Sierra

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?

I can see why you are frustrated. Can you get to sleep when you don't use a CPAP? What are the set pressures of your machine? Are you using a ramp up of the pressures or? I assume you were diagnosed with apnea after doing a sleep test? If so, what was your diagnosed AHI? What % of the AHI was central apnea? Is your CPAP reducing your AHI? Also, what specific manufacturer and model of a machine are you using? Sorry for all the questions, but I am just trying to understand the situation a little better before making any suggestions.

I think if a person is suffering from central apnea events and hypopnea events that are central in nature, there can be significant benefits to a fixed pressure mode. The Respironics and ResMed machines are smart enough to distinguish between central and obstructive full apnea events. And, they do not raise pressure in response to a central apnea event. However, I don't think either can distinguish between central (reduced breathing effort) and obstructive (flow resistance) hypopnea. As a result the machine can chase its tail and raise pressure unnecessarily. If one is sensitive to pressure that raises central events even more. In other words, the Auto is not so auto or good.

You may get a further improvement by turning off the Flex. That in turn could let you lower your pressure even more. The lower pressure is more comfortable, and may create fewer central events.

Here is a link to the full Technical Manual for the DreamStation machines. Because it covers all machines it is pretty difficult to follow. However, it should be more obvious to you when you go into the machine setup. Since you have the most basic CPAP model most of the options will simply not be there. See page 4-11 for help with the User Menus. I saw some disappointing things though. If I read it right, only the Pro and Auto models give you the AHI. I don't know how you could use and adjust a machine without knowing what results you are getting. The AHI is most basic of measure. It is the count per hour of the number of events you are having per hour. Less than 5 is considered OK. Less than 1 is ideal.

On page 8-18 the section on how to get into the clinical setup starts. I would be careful if you go in there. If you are going to make any changes make sure you write down what they were at before you made a change. The Therapy menu would be the most critical, and in the absence of any information, I would suggest you not change anything there. Possibly the only item in there is the set pressure though. For now I would focus on the Comfort Menu. See page 4-21 for more help. You should be able to turn on the SmartRamp feature. I would suggest a higher than 4 cm start pressure for the ramp. 6-7 generally feels comfortable. You will not be able to set it higher than the therapy pressure though. Since you may not be able to see AHI (unles your iPad gives it to you), I would also be careful with Flex. If you turn it on and adjust it, the AHI may suffer. So, you will want to know where you are before you make any change.

But back to your original question, the CPAP model is very basic, and if possible I would try to get the Pro or Auto version. Or the ResMed AutoSet would be good too. It lets you use the Flex (EPR) on Ramp only. The DreamStation does not appear to have the ability to do that.

Hope that helps some,

The For Her machine is the same as the standard machine and can go up to 20 cm in pressure. In the For Her mode however I believe it only goes up to 12 cm in response to apnea events.

I found this link which gives a little detail on adverse reports on the ResMed S9 machines. However, to drill down it appears you have to pay for the service.

http://fdable.com/basic_query/maude/98148749ff1d5b98bb89fc9116169525

From what I could find it seems the machine has not had any formal recall, but is susceptible to running the humidifier dry and causing a stink. I have done that on my A10. It also seems like the humidifier can be damaged by overfilling and the water causing damage to the humidifier circuitry.

You might want to call ResMed directly and complain. I believe their headquarters is in Australia. I assume off warranty, but who knows, they may be willing to do something to protect their brand reputation.

The other option is just buying a new machine of course. If you are paying for it out of pocket, I recall seeing somewhere that it may be less expensive to buy out of the US and have it shipped to Australia. I see the current price for a new AirSense 10 AutoSet is $785 US (1100 $AUD?) at Second Wind CPAP. They ship internationally. A quick check of an on line place in Australia shows $1800 AUD for the same machine.

Machines tend to be cheaper in Canada, but most dealers say they will not ship internationally. This one company I found does not rule it out. Here is the same AirSense 10 AutoSet with heated hose for $825 CDN, which I think works out to be about $870 AUD. They do not rule out international shipping as an option but shipping is not free and you have to contact them to get the cost. The For Her version is available at the same price. But, if you need more than 12 cm pressure the For Her mode will probably not work for you anyway.