Sierra

A couple of suggestions. Have you considered using SleepyHead to view your detailed machine data? It requires a machine compatible with SleepyHead (most ResMed and Phillips Respironics machines are), a PC or Mac, and a SD card reader. Some links to look at.

SleepyHead Download

SleepyHead Basic Manual

As for air leaking out of the mouth, I have had that issue too. I have doing the mouth taping trick to stop it, and it seems to work very well. Here is a video to look at on mouth taping. It is not really uncomfortable at all when you get used to doing it.

How to Get a Better Sleep with Mouth Taping

Dophin, I recall reading somewhere that the ResMed MyAir application is only available in North America. No idea if that is true or not. I am in Canada, but do not use MyAir anyway. My preference is to use the SleepyHead free software available for download. It gives you a lot better view of your machine data than MyAir does. To use it you need a PC or Mac with a SD card reader. Your machine has to be the Elite model or AutoSet to record detailed data, and of course the machine needs to have the SD card installed on it.

SleepyHead Download

SleepyHead Basic Manual '

Which model of mask are you using? Is it possible the silicone is getting old and less flexible, or is it new? I have only tried two nasal pillow masks, the P10 and the F&P Brevida. The P10 has been more comfortable for me, but my wife now uses the Brevida and likes it.

It doesn't seem to make sense that it would be a static problem, although it is not clear these machines are grounded. My wife uses the S9 with the Brevida mask and has not mentioned this kind of issue. The heated hose will have power in it, but I can't see how that could get to your nose. Seems the most the hose heater could do is fail open. If you have an unheated hose, you may want to try that to see if it makes any difference...

I have the A10, but my wife has the S9. Yes, having the removable lid on the S9 reservoir makes it easier to clean out the bottom. However, it is a lot more complex, with 3 parts to it, while the A10 is pretty much one piece. I have to say I prefer the built in humidifier and the reservoir over the S9. The one nice feature of the S9 is that there is a built in light to let you see the water level when room lights are dim or dark. With my A10 I end up leaving a mini flashlight beside my machine so I can check the water level each night to make sure I have not forgotten to fill it.

I use the ResMed AirFit P10 nasal pillow mask and have experienced something similar, but I would not say as painful as a bee sting. I attribute it to the skin being pinched somehow. I generally just pull the mask out slightly from my face and allow the silicone to inflate and straighten out. Then I put it back. Generally goes away. If I don't shave closely to my nose, and there is a bit of stubble left, that seems to make it worse. The P10 comes as a fit pack with three different sized mask inserts. I have found that using the largest size possible that doesn't leak works out the best. A smaller size will go to far into the nostrils and cause irritation. It is best to have the mask cones sitting on the bottom of your nose rather than inside -- at least with the P10 version.

A quote from the link below.

"UARS patients present different features than other Sleep related Breathing Disorder (SRBD) [6,7,8]. The most frequent symptoms are excessive daytime sleepiness, fatigue and sleep fragmentation. However, UARS patients also present significantly more often with sleep-onset and sleep-maintenance insomnia, postural hypotension, headaches, gastroesophageal reflux, irritable bowel syndrome, anxiety and alpha-delta sleep [9,10,11]."

Treatment of upper airway resistance syndrome in adults

Have you talked to your sleep specialist about it, and asked if there is anything that can be done to reduce it, such as limiting the base and IPAP pressures?

I am aware of this link about the causes and possible solutions, but that is about it. I have not suffered from it so have no personal experience.

Getting back to your issue of apnea right at sleep onset, that could be either central or obstructive. Your muscles relax when you go to sleep and it is quite possible that your upper airway constricts to reduce flow or even collapses stopping flow as you go to sleep. Since your sleep report had no central apneas reported, it seems more likely that it is obstructive. It would be helpful to know if any centrals were detected during the titration test, as the pressure from the test can produce central apneas.

But, assuming the more likely case of it being obstructive in nature, and that the hypopneas are a flow reduction due to upper airway restriction, a PAP device is likely to address the issue. If you get the pressure in the airway up BEFORE you go to sleep it is much less likely to have the airway collapse when you do fall asleep.

The next step should be to get a trial machine and see what the machine can do for you in actual use at home. It would be most efficient to get a flexible machine like the ResMed For Her AutoSet, as it can be set up to get you to sleep in a few different ways, which you could try to see which works the best. They would be:

• Use it in CPAP fixed pressure mode and start at that fixed pressure with no ramp up or hold in pressure. The machine will be active right from the start in detecting any apnea events, so you will quickly see if you continue to have sleep onset apneas, and what pressure is required to stop them. That said they should know that from the titration test...
• You could add in the ramp/hold and use EPR and not use EPR during the ramp or hold.
• You could use the For Her AutoSet algorithm to see if that works best for hypopnea reduction while sleeping, or if the standard mode works best.

In other words lots of options to try. I suspect one of them will work for you.

1. I believe the VPAP Tx machine is a special machine that ResMed makes for titration testing. It is not one that would be prescribed to a user for ongoing use.
2. Did you get any feedback on the results of the titration testing? On the initial in lab test was there any indication of RERA events, or a RDI index value? They are helpful in determining what type of apnea you have.

In the absence of any further detail, my suggestion would still be to push for a ResMed AirSense 10 AutoSet For Her version. It has an optional For Her mode in the machine that is better for treating hypopneas and RERA events. It also has the advanced features that can be set for getting to sleep.

Here is a link that provides a deep dive into how a titration test is done and the various options for treatment. But, at this point it would be really helpful to get more detail on what the outcome of the titration test was. At this point I don't see anything that would suggest you need a AirCurve BiLevel or ASV type of machine.

Sleep Lab Titration Guide