Sierra

I think you are getting closer to some good settings. From where you are now I would make the following changes.

• Increase the minimum pressure to 7 cm (I think currently at 6 cm)
• Ramp Time: Auto (You currently seem to have it in a timed ramp)
• Ramp Start Pressure: 7 cm (Currently it looks like it is set at the default 4 cm, which is low)
• EPR Level: 3 (your current setting I think, but just check it)

Those settings should improve your comfort level in going to sleep.

You may be getting some mouth leaks. However many of them look like the mask is moving around and leaking for short periods of time. At 23:20 and 1:40 there are what looks like a mouth leak. They tend to be longer and have flat tops. You might want to try 3 pieces of tape vertically if it is only 1/2" wide to see if that helps. I use one horizontal piece of tape, but it is 1" wide. You are not getting too many leaks over 25, so overall it is not real bad. It may be affecting your AHI some, and your sleep quality some. I have forgotten. What exact mask are you using?

Is the machine in Auto mode, and you are just changing the Maximum pressure? If so that may help. The low CA index is a good sign. More pressure usually helps with obstructive apnea. Do you have EPR turned on? It usually helps to have EPR on Ramp Only. Otherwise it may make more pressure necessary to control obstructive apnea.

The tape I use is the one recommended by the dentist in the video. It is a 1" wide 3M Nexcare Gentle Paper tape. I buy it at Walmart for about $2.50 a roll in Canada.

My thinking is that if these central events that don't let you get to sleep occur when you are not using the machine, then it is probably not an issue with the machine. If it only happens when you are using the machine, then there may be some options to fix it. It will depend on what machine you have and how it is set up.

The AutoSet 10 has some built in capability to view data. If you go to the User Menu and look at the Sleep Report menu, near the bottom there may be some more detailed AHI data and breakdown for you to view. If it is not there, then you can go into the Clinical Menu and make a small setting change that will let you view more detailed data. Hold the Home key and round set button in at the same time for about 5 seconds. This will bring up the to Clinical Menu. When you go into it, then go down near the bottom to the Options section. There will be a setting called Essentials. Go into that by pressing the round button, and then change it to Plus. Go out by pressing the home key and then select return to user menu. Now when you go into your User Menu sleep report you should see more detail. You can set the report for 1 day, 1 week, 1 month, 1 year, and then see what your results average over that time. By comparing your 1 week data to the 1 year data, you should get some idea what has changed. Look for changes in obstructive apnea, and central apnea. No where near as useful as SleepyHead, but it may give you some idea what is going on, and what has changed.

SleepyHead is very revealing. You should be able to see where you were in the past, and where you are now. There are small portable memory card readers that fit into a USB port that are not expensive. See this one at Walmart. Any place that sells computer equipment should have them.

By either looking at your data in SleepyHead or by taking your SD card to your sleep clinic, you need to find out what is going on.

I have what sounds like similar nasal congestion issues. It gets worse when I get a cold, but it is always there. I am not a medical professional, just a CPAP user, but here is how I have addressed it. When I am getting ready for bed, I blow my nose to make sure it is clear. If there is a congested side I will use one squirt in that nostril only of Walmart generic Otrivin (xylometazoline). I try not to use the nasal spray in both nostrils or every night as I understand this drug will create a rebound effect, and if used too often it will actually make congestion worse. I read an article by a sleep doctor that recommended the use of a corticosteroid nasal spray intended for allergies. I tried Nasacort 24 hour, and never noticed any improvement so discontinued use of it.

For a mask I now use the ResMed AirFit P10 nasal pillow type. I tried the AirFit F20 full face but could not sleep with it due to leaks blowing in my eyes, and nose irritation. I also would breath through my mouth and wake up with a dry sore throat, even though I have a heated hose and humidifier. For a few months now I have been using mouth taping with my nasal pillow mask to solve the mouth leak problem. My wife thought I was crazy, but she finally admitted she also had a mouth leaking problem and tried the mouth taping too. She is now also sold on it. Leaks are way down, and her AHI is also significantly down. My theory is that with mouth taping and a nasal pillow type mask, your nose essentially is forced to stay clear all night, and that is my experience. Yes, when I wake up one nostril may be plugged, but of course the other is open. It seems to make no difference breathing through one nostril. The amount of air we breathe once we relax and go to sleep is much lower than during the day or when doing exercise.

I have heard stories from others about having to go to a full face mask when they get a cold. So far that has not been the case for me. I have the F20 mask in my closet collecting dust, but so far have never been forced to use it.

Hope that helps some,

So first of all your apnea with an AHI diagnosis of 18 is at the lower end of the moderate range for apnea. Many of us are much higher, my wife at 80+, and myself at 37. While there is not a direct relationship, generally a lower AHI will need a lower pressure and will be easier to correct. That assumes there are no central apneas of significance. Central apnea can be more difficult.

Choosing a mask can be difficult, and a full face generally is more difficult than a nasal, or nasal pillow. The down side of the nasal type is that if you open your mouth in the night, it will show up as a large leak, and will most likely cause a sore/dry throat. Treatment can be compromised too. Most if they have that issue are directed toward a full face mask as a solution. The other alternative which both myself and my wife use is mouth taping. It is not nearly so bad as it sounds.

There are probably hundreds of different masks. I use the ResMed AirFit P10 nasal pillow, and like it except for the flimsy straps. I switch positions from left side to right side to back several times a night, and it works. My wife uses a F&P Brevida nasal pillow and gets good results. The new Respironics DreamWear mask system looks interesting. The same headgear will accept a nasal pillow, nasal, and minimum contact full face insert. It would minimize the cost of switching types if one does not work out. The nasal and nasal pillow are very similar with one on the nose and the other into the nose some. Just a guess but I would expect the nasal pillow one to be a little more stable. I have no experience with any of them.

Your ResMed AirSense 10 is a good machine if it is the AutoSet model. Who will be setting it up for you? The Doctor? I think the most important thing to use in the setup for maximum comfort is the Auto Ramp feature, and a high enough Ramp Start pressure. About 7 cm should be comfortable. By default the machine will start at 4 cm which can feel suffocating. I also like to use the EPR feature set at 3 cm and for Ramp Only mode. This makes it more comfortable to go to sleep but does reduce therapy effectiveness after you go to sleep. You may have seen the link before but just in case here is a link to the technical manual for the AirSense 10 machines. Even if your doctor is going to do the setup the manual is a good read so you understand how it works and what it is capable of doing.

As far as tips on getting started, I would make sure to use the machine for at least an hour or so while watching TV or reading a book, before you actually try to sleep with it. You do have to make friends with your mask and machine so you are comfortable using it when sleeping...

Without more information I would be just guessing. But if those readings are real, they are too high. Your best bet is to download a free software program called SleepyHead and look at the results on your computer. If there has been a SD card in it, there should be a lot of historic data on the card. Here is a link to a basic guide to SleepyHead. You need a Mac or PC, and a SD card reader to use the software.

If you wish to, you can post a Daily Report screenshot from SleepyHead here for comments.

What do you mean by COA?