Sierra

I did a quick look for the For Her machine including the heated Climate Line hose. I recall you are buying your mask locally. Here is what I got:

PapSmart $699

CPAPOutlet $825

MonsterCPAP $825

CPAPMachines $910

Without the Heated Climate Line Hose in package there are:

SleepYeti $880 less 10% on first order - $828 with heated hose after discount

CPAPMachinesCanada $895

Notes:

• I have bought from CPAPOutlet, CPAPMachines, SleepYeti, and CPAPMachinesCanada. All of them seem OK.
• The Papsmart price does not appear to include shipping. They have another option for $749 which appears to include your choice of two masks. The site seems kind of dodgy though. No physical address.
• I would recommend calling each one to ensure the have the machine in stock, and that it is new, and where in Canada it will be shipped from
• Also check that you will get all of the following in the package: APAP, power supply, travel case, Slimline Hose, ClimateLine Hose.
• Verify method of shipping. If Canada Post you may want to pay extra to use a courier...

Hope that helps some

There is no way to tell ahead of time if the For Her algorithm would be better for you or not. You would simply have to try it and see how it compares to the standard AutoSet mode, which is still an option on the For Her machine. There is no down side that I am aware of to the For Her version is does everything the standard AutoSet machine does plus it offers the ability to try the second mode. Oh, and it does have a different coloured case. The main limitation I see in the For Her mode is that it only responds to obstructive apnea up to 12 cm of pressure. So it would not be suitable for someone having apnea above 12 cm. From what I see from your pressures you are well below that, and it would not be a limitation to you. But again whether it will be better or worse than the standard mode would only be known by trying it. The big plus is that you have the extra mode available to you to try.

See pages 4, and then pages 6-7 for a description of the modes available and how the For Her mode is different.

AutoSet Technical Manual

I checked the ResMed technical manual for this device. You can find it at this link:

ResMed AirSense Technical Manual

All it says on page 33 under Troubleshooting is this:

"Tubing blocked, check your tubing

Air tubing may be blocked. Check the air tubing and remove any blockages. Press the dial to clear the message and then press Start/Stop to restart the device."

Not much help, if you are sure the hose is clear. Do you have a second hose to try?

Could there be anything plugged in the mask? I recall that the Dreamwear mask directs air down through tubes on each side of your head. Could they be plugged? The mask should have a vent system where air comes out. Could it be plugged or blocked? Do you have another mask to try?

Have you checked the air filter on the left side of the machine? Could it be plugged?

That is about all I can think of. I would check the water reservoir and the fittings where it connects to the machine to see if there is any problem there. Pages 24-27 in the manual show how to take it apart. However I doubt you need to take it apart just to inspect it. Any blockage should be visible.

Do you know what the pressure settings are for the machine? They should display when you first start the machine up. The one in the middle is the current pressure and the two numbers in the top right are the minimum and maximum.

Last you mention that the machine is about 3 years old. The warranty is 3 years so you might want to report the problem right away in case you are in time to make a warranty claim if it is defective.

I have not personally used one, but I have heard others say they like them. I have heard buckwheat pillows work well for some, but have not tried them either. In general I don't like foam pillows because they keep pushing back. Perhaps with the shredded foam filling of the My Pillow, it does not push back so much.

I started out with a memory foam pillow but found it pushed back too much on my AirFit P10 nasal pillow mask and caused it to dislodge and leak. The pillow I have been using for some time now in an inexpensive Costco down alternative pillow made from microfiber. It tends to form to your head and also does not push back much against the mask. You do kind of have to reform it every night as it develops quite a indentation where your head is. I use a satin pillow case cover over the down alternative so my head slips around on the pillow rather than pull the straps of my headgear off.

Hope that helps some

I read the diagnosis to mean that your AHI is 13.3 which is classed as mild apnea. However of that 13.3, central apnea index was 10.5, or 80% central apnea. That is high central apnea and probably why they skipped the APAP and BiLevel machines and went straight to the ASV machine.

I did a little searching on line for SleepyHead charts with an AirCurve 10 ASV machine. I found the one below, which is showing a very good AHI. The pressures seem to be set up a little differently than yours with the minimum EPAP lower at 5 cm and the pressure support range higher at 5-20. Pressures tend to be individual, and I don't think you really want more pressure. However, one significant difference I noticed is that the Mode on this machine is set to ASVAuto, while your machine is set to just ASV. Here is what I see in the clinical manual about the difference. A quote:

"ASV mode

In ASV mode, the expiratory positive airway pressure (EPAP) is fixed and can be manually adjusted to eliminate obstructive events. The Pressure Support (PS) varies between the Min PS and the Max PS to answer to the patient's need. Mandatory breaths are delivered at the patient’s recent spontaneous breath rate, ie, the timed backup rate is automatically calculated to match the patient’s needs and is applied appropriately in the case of an event.

ASVAuto mode

In addition to the functionality of the ASV mode, the device in ASVAuto mode automatically adjusts the expiratory pressure in order to provide only the amount of pressure (EPAP) required to maintain upper airway patency. The device analyzes the state of the patient’s upper airway on a breath-by-breath basis and delivers expiratory pressure within the allowed range (Min EPAP and Max EPAP) according to the degree of obstruction. EPAP is automatically adjusted depending on three parameters: inspiratory flow limitation, snore, and obstructive apnea."

A question you might want to ask of your sleep doctor is if there may be some benefit to you to switch to the ASVAuto mode. It sounds like it gives the machine a little more flexibility in keeping the EPAP pressure lower, which may help with the aerophagia. Also there may be some opportunities to limit PS and IPAP as well.

My understanding is that your fixed pressure CPAP is currently set a 5 cm and EPR is on full time at 2 cm. That means your inhale pressure (IPAP) is 5 cm, and exhale is 4 cm (EPAP, the EPR of 2 cannot reduce pressure below 4 cm). This setup seems to be producing too many CA events, and no OA events. Generally that means too much pressure, although the effective EPR of 1 cm may be contributing to the CA as well.

So my logic is that you do not need more than 5 cm pressure based on what your machine is now doing. To prevent central apnea events it would seem prudent to limit maximum pressure to 5 cm. It can always be changed later of course. And, if you set the minimum pressure at 4 cm, the machine will start there, and possibly stay there, or lower than 5 cm. With SleepyHead you will be able to see what is happening, and when the events occur. That will allow a further refinement of the pressures. And as was suggested I would turn EPR off, as it may cause CA events also. Again that is easy to change later too.

The reason for setting a max of 5 cm instead of higher and letting the machine have control is that flow limitation, snoring, and hypopnea can drive pressure up, and potentially cause the CA events to really increase. The machine cannot tell the difference between a hypopnea that is central related from one that is obstructive related to my knowledge.

That is the discussion I would have with the technician that is setting up your machine for you.

Welcome to the forum. I think your suspicion is a possibility. A higher pressure can in some individuals initiate more central apnea events. However, I'm not sure that would be weight related. Do you know what your breakdown of central to obstructive events has been in the past, compared to now?

It would be very informative to see a Daily Report from SleepyHead from a couple of your typical problem nights. It will tell you when the events are happening in relation to the pressure the machine is using. SleepyHead is free, but you need a PC or a Mac and a SD card reader to use it. If you want to give it a try here are a couple of links. On a PC you can save a screenshot by just pressing F12. It makes an image file in your SleepyHeadData/Screenshots directory. Then to display it in a post here, just left click and drag the file from Windows Explorer to the body of your message.

SleepyHead Download

SleepyHead Basic Manual

Those are very interesting reports. The ASV seems to be very effective in normalizing CA and OA events. However, it seems they may not really be eliminated, but are instead classed as unidentified apnea. I also consider hypopnea events to be potentially either obstructive or central events in development, but do not go to full apnea.

I am not a medical person so really can't say if avoiding mouth breathing with taping would help to prevent aerophagia. It may be worth trying just to see what it does. Your machine is certainly using lots of pressure on IPAP, right to the limit of 25 cm the machine is capable of. It seems well documented that more pressure can cause aerophagia. I would not hazard any kind of guess to suggest whether or not lower EPAP and/or PS would be possible. Something to discuss with your sleep doctor though.

It would be helpful to optimize your SleepyHead layout a bit so more data can fit on the screen. The F10 key hides the right menu, as it is kind of redundant anyway. Clicking the triangle beside the date hides the full month display and lets more data below show up. And if you go to File, Preferences, Appearance, and then uncheck the pie chart display box, that will hide too. The breakdown still appears in the colored bars above it. Last drag the gray lines between the graphs to scrunch them down a bit so more graphs can display on the screen. In addition to what you have, I like to see Flow Limitation, Snore, and Leaks.

