I find that feature of no value to me in any case. I helped another person get one in Canada recently and they were available at a very good price of $695 Cdn. The on line vendor which does not ship to the US had good stock of them.

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.