Sierra

For someone without apnea issues, it certainly would be easy to fake obstructive events, if that is what you mean. You just hold your breath for more than 10 seconds. My wife seems to think her "yoga breathing" which is just holding your breath for about 15 seconds three times in a row helps her get back to sleep. Not sure it really does, but for sure it blows her obstructive apnea score up. When I look at her SleepyHead results I can pick up her yoga breathing up very easily.

The risk reduction is likely lower when you start with a lower AHI. But the pressure require and resulting discomfort is likely lower too. I am not aware of any significant risks of apnea treatment, although I have heard of some getting their nose hairs smoked!

Not a medical professional, but I suspect CPAP treatment has little opportunity to delay or enable apnea development. Treatment is likely to reduce adverse effects of apnea though.

I presume the OP meant AHI (not HSI) when she quoted a diagnosis of 7. Doesn't an AHI >5 qualify as the minimum needed for a CPAP in the US?

I try to do 1 hour of cardio exercise per day. I noticed some years ago that my heart rate would reach a certain level and then kind of go wacky - much higher than normal. I talked to my doctor about it and he arranged for a 24 hour Holter test which measures ECG. It came back with slight indications of increased heart rate at times, but he said that it was normal and nothing to be concerned about. I also complained that my resting heart rate seemed higher than it should be. In any case the end result is he changed my blood pressure meds from a ACE inhibitor plus a diuretic to a ACE inhibitor plus a beta blocker. I got a 10% reduction in blood pressure and about 20% reduction in heart rate. Since that time I have become convinced that the exercise machines at the gym I use were not reliable in reporting heart rate. These machines have been replaced and I now never get any indication of wacky heart rates.

Since going on CPAP I have been having some issues with central apnea. I started to get suspicious of the beta blocker possibly being a contributor. I convinced my doctor to cut the dose in half, and things seem to have improved a bit.

I don't think you are being overly cautious. Have you been using a CPAP? Is your AHI good now? Some can suffer from a condition called Upper Airway Resistance Syndrome. Here is a link that has more info on it.

UARS - Stanford Health Care

It may not show up as a high AHI number, but if it is measured and reported in a sleep study, the RDI can be high. A CPAP can be helpful in treating the condition.

OK, that helps a lot. Here are my revised suggested settings. Here is a link to a video that shows you how to get into the Clinical Menu to make these settings. The video is very good with a few exceptions. He recommends to use EPR full time, and I can't agree with that. As suggested below I would set it at Ramp Only. He also skips over increasing the Ramp Start pressure which I also think is important.

ResMed AirSense 10 AutoSet Setup

• Maximum Pressure: 20 cm (that is the default and based on your old machine settings probably OK for now)
• Minimum Pressure: 10 cm (I suggest this based on your old machine at 15 in fixed mode. With some review in SleepyHead you will likely have to increase that more, but 10 should be OK for now)
• Ramp Time: Auto (This will hold the machine at the start pressure until you go to sleep)
• Start Pressure: 8 cm (You can adjust this pressure to what feels comfortable to you and lets you breathe very free and easy while you are awake. I would not go below 7 cm though.)
• EPR: On
• EPR Type: Ramp Only (With the Ramp Only setting it will only be on before you go to sleep for maximum comfort. After you go to sleep it will turn off and provide better therapy.)
• EPR Level: 3
• Climate Control: Auto (providing you have the heated hose)
• Tube Temperature: 27 C

A little further down on the setup menu under Options you will find this item:

• Essentials: Plus (Setting it to Plus will give you more options on your User Menu, and a more detailed Sleep Report.)

I make these suggestions based on you feeling comfortable adjusting the machine. If you do not, then for sure see a sleep technician and get them to make the changes for you.

Joe, what was your set pressure on the old machine? That would give me a better idea on what to advise you for comfort settings. To make the changes you likely need will require going into the set up menu. Are you OK with that?

Some other thoughts. All the AirSense 10 machines come with a heated humidifier. However, the heated ClimateLine hose is often an option. If you do not have the heated hose, you may want to consider getting one. It allows the automatic operation of the humidifier to give you the most humidification while preventing condensation inside the hose. It is reported that maintaining high humidity can reduce sinus issues. Another option the AirSense 10 has is a preheating mode. With the user menu you can initiate a preheating mode that brings your humidifier up to temperature before you go to bed, as long as it has 15 minutes or so to work.

