Sierra

Good to hear you got a new machine. The AirSense 10 AutoSet is a good machine, but it needs some setup to maximize the comfort. First off, it sounds like your minimum pressure is too low if you are awake in the night and it feels like you are suffocating for air. The machine will go as low as 4 cm pressure if you do not set it higher. 4 cm can feel suffocating, especially compared to a fixed pressure machine. What pressure was your old machine set at? That will give some idea how high the minimum therapy pressure should be set.

Here is how I set this machine up for comfort. See the Comfort set up options on page 16 of this manual. To get into the Setup Menu, press and hold the lower Home key and the round set button at the same time for about 5 seconds. Use the Home key to get back to the regular menu when you are done.

• 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 (I saw from an earlier post you had EPR turned off on your old machine. 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, like you had on your old machine.)
• 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.)

That is about it for comfort. The key part for now is getting your minimum Therapy pressure right to make it comfortable. I see from an earlier post you have SleepyHead. Have you put the data in for you new machine? It will be very helpful in fully refining your machine settings after you gather a bit of experience with it. Any questions about SleepyHead, just ask.

You are at the point where it would be really helpful to look at the data in SleepyHead to see what is really happening.

Certainly something to check into. If you travel by air, you may want to look into the issues associated with that. I have seen some passengers get into difficulty getting on a flight. It may only apply when you are using oxygen from a bottle, but in that case there seems to be some obligation on the passenger to show they have enough oxygen to last for the length of the planned trip plus some margin that the airline determines. If they decide you don't have enough, you are not allowed on board. And, that may also only apply when you need oxygen all the time, not just when sleeping...

Some comments on your SleepyHead layout. I think for what I am seeing here, you would be best to show Event Flags, Pressure, Leak Rate, and Mask Pressure on one page. No need to show the rest of the graphs for now. It would also be helpful to include all the information in the Detail Bar on the left. While it is not there, I'm guessing from your Event Flags bar that OA is very low. I only see one OA event and it looks like it happened with pressure at about 7 cm. This suggests you may be able to get away with a lower pressure. It may also reduce the CA, Hypopnea, and your leak rate. And for sure lower pressure is more comfortable. I think after you gather a bit more data you may be able to reduce your max pressure to 9 cm, and increase your minimum to 8 cm. The other thing I notice is that you seem to be having more RERA events than I normally see. They do see to occur before you wake up. That is something to watch for.

The reason for setting the minimum pressure to 7 cm is so you can set the Ramp Start pressure at 7 cm. When the ramp start pressure is 7 then the EPR on Ramp Only will bring the exhale pressure down to the minimum of 4 cm. So you get the maximum inhale of 7, and minimum 4 on exhale right from the start. That should feel more comfortable. The other reason is that your machine is bringing up pressure fairly quickly after the ramp is over. You may as well get it up a little higher sooner. It may avoid some apnea events. And, with the ramp set to Auto, the ramp period will only last until you go to sleep. If you are slow going to sleep then it lasts longer.

I see you are waking up at maximum pressure or close to it. The next step may be to lower max pressure some if you can get away with it lower, without AHI going up.

On the mask leaking, one of the things I do is use a satin pillow protector. I think it lets my head and headgear slip around better without pulling the mask part off my nose and causing a leak. The other thing I do is try to sleep with my head on the bottom corner of the pillow so the mask kind of sticks out from the edge of the pillow. When I roll over, I go to the other side bottom corner. Which version of the DreamWear are you using? Nasal pillow, or nasal? I think they include or sell covers for the side tubes as options. I think they are intended to prevent marks on the face, but perhaps they might let the mask slide easier on the pillow without dislodging it.

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.