Sierra

The normal treatment objective is got AHI under 5. Most who are on CPAP try to achieve closer to 1. My wife routinely scores under 1. In other posts you have said that your AHI is mostly obstructive and you are currently on a fixed pressure of 14. Fixed pressure can work well but the pressure has to be right. Obstructive apnea is most often solved with more pressure. You kind of have two choices. One is to go back to the sleep clinic and have the titration study for pressure done again. If you are paying that can be expensive. Or you could use SleepyHead, make small pressure adjustments, and use the results in SleepyHead to guide you. You have to watch that the increased pressure do not start to create clear airway events. That is normally what is done in a lab titration study. They increase pressure while you are sleeping to see how much pressure is required to stop obstructive events and when central events start to occur. The objective is to find the minimum pressure that prevents obstructive events, and that it is low enough to avoid central events.

Your setting is right then. I have heard good things about this mask, but have no experience with it. Perhaps others could give suggestions as to how to adjust for a better fit. As I understand it this DreamWear headgear can be used with inserts that convert it from nasal to nasal pillow and to full face. Possibly the full face might work better at higher pressure, but I have no experience to suggest that. I found this document on the DreamWear Mask System but could see no mention of maximum pressures it is rated for. It does include some tips on fitting it. Also this manual for the nasal version. Still no pressure rating though.

Another possibility here is that you are opening your mouth and air is escaping out. That flat topped leak event that lasted through midnight looks like a mouth leak. I have that issue and have solved it with mouth taping. Sounds bad but really isn't. Perhaps worth a try. 25 cm of pressure might make it hard for the tape to stay in place though.

I tried the AirFit F20 (silicone material) and had similar issues to yours. I gave up on it, but since that time I have read that putting pads of just cotton t-shirt fabric under the seal portion can help. There are also commercial versions of the mask pads you can buy.

I also have issues with mixed apnea, and initially had trouble getting AHI under 5 with pressures as high as 15 cm. With various changes such as turning off EPR (like Flex on a DreamStation) I have managed to get AHI down more and pressure down. More recently I have switched to a fixed CPAP pressure of 11 cm and over 6 weeks averaged about 1.7 for AHI. My theory is that in auto mode these machines can get confused by mixed apnea and end up chasing the pressure and AHI up. So you might want to talk to your tech about trying a fixed pressure. You may have to move it around a bit to find out what pressure gives the best results.

You may want to consider downloading SleepyHead which is a free data viewing software program that can be very helpful in evaluating your results. Of your current AHI do you know what % is central and what % is obstructive? SleepHead is good at showing that, as well as at what pressure they are happening.

You should be able to pick up a card reader for as little as $5 at Walmart.

My wife uses a F&P Brevida nasal pillow mask and started mouth taping on Nov 14. See last night's results for an example. Leaks are down to essentially zero.

And she has had a signficant reduction in OA events (light blue in bar chart below) since Nov 14 as well.

My hope is that the Swift FX nasal pillow will be better still for me. It is rated up to 20 cm. But, that said it is in the mail, so I have no evidence of what it will do yet.

Your machine while it is older should be compatible with SleepyHead providing it has a SD card in it that is collecting data. SleepyHead is free, but to use it you need a PC or Mac with a SD card reader. Using it to view your current data will be helpful in determining the best new machine to get, and what the benefits may be. Here is a link to a basic manual for it.

A ramp start pressure of 4 cm is pretty low and can feel suffocating to some. A higher pressure around 7 cm can feel more comfortable. An Auto ramp is nice compared to a timed ramp. You do not have to guess how long it will take you to go to sleep, and the pressure stays fixed at a preset comfortable level rather than ramp up.

As for your current machine is it fixed pressure or auto? The reason I ask is that you may want to work on your doctor to request an auto machine. The fixed pressure CPAP machines can come in pretty dumb as a brick versions that have no data capability. Here are some links that might help identify exactly what you have. They list the current Respironics machines, plus the obsolete older ones.

CPAP - Fixed Pressure Machines

APAP - Auto Machines

You can find out from the Clinical Menu what the total machine hours are on your System One. See this video on how to find the hours on your machine. Some sources say average life of a machine is 20,000 hours but with good maintenance can last up to 50,000 hours.

As far as fixing your machine there are usually replaceable seals in the humidifier that might be the problem. Or I believe on that machine the humidifier is a separate part, so you could just replace it.

Are there more intelligent units out there? Yes, to some degree. Not totally sure what features your machine has, if it is a fixed CPAP, or an Auto, but yes there probably are machine with more bells and whistles. They have not changed in that they all pretty much deliver 4 to 20 cm of pressure, which is the core specification. If you have a fixed CPAP, there would be benefits in going to an auto machine. And if you are interested in looking at your machine data in more detail for example with SleepyHead software, the data capability of machines have improved. Old machines stored detail data for a few days. New machines can probably store closer to a year of data. And the other more controversial "improvement" has been transmission of data back home. Some consider it an invasion of privacy, and others use it. It is rather hard to turn off permanently however, as ET really likes to call home! My machine has it, but I have never signed up for the MyAir (as ResMed calls it) reporting. I think it is mainly intended to monitor compliance for those who don't own the machine and it will be taken away if they don't use it. I find the reporting to be too simplistic, and much prefer the detailed reporting of SleepyHead.

The current two most popular auto machines are the Respironics DreamStation Auto, and the ResMed AirSense 10 AutoSet, or AutoSet for Her. If you are female or use lower pressures (<12 cm) the For Her version may make better sense in the ResMed line. Even for males using lower pressure, if you are not put off by the appearance, can make some sense. The For Her is just an optional algorithm that you can use or not use. It is just one more option for treatment, and the machine also includes the standard algorithm. Just a setup change.

I think of the DreamStation vs ResMed choice the ResMed has a couple of advantages.

• The ResMed uses a different type of algorithm. It generally ratchets up pressure and holds it longer than the DreamStation which tends to bump it up faster and then back down faster. They both work, but the ResMed can give a smoother through the night pressure ride.
• The ResMed has a feature that allows you to use the EPR setting on the ramp portion only, and then have it shut off after the ramp is over. EPR is like Flex on the DreamStation, and improves comfort but during sleep hours can compromise treatment and can require a higher pressure to get the same results.
• Not sure if your machine has an auto ramp, but both the DreamStation and AirSense 10 have it. I does not ramp up the pressure, but just holds it until you go to sleep. The combination of auto ramp and ramp only EPR on the ResMed makes for a very comfortable going to sleep mode.

That is about all I can think of. If your insurance offers it at no or little cost, I would go for a new machine. What pressures are you using? If you want to post a SleepyHead daily report I can give you my opinion on how a new ResMed would act in comparison to what you have now.

Yes, those leaks look high. I like to see leaks under 25 L/min, and lower is better. SleepyHead is showing you are using a Nasal mask. Is that correct? If you machine is set to Nasal, but you are using a full face mask, that could cause the indicated leaks to be higher than they actually are. What specific mask are you using? A nasal mask may not be the best choice for a pressure of 25 cm. Here is a link to a thread from a few months back about best masks for high pressure. The consensus seemed to be that the F&P Simplus was a good one to try, but pads may be needed to get a good seal.

https://myapnea.org/forum/need-advise-on-a-mask-for-high-pressure

On the snoring, yes there is some, but not what I would consider real bad. But, if it is annoying you then it is a problem. You could try increasing EPAP 1 cm at a time to see if that helps. But, I would watch very carefully to see that clear airway events do not increase. Currently CA is not that high, so you may have room to use more EPAP pressure. The majority of your events appear to be OA. That should improve with increased EPAP.

I open my mouth as well. Another alternative to a full face mask is to tape your mouth. Surprisingly it is not as bad as it sounds, and I prefer it to wearing a full face mask. I just use 1" 3M Gentle Paper tape from Walmart. It costs $2.47 for a 10 yard roll. Here is a video explaining the benefits of mouth taping to ensure you breath through your nose.

How to Mouth Tape for a Better Sleep

In Ontario Canada, they have kind of a goofy system where you can get a home study (not sure who pays), but if it is positive then you have to go for a full in lab study before they will write a prescription. This seems to be driven by the health care plan there which pays for most of the cost of the CPAP. I suspect they want to make it difficult to get one, because they are paying.

For the OP, I suspect he was not far off the mark with the "ripped off" conclusion. That sequence of testing is the worst I have ever heard of.