Sierra

I have been trying to think how you could get titrated to a fixed pressure of 5 cm, and now you are getting higher AHI including both OA and CA events. Getting CA events if you are sensitive to pressure is not unexpected. However getting more OA events with pressure is unusual. About the only way I can think of to explain your outcome requires the assumption of two causes. One is that during your titration test, the technician quickly observed that you are sensitive to pressure causing CA events, and as a result limited pressure to 5 cm, so your titration outcomes are based on that very low pressure. Now you are using the AutoSet machine with the maximum pressure set at the machine maximum of 20 cm. It is responding to snore which does not seem to be an issue, flow limitations which you have a few of, and of course to obstructive apnea, which seems to compound the problem by creating both central apnea and obstructive apnea. There is a condition which some may describe as mixed or complex apnea where you have a respiratory control system instability. In SleepyHead that can show up as an oscillation of the Minute Ventilation rate. It creates a waxing and waning breathing effort effect. Sometimes at the minimum of the breathing effort this is identified as a central apnea event by your machine. And other times it may result in an obstruction and is flagged as a OA event. However the cause is really the same -- the breathing control system instability. And the control instability can be made worse with higher pressure and pressure support or EPR.

Here is a SleepyHead screen from a couple of nights ago where I observed something like that. What you can see is that up until 6:34 I was sleeping well, with a uniform regular breathing pattern, and very stable Minute Ventilation. Then something happens. The machine did not flag it, but you can see from the Mask Pressure graph it started to test it with the 4 Hz pressure cycle. The band that paints is fairly wide indicating an obstruction, but it does not last long enough to get flagged. However this starts the control instability cycle, like a car on cruise control encountering a hill. The waxing and waning starts and the Minute Ventilation starts to cycle. Part way through the waning part the airway closes and is flagged as a OA event. Wide mask pressure band painted. The next cycle ends in a CA event. Notice that the mask pressure band painted is not as wide. Then this continues with the next two cycles ending in an OA event, one in nothing, and then one more as a CA event. So that is my understanding of what mixed apnea may be. The control system instability creates both obstructive and central events. So that may be what is happening in your case. If you look at the zoomed in view of the areas where you are getting a mix of events you may see a pattern like this.

In any case I hope that helps some. It is about the best explanation I can come up with. I am guessing but I think with the APAP machine you now have the solution may be to really reduce pressure to the point where the respiratory control system is stable, and at the same time, hope that pressure is enough to resolve the obstructive apnea.

Welcome to the forum. I actually had an experience using my AirSense 10 AutoSet somewhat similar to yours. The cause may not be the same, but just in case, I will explain. I woke up in the night thinking that there was a fire in the house because I could smell smoke. However, there was no smoke alarm, so I convinced myself to go back to sleep. But it seemed to get worse so I even reached over to feel the machine to see if the machine was overheating or was on fire. It felt fine, so I finally got up to see what the heck was going on. What I discovered was that I had forgotten to fill my humidifier, and it had run out of water and boiled dry. The heat combined with some residual minerals etc in the bottom of the reservoir was making the stink. It was not unlike the smell from a bag of well used sports equipment. The solution was easy. Clean the reservoir and fill with clean water.

If that is not your problem, then I would suggest a thorough cleaning of your equipment if it really picked up smoke from the house. I would use full strength vinegar with a bit of a soak. This is what I use to clean my water reservoir and equipment. In your case I would follow that with a solution of baking soda and water to deodorize. Then a wash with Dawn liquid dish detergent and water, and finally a rinse with water. Hang up to drain and dry. With a thorough cleaning there should be no smell or health risk. If the issue is smoke from the house, you may want to change the air filter on the machine (located on left side). There may be some smoke smell trapped there.

Danny, I am not a user of MyAir, so I don't know if you can download the data from there. I suspect you may be able to view the data there, but possibly not download it. Unfortunately the MyAir data from what I have seen is pretty high level and essentially a summary, but not the detail. It is mainly to monitory compliance.

On the ResMed AirSense 10 Elite and AutoSet detailed data is only saved if you have the SD card installed. If you put the card in now, you may get some summary data on it from the memory in the machine. The basic AirSense 10 fixed pressure machine does not save any detailed data.

Not sure your intended purpose of downloading the data, but you may want to consider putting the SD card in and installing the free software SleepyHead on your PC or Mac. You need a SD card reader to get the data from the card to the computer. This is very good software for monitoring your machine performance. But, it is not going to get your last months data back. Your machine provider may have it though. Detailed data does get sent via WiFi. However, you need the ResMed software to use it.

You may want to look through the progress of the SleepyHead charts at this other thread. The situation is not totally unlike yours. He now has AHI down to the 2 range, but started out around 20. The starting point was with the machine set to deliver pressures up to 20 cm and quite high pressure support (differential between EPAP and IPAP), which is similar to the EPR on your machine. The progress was made by setting the pressure support to zero, and then by reducing the maximum pressure. I believe he is now at a minimum of 9.5 cm and max of 11 cm.

If you want to help others, then why don't you just post the solution you found here?

That certainly is a bit puzzling considering that your titration prescription was 5 cm fixed with 2 EPR. My observations are that the majority of your central apnea which is the most significant component is occurring at the higher pressures. That is not unexpected. However, it seems a bit odd that you are also getting obstructive apnea at those higher pressures. Just looking at your graphs, is it possible you were awake from 4:30 to 5:45? There is an absence of events during that time, and your respiration rates seems high.

I am not a sleep technologist, just another CPAP user, that his issues with mixed obstructive and central apnea. Not sure if you are comfortable with adjusting your machine, and if not then ask your supplier to consider it. That said, if it were my machine I would put a limit on the maximum pressure to see if it helps reduce the central apnea events. I would also turn the EPR off. It often makes central apnea worse. If you can't make any progress with it turned off, then it may be worth trying it again. But for now I would turn it off. It makes the pressure on inhale run higher, and at this point, I think you want to limit pressure. So, my thoughts would be to leave the minimum at 5 cm and set the maximum at 10 cm, and turn EPR off to see if that improves things.

The other thing that would be interesting would be to zoom in on that cluster of events that starts at about 6:00. You can do that by left clicking on the area repeatedly until you can see the individual breaths of air. It could be revealing as to the type of central apnea you are having. Post what you get when zoomed in.

Hope that helps some.

I believe sleeptech is talking about CO2 levels in your blood. That is one of the things measured when you do a sleep test. Oxygen is also measured which tends to be the inverse of CO2. If O2 goes down, then CO2 then typically goes up. There are fairly inexpensive O2 meters that clip on your finger and monitor your O2 levels overnight. If you get one that is compatible with SleepyHead, I believe it integrates the results with your other sleep data. When you click on the Oximetery tab in SleepyHead it will give you a list of compatible machines.

I see from your posts about a month ago that you are using the AirSense 10 AutoSet. Have you downloaded SleepyHead and are you tracking your results with the software? Apnea and treatment with an APAP is not always simple. It would be really helpful to see a few of your good nights and bad nights using a screenshot of your Daily Report. If you need help with SleepyHead post back and let me know. From what you say in your posts, about all I can say is that your main issue seems to be central apnea. Central apnea is not well treated with pressure from a CPAP. It can be aggravated by higher pressure, and also by EPR. In about 25% of cases of CPAP treatment central apnea can emerge from the treatment. About 75% of those go away after 8 weeks or so. Hypopnea can be obstructive or central in origin, and it is hard to tell them apart. It is possible that some of your hypopnea are central in nature. What is the history of pressures that you have used? Have you used a fixed CPAP mode, or the auto APAP mode?

In any case like I say, it would be much easier to discuss what is going on while looking at some SleepyHead daily reports if you can post some here.

I think for someone with mixed apnea this is a pretty good result. You are probably not far off an optimum pressure setting if this is a typical result. Your CA event frequency is very low. I cannot achieve that on any kind of consistent basis. This indicates to me that (again if this is typical) your pressure is not too high. Your OA events are now dominating the total AHI. That suggests your pressure could be allowed to go slightly higher. However, that said, I would not be too quick to increase the maximum pressure setting. You are in a pretty good place now. It may be time to focus on the comfort issue or whatever you think may be preventing you from getting a 7 to 8 hour sleep at one stretch.

Pat, I have no personal experience with this mask, but I have bought a ResMed F20 using the sizing guide they provided. I believe I ended up with a mask that is too big for me. I have looked at that sizing guide chart for the DreamWear and find it quite confusing. For example if your nose length measures small but your nose width is into the extra wide section what mask size do you need? And your example is the same. The cart is based on nose size. What do you need if your mouth is not in proportion with your nose. I guess this all highlights the need to fit each mask to the individual. The nasal pillow mask perhaps do it right. They provide all sizes of inserts in the fit pack version of the mask probably at probably a reduced profit margin. It at least gives you the chance to try each size and use the one that fits best.