Another issue is your mask. What type are you using? If you are using a nasal mask, or nasal pillow you can open your mouth in the night. Air escapes out of your mouth and you wake up with a dry mouth and sore throat. Some tape their mouths closed to prevent mouth leakage when using a nasal type mask. Using a full face mask is the other option, but with it you can still mouth breath and wake up with a dry mouth and sore throat.

The CPAP draws fresh air in from your room through a filter on the left side of the machine. It is compressed to provide the therapy pressure, and flows out through the humidifier to pick up moisture. The air then is supplied to the mask through a hose. Generally right at the mask there is a vent. Air continually flows out of that vent when you are breathing in and out. The air flow never reverses in the hose, so any contamination in your breath does not go back into the machine. The mask itself can get contaminated from your breath of course. But, essentially you are the only source of contamination, providing the air in your room and water in the humidifier are not contaminated. I'm not a medical professional, but I think that it is not possible to get a cold or the flu from yourself. You would already have it, and once you get over it, you are highly unlikely to get sick from the same virus again. So, despite the endless SoClean adverts on TV, I am not convinced that a CPAP machine is any kind of health risk given reasonable care.

I use undiluted vinegar to disinfect my mask and hose. I use vinegar first, then Dawn dish soap with water, and then a final rinse with water. I also clean out the humidifier reservoir using the same sequence. The vinegar is very good at removing any deposits which may accumulate over time.

This all said, a CPAP does pressurize your nose and throat. Your ear and sinuses are connected to your nose and throat, and gets pressurized to some extent as well. This can cause some some temporary discomfort in some people. If you are having this issue, you may want to see an ENT specialist for an opinion.

The short answer in my opinion is that with reasonable care and cleaning the CPAP machine should not cause flu and colds.

A setting of 10 is moderate. The machine is capable of going from 4 cm to 20 cm. I am now using a pressure of 11 cm. If you are going to run the machine in the For Her Auto Mode, and your recommended fixed pressure is 10 cm, I would set the minimum pressure to 8 cm, and the maximum to 11 cm as a starting point. Then after some experience with that setting and using SleepyHead to monitor the results, you can either refine those pressures, or go to a fixed pressure based on actual experience with the machine. Here is a cut and paste copy of what I gave another user of the ResMed for initial setup for comfort.

• Ramp Time: Auto (This will hold the machine at the start pressure until you go to sleep)
• Start Pressure: 7 cm or more (I would not set it at less than 7 cm unless your minimum pressure has to be less than 7 cm. You can't set Start Pressure higher than your minimum pressure. I adjust this pressure even higher to give me a feeling that there is no mask on my face at all. This pressure should be high enough that breathing is very free and easy)
• EPR: On
• EPR Type: Ramp Only (The purpose of Ramp Only is to give more comfort while going to sleep and a more effective therapy pressure after you go to sleep)
• EPR Level: 3
• Climate Control: Auto (providing you have the heated hose)
• Tube Temperature: 27 C

A little further down on the setup menu under Options you will find this item:

• Essentials: Plus (Setting it to Plus will give you more options on your User Menu, and a more detailed Sleep Report.)

If the issue of apnea events right as you go to sleep is not solved by this, there are other options. But I would start with this.

Sorry, but I missed this post. The difference between a central hypopnea and an obstructive hypopnea is the breathing effort. With obstructive hypopnea there is normal or even increased breathing effort but reduced flow due to a partial obstruction in the airway. With a central hypopnea there is simply reduced effort to breathe with no obstruction. With central apnea it is quite common for breathing effort to go in waxing and waning cycles. Your body is having trouble with the control system which is designed to keep oxygen and CO2 levels relatively constant. If this reduced breathing effort continues for longer than 10 seconds with flow less than 50% it gets flagged as a hypopnea event. The machine however has no way to distinguish if it is due to reduced effort or due to obstruction, so it just says hypopnea.

Here is a link to the technical manual for the AirSense 10 AutoSet. It gives you a better idea what it can do than the sales promo materials. The main difference between it and the DreamStation Auto is that with the ResMed you can set EPR to the Ramp Only part of the night, which is nice. The DreamStation uses a bit different algorithm for adjusting pressure in Auto mode. It tends to adjust pressure up and down a lot at night, where the ResMed keeps pressure more uniform. Other than that, they are pretty much the same.