Sierra

I don't think the noise is a leak issue. Those that complain about it seem to attribute it to velocity/noise in the side tubes. As for the intentional venting, that is normally based on the dead space the mask itself has. There should be no need for additional venting from the mask. But the bottom line is that the mask does not have to please everybody, just you! It seems that users all get to something that works for them, and that is a good thing.

Welcome to the forum. I certainly was anxious and suffered for it when I started using the CPAP. I suspect it is fairly normal. That said, there are a few things that may help some. The default minimum pressure on these things is 4 cm. That is quite low, and can be uncomfortable for going to sleep. If you have not picked up the machine yet, I would ask them to set up the minimum to about 7 cm if they are agreeable given your degree of apnea. The other thing to do is try using the machine and mask while watching TV. This will give you some time to get used to it, rather than trying it for the first time at bedtime. Hope that helps some.

With the minimum set for 6 cm, you could use the settings I posted above for the Auto Ramp mode. Just change the Ramp Start to 6 cm. If you can post some examples with the new comfort settings and the SleepyHead format changes it would be helpful.

Other options you might want to try for your husband is a chin strap and/or mouth taping. But if he is claustrophobic that might not work either. The Breathewear Halo is the best chin strap I have found.

The normal first step is to do a quiz to determine your risk for apnea, and if that is high, then do an actual sleep test. Here is a link to the quiz they do. Your doctor should have the forms also. The three tests are; STOP, BANG, and Epworth.

Sleep Apnea Screening Quiz

I noticed something funny going on with the forum last night. Your whole thread seemed to disappear for a while. I think it may have something to do with their spam prevention when newer users try to upload multiple images. I think they may go into a time delay as you suspect.

In the bottom left of the graph area there are two boxes; Flags, and Possibly CSR. If you click on the right box you can turn the flags to be displayed on (green) and off (red). You may have inadvertently turned off the flags for central events. You can get a bit better layout of the screens by clicking on the black triangle beside the date to hide the full month calendar. And if you go to File, Preferences, Appearance, and then uncheck the "show events pie chart" box to hide that too. It covers up more important information. Last if you click on the Details tab it will let more important information show.

Based on your chart posted, it looks to me that you have a lower minimum than 8 cm? It should be shown in the Details area. With the minimum lower than 8, I would have to rethink the settings for comfort that I posted above. The issue is that you can't set the Start Pressure for the ramp higher than the minimum.

You can also scrunch the graphs a bit by clicking and dragging on the grey dividing lines. If you click and drag on the title of the graph you can rearrange them. It would be helpful to see the snore and flow limitation graph, if you can drag them up. Your machine seems to be responding to events that are not being flagged. I'm thinking it must be snore and/or flow limitation.

It always confuses things when you make a bunch of changes at once. For now my suggestion would be to try and improve the comfort factor, and leave the therapy pressures alone. You also may want to consult with your sleep clinic before changing the therapy pressures. To improve the comfort I would make the following changes first and then monitor what happens with SleepyHead for a few days before doing anything else. Apnea is never consistent from night to night, and you don't want to base changes on one night's experience. In order they occur in the clinical menu I would do the following to sort out your EPR issue. This is on the understanding your current therapy pressures are 6 minimum and 10 maximum.

• Ramp Time: Auto (This will bring up the next setting for Start Pressure)
• Start Pressure: 6 cm
• EPR: On (No change as you already have it on)
• EPR Type: Ramp Only
• EPR Level: 3 (your current setting)

That is the only change for now. The machine with these settings will go up to 6 cm (Start Pressure) on inhale, and down to 4 cm on exhale, during the ramp period only. This should feel quite similar to what you have now. When the machine detects you are asleep, the ramp ends, it will stop the EPR, and it will go to your current minimum pressure of 6 cm for inhale and exhale. Without the EPR on during sleep I would expect the machine in Auto will not try to raise the pressure as much, and you may end up with pressures nearer 8 cm than 10 cm. That should be more comfortable, and your apena events should be about the same. But, you will need a few nights to determine that.

Hope that helps some. Here is a link to a technical manual on the machine that you can use for reference. It is a good idea to save this as a PDF for future reference.

AirSense Technical Manual

With the additional info you provided that your minimum is 6 cm, I edited the above to suit.

With mixed central and obstructive apnea I think it makes some sense to try and balance the obstructive to central if you can't get central to zero with lower pressure. As you lower pressure you tend to get more obstructive and less central. If you can get to zero central with obstructive OK, then that is usually a good point to settle on. Cranking up pressure is almost always bad for central apnea issues. One of the things I monitor in SleepyHead is total time in apnea. I try to minimize that number rather than just focus on the AHI.

I am not a medical professional and I have no personal experience with PLMD. With respect to the apnea it is fairly normal to have more events when sleeping on the back. It is just a gravity thing with the tissue that is blocking the airway. However, the difference between 40 back and 0 side seems extreme. I have heard of the tennis ball trick, but it sounds like torture to me. Has he tried a CPAP? If nothing else a CPAP will almost always stop all snoring.

Interesting that the Response is set on Soft. You are the first one that I have been aware of that has used it. It just slows down the speed at which the machine increases pressure in Auto.

• The Ramp is turned off
• Your EPR is on full time and set at 3. That means when your pressure on inhale hits your maximum of 10, the EPR will be reducing that pressure by 3 cm on exhale. So you really have a 10 cm inhale and 7 cm exhale. The issue is that you can get apnea on the exhale or transition between inhale and exhale. With the EPR turned off the pressure will be the same on inhale and exhale. What I found is that when I turned EPR off then the automatic pressure would reduce by about 2 cm. In other words it took less pressure to get the same results.
• If you want I can give you what I would suggest for comfort settings. My thoughts would be to leave the treatment pressures alone and in auto until you see what changing the EPR comfort setting does.