Sierra

There are three kinds of lies; lies, damned lies, and statistics!

On a quick look here this seems to be a problem in classification. If you look at the statistics in the US for 2015, Alzheimer's is 5th.

US Statistics

Australia Statistics

What the Australia list does is subdivide categories that the US lumps together, such as cancer and cardiovascular diseases. That makes Alzheimer's jump up in the list. Either that or there is something in the Australian water!

I think you are correct in concluding that the OA events led to the CA events. And in fact the initiating disturbance may have even started well in advance of the window you show. Notice how the Minute Ventilation was already cycling compared to the right side of the chart where it has stabilized. There may have been a less than 10 second hypopnea or OA event earlier that upset the stability. You will note on the mask pressure chart a higher frequency (4 Hz I think) oscillation toward the end of an event. That is the machine inducing a flow variation to test whether the airway is open or obstructed. If obstructed the flow variation results in the pressure making a larger amplitude. If the airway is open the amplitude is reduced. The difference is not huge, but if you look close you will see it. Knowing this is helpful because the flow test starts after about 4 seconds, and if the event lasts less than 10 seconds it does not get flagged or counted. This knowledge lets you manually identify the type of events it really is even if the event is not flagged. If you scroll left you might find a short event or something else starting that cycle.

My analysis of the way to control this is a bit different though. Your effective treatment pressure for obstructive apnea may be as low as the green (EPAP) pressure. That means your first OA event in this window probably happened at as low as 5 cm pressure. This is because you are using EPR. The machine responded to bring the green EPAP up to 7 cm and the OA events stopped. This suggests 7 cm is enough to stop OA events. The peak IPAP (red) pressure hit 10 cm and the CA events started. If you set the EPR for ramp only you will not have this split in pressure. I'm thinking the machine may then bring EPAP up to 7-8 cm instead of 10 cm and at that pressure you will not get CA events. Keep in mind that is a theory and the proof is in the practice.

My thoughts remain the same. Increase minimum pressure to 7 cm, use Auto Ramp, Start pressure of 7 cm, EPR still at 3, but Ramp Only. After that, I suspect you can reduce the maximum pressure to as low as 8. But for now the 10 cm max is not hurting you as long as the machine does not try to go there in Auto. I suspect it will not based on what I see.

Keep in mind that if you just reduce maximum pressure to 9.5 and leave EPR on, that will make maximum EPAP 6.5, and that may not be enough to prevent OA events.

Apnea is normally classified using the AHI index. It is a count of the total number of obstructive and central apnea event plus the total of the hypopnea (reduced flow) events in the night divided by the hours in bed. It ends up as an events per hour number. 0-5 is considered normal, 5-15 is mild, 15-30 moderate, >30 severe.

On your questions, once you get into the routine, it might add 5 minutes getting read to go to bed. I don't wear an eye mask. I like a totally dark room.

With mild to moderate apnea you could consider a dental appliance as an alternative to a CPAP. They need to be fitted by an experienced dentist and if not covered by insurance can be expensive. A recommendation for a CPAP depends to some degree on where you live and who is paying. On a pure technical basis, I think the best choice is an auto CPAP. The two leading brands are ResMed and Respironics (DreamStation). I will admit I am bias, but of the two I believe the ResMed AirSense 10 AutoSet For Her is the best choice. If you want to know why, ask and I will explain more. The DreamStation Auto is a credible machine too if you are forced to take it. If you are a guy, and your pressure requirements are lower, the For Her version (despite some styling appearance things) is the better choice. You can turn off the For Her mode if it doesn't work for you, and the cost of both models are the same.

On thought before starting, I would thoroughly question the Sleep Clinic on what the appropriate machine is if you have any indication of central sleep apnea. It could change the best type of machine to use. Do some research on central vs obstructive sleep apnea ahead of time so you understand the implications. The other aspect is the mask. Most of the comfort issues with using a machine start with the mask. If they offer different version to try as a trial I would encourage that. There are many different masks and not one mask suits everyone.

Hope that helps some. Ask if you have more questions. It is always best to be informed going into this thing!

If your data is all trashed, you may want to make a clean start by uninstalling SleepyHead, do a download of the current version, and install it. Create a new user account. Reformat the SD card and put it in your machine. It should tell you that it is setting up the card, and I would expect give you an error message if it can't use the card. After you use the machine then take the SD card and try importing the data.

Here are some sample SleepyHead charts from my experience with CPAP. The first one was in Auto mode with pressures set at 10.4 min, and 13.6 max. EPR was in Ramp Only at 3 cm. Ramp mode was Auto with a start pressure of about 7.7. SleepyHead does not report the ramp status accurately. This was after I switched to ramp only EPR. I unfortunately had a major whoops and switched the SD card from my machine with that of my wife's, and I lost my early data. But, the pressures were running higher and results were worse with the EPR full time.

