Sierra

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.

It would be best to paste a screenshot here, so I could look at what your are looking at. On a PC just press F12 and a window will pop up in the bottom right showing where the image file has been saved. With Windows Explorer, just left click on it, and drag it to the body of a message. Then it will upload to this site. Use the Write a Reply Button at the very bottom of this thread so you get a full screen width for the image to display.

If you are looking at the list of events on the left then the number in brackets is the length of the event in seconds. It takes a minimum of 10 seconds to make it an event, so the number should be 10 or more.

Looks like you figured it out. The Home key is the big wide rectangular one near the bottom front.

See this link. There is a media screen where you can switch the views between the three different mask types.

DreamWear System

I have found the ResMed AirFit P10 stays on my face the best when I put a chin strap over top of it. The F&P Brevida is the second best I have tried. I have not tried the DreamWear masks.

Generally a cervical collar is most helpful in resolving clusters of obstructive apnea events which occur due to a "contorted" neck position. The collar tends to correct that. I'm not sure how it would prevent mouth leaks though.

To see how the EPR is set up it is easiest to go into the Clinical Setup Menu. Just press and hold the Home button and the round Set knob for about 5 seconds. This will bring up the option to go into the Clinical Menu. Just press the Set knob and rotate it to go up and down the menu like the standard user menu. In the Comfort section you will find how the EPR is set up, and the ramp as well. If you could post back what you see in the comfort section for settings I can give you a better idea if there is any opportunity for improvement. To get out of the Clinical Menu just press the Home key only, and then select go back to the User Menu.

There is always one thing that seems to be common with dogs on the bed. They only want to sleep in one spot -- the same one that you want to sleep in!

Here are some links to SleepyHead. You need a Mac or PC to run the free software, and a SD card reader to get the data from your machine SD card to your computer.

Download

Basic Manual

I have not used the Oximeters, so perhaps others could help you there. Here is the screen that SleepyHead displays which give some models that are compatible with SleepyHead data import.

From your sleep tests it sounds like you really do not need a lot of pressure to address your obstructive apnea. You may need more for the RERA events. Again SleepyHead should be helpful in identifying what your specific issues are.

As far as repeat sleep tests, I think the need for them are minimized by monitoring yourself with SleepyHead, and only going for repeat tests when/if issues are not being resolved. My wife has been on a APAP for 4 years now and has never had another sleep test after the one at home for diagnosis.