Sierra

When you use the heated ClimateLine hose and accept the default Climate Control default option of Auto, there is only one more option to set which is the tube temperature. My machine uses metric units so it defaults to 27 C and I just accept that as well. There is no humidity temperature to set that I know of. Have not had any issues with rainout using those settings. But I do snuggle up with my hose under the covers! I suspect that the machine adjusts the humidity to a level that does not over saturate the air at the selected temperature ( 27 C in my case).

I had a look at your sleep report. The basic data you covered with a post in your other thread pretty much covers the results. Some comments:

• you slept about 2.5 hours which is not a lot. Probably on the margin for a valid test.
• No full apnea events, but quite a few hypopnea and RERA events
• I found it interesting that they had columns for obstructive hypopnea, and cental hypopnea, but all them were left as unclassified hypopnea. If you were doing another sleep test and trying to decide on a lab, you may want to ask them if they classify the hypopnea events.
• It appears they are using the Medicare standard for apnea classification which only considers AHI and not RERA events, so you got no diagnosis of apnea.

I am assuming you are located in the US? I found this undated article from what appears to be a US sleep clinic which covers the issue of diagnosis using RDI vs AHI. My short read of it is that Medicare are playing a dirty trick and while they use the term RDI, they exclude RERA events, which makes it essential the same as ADI. And worse still it appears virtually all insurance company follow Medicare rules and ignore RERA. Your insurance company may be different, but it would seem most likely they will not pay for a CPAP unless you meet the AHI criteria. They should pay for a sleep study however.

At What Severity Will Insurance Cover CPAP for Sleep Apnea?

That brings up another question you could ask a prospective sleep clinic you are considering for a study. Do they use Medicare guidelines or American Academy of Sleep Medicine (AASM) guidelines (which include RERA events). If they use AASM that would significantly improve your odds of getting a positive diagnosis and a prescription for a CPAP. You will need a prescription for a new machine even if you pay for it yourself. A used machine may not need a prescription though. Not sure. That article includes a link on where to get a CPAP machine at low cost. One of them is SecondWindCPAP. I believe they are a reputable place to buy from new at a fairly good price, or used. One thing to watch for is that the machine captures detailed data, distinguishes between central and obstructive apnea, and identifies RERA events. The safe bets are the ResMed and Respironics (DreamStation) Auto machines, (ResMed preferred).

I recall I told you before that all your current data suggests you may not benefit from a CPAP. Now that I see the RERA issue more clearly, I have to change my mind. I think it is quite possible that the RERA and hypopnea events may be disturbing you sleep to a significant degree. Just my thoughts, and again I am not a medical professional. Just giving my opinion!

I would increase the air temperature setpoint to 81 F. I have mine at the recommended 27 C, which converts to 81 F, and have no problem with water in my P10 nasal pillow mask. The room now that winter is coming probably gets down to 65 F or so at night. I do route my heated hose and P10 hose extension under the covers to keep it warm though.

Hope that helps,

I am not a medical professional, and know little about the issues you have identified, other than the apnea part. Based on your previous thread and reported outcome of a sleep study I recall you had a diagnoses AHI of 4.7 which is just short of the Mild apnea classification based on API. However, I also recall you had some significant RERA events for an overall RDI of 18. In the province in Canada where I am, RDI is used equally with AHI, and you would be classed as having moderate apnea with a RDI of 18. Practice guidelines in this province would then offer a health care covered cost of a CPAP trial. A CPAP trial with an auto machine that records all types of apnea, hypopnea, and RERA would be very informative.

It is possible that the RERA events are a main cause of your sleepiness. They often do not cause the large O2 excursions and are not caught with O2 testing. Good CPAP machines however can detect them. They don't to my knowledge increase pressure based on them though.

The other consideration is that CPAP treatment can create apnea, especially of the central type, and the more pressure you use to treat obstructive apnea the more central apnea may increase. This condition is sometimes called Complex Sleep Apnea. Here is a good article on the subject of Complex Sleep Apnea written by Dr. Robert Thomas, M.D., Associate Professor of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center. It can also be found in the Blog section of this site.

When you get your insurance coverage back, I would do another sleep test, and if it confirms an RDI in the 18 range again, then push for a CPAP trial. The machine I would recommend is the ResMed AirSense 10 AutoSet. It will record the data you need to see, and it can be viewed in SleepyHead, so you can come to your own conclusion as well as get one from the Sleep Clinic.

Hope that helps some,

That is a good fixed pressure CPAP that is compatible with SleepyHead and saves detailed data to the SD card. Make sure the SD card is installed in it though. If not just buy an inexpensive one. All you need is 4 GB, but up to 32 GB will work. If you use SleepyHead you will see your pressure and when apnea events are occurring. There may be an opportunity to run a lower pressure and reduce the bloating problem.

Here is a link to SleepyHead download site, and a basic manual:

SleepyHead Download

Basic Manual

If you need help with installing SleepyHead or interpreting the results, just post your questions.

Welcome to the forum. It is possible your old machine was inaccurate with respect to pressure. You are correct in that a higher pressure may be responsible for the bloating issue. How have your AHI readings been on the new machine compared to the old machine? What machine make and model do you have now? If it is compatible with SleepyHead you may learn something by downloading this free software and looking at your data with it. It requires a compatible CPAP, a PC or Mac, and a SD card reader.

If anything air leaks will improve your oxygen saturation values. CPAP masks have a vent that is open all the time. That is also how you exhale stale air. It does not go back into the machine. It short circuits and goes out the mask vent. The other purpose of the mask vent is to freshen up the air inside the mask. There is a certain design mask purge flow rate that is based on the size of the mask. The larger the volume of the mask the higher the purge rate. If you look in the manual for each mask you will find at the end in the specifications section a value which indicates the volume of the mask. You will also see a graph which shows the purge flow rate vs the pressure. That purge rate will be higher on masks that have a higher volume (dead space).

But to your question. Mask leaks essentially increase the purge rate. This increase the oxygen content in the air your breathe. So, if anything a mask with a high leak rate will increase oxygen in the mask, and as a result increase oxygen in your blood levels.

In theory your O2 monitor should reflect the number of apneas and hypopneas (your AHI). Each one should lower O2. The other hidden issue it might uncover is the impact of flow limitations that are not included in the AHI value.

Yep, you are in a Catch 22 situation. I understand it, but have to feel sorry for you at the same time. As far as pulling the SD card and checking up on you, they probably already are doing that. Each morning after you shut the machine down you will see some activity on your display. That is the machine using WiFi to transmit your data to the provider already.

With the Breathewear Halo chin strap I use, I put the P10 mask on first, and then the chin strap second. However, I need the chin strap for two purposes. One is to keep the mask from slipping off, and the other to keep my mouth closed. In your case I can see it may make sense to put the chin strap on first.

On the doctor issue, you need to get someone who has experience with the AirCurve 10 ASV machine. It is a pretty sophisticated and complex machine. Sells for about $5000 on line in Canada. If they were not so expensive I would buy one. I have put that decison off until I am unable to keep AHI under 5 with the standard AutoSet model.

I found a document that you might be interested in. It basically outlines the ResMed view on how to titrate the settings on the various machines, including the ASV model. Here is a link to it:

Sleep Lab Titration Guide

The section that covers your ASV machine starts on page 30. The basic setup for the ASV and ASVAuto modes are given on page 33. Your machine appears to be the basic setup for the ASV mode, but with the EPAP set at 10 cm instead of the recommended starting point of 5 cm. This could be because they tried it in the lab and had to increase EPAP to eliminate obstructive apnea? Or, it could have been just a guess. There is a possibility that it is too high. But that is not certain as your hypopnea has not been eliminated. I do not see any OA events though.

There is another recommended setup for the ASVAuto mode. It is pretty much the same as the ASV except there is a range allowed for the machine to adjust EPAP in, with a recommended setting of 4 cm minimum and 15 max.

So if you can get in to see a doctor that understands the machine, I would ask them if it could be changed to the ASVAuto mode with the recommended default settings. The Auto mode may allow the machine to use less pressure. That in turn would make the mask more comfortable, and hopefully reduce the gas problem too...

Hope that helps some,

Here is another thread that you might find interesting. The OP indicates he is a physician and was having issues with AHI in the 10-20 range. In his case it was predominantly centrals and not the more difficult mix of OA and CA you have. The solution was a significant reduction in pressure, going to fixed pressure CPAP mode, and stopping the EPR.