This is my sleep from last night which now is about right on with my average results. Fixed 11 cm pressure, EPR 3 Ramp Only, Auto Ramp, and a start pressure of 9 cm. More recently I have started to look at Minute Ventilation which is essentially the flow rate smoothed out a bit. It is kind of like a plot of your speed when driving in cruise control in a car. When cruise works well the speed is more constant. When it is not the speed varies up and down a lot. It becomes a bit more obvious when you zoom in. At least in my case this seems to be the root cause of my central apnea. My autonomic respiratory control system does not work well, and it works less well when the pressure is higher. It is like a control system hunting and not achieving stability. You can see now with a lower fixed pressure Minute Ventilation while still not perfectly flat, is much better.

Not saying the same will work for you, but it might. One major learning for me was that the Auto mode seems to get fooled by hypopnea. I thought when I achieved pretty good results with a fixed pressure of about 12 cm, I could improve on that by going back to Auto, setting the minimum at 12 cm, and then the maximum at 13 to give it some room to correct abnormal obstructive apena, possibly when sleeping on back. In other words have the best of both worlds of fixed pressure and some automatic control. It did not work and in fact made my AHI worse. That was the point where I decided that in Auto my machine was chasing hypopnea events that were central in origin. Of course that just increases pressure and does not make things better, it makes things worse.

One other thought. If you end up with fixed pressure working for you and you want to go with two machines, you might want to buy a fixed pressure machine like the AirSense 10 Elite. While it does fixed pressure only, it still has detailed data capability. SleepyHead can handle data from two different machines. In Canada it would not be worth it as there is only about $30 difference between the Elite and the AutoSet, but I understand there may be a much larger difference in Australia in price. Avoid the AirSense CPAP model as it does not capture any detailed data - kind of a dumb brick. Or, if it is much cheaper, you may want to forego collecting data when using the brick, and just depend on the other machine to get an idea what is going on.

Hope that helps some,

My understanding is that success with an oral device is most likely with mild apnea, and sometimes is achieved with moderate apnea. With severe apnea you may get a reduction, but not likely full relief from apnea. Just my thoughts as an observer, not a professional. Here is a link that you may find helpful. It includes a pdf document which compares the various oral devices.

Sleep Apnea Treatment Options

On your SD card, make sure the lock switch is off when it is in your machine. If that does not work, you could reformat your SD card with a computer, and then put it back in your machine. The machine should then automatically set up the card properly. Last resort get a new SD card.

Zooming in to the detail in SleepyHead can let you manually decide if events are real or not.

It is worthwhile to do a weekly clean of your mask and hose. I uses pure kitchen vinegar first, followed by water and dish detergent, an finally a rinse with water and hang up to dry. Pure vinegar is strong enough to kill any bacteria.

On the flu and pneumonia I would make sure to get your flu shots annually, and also get the pneumococcal vaccines. For the best coverage there are two of them. One is the standard pneumococcal and the other is Prevnar 13 which extends the protection more. People do not often die from the flu, but one can die from pneumonia which develops from the flu.

I did a little more digging and in the ResMed standard machines the S6 may have been the last one without automatic altitude compensation. I also recall the S7 portable did not have compensation either. Other brands may be different.

Posting photos is the same as posting a SleepyHead screen shot. I would keep them small in file size though. This site seems to do funny things when someone tries to upload several graphic files.

SleepyHead supports some O2 devices and apparantly integrates the results with CPAP results. If you click on the Oximetery Wizard Tab in the SleepyHead Welcome screen it will tell you which ones are compatible.

What would be telling at this point is the pressure the machine is going to with EPR and then without EPR. The pressure it goes to, and a result the frequency of CA events is likely to be lower when pressure is lower. SleepyHead is good for seeing that.

On a PC you just press F12 to print a screen shot which saves to a directory that will be displayed (briefly) in the bottom right of the screen. When you get that screen shot capture file just use Windows Explorer to left click on it and then drag it to the body of a message here that you are composing. Make sure you use the Write a Reply button at the bottom to start the message so you get maximum width. Some tips to get a good layout in SleepyHead:

• Click on the triangle beside the days date to hide the full month calendar display.
• I recall F10 hides the redundant menu bar on the right
• Go to File, Preferences, Appearance, and uncheck the "Show event breakdown pie chart". It is redundant too and hides more important information.
• Leave the Event Flags pinned at the top, and scrunch up the graphs a bit by clicking and dragging on the grey dividing lines. If you click and drag on the title of each graph you can reorder them.
• I think Pressure, Flow Rate, Mask Pressure, Flow Limitation, Snore, and Leak Rate are the most important if you can get them onto one page.
• The Daily report with the Detail tab on is probably the only screen you need to post at this point.
• If you have afternoon nap, or other sessions that are not helpful you can hide them and only show the real sleep session by clicking on the switch beside the Session list. Green on, Red off. Also when you do two sessions with different pressures in a night, you can show one and hide the other to see the different Statistics for each.

Hope that helps some. When thinking about it further, I suspect if you can get your pressure low enough to prevent undue CA events and minimal OA when at altitude that setting will probably be fine at Sea Level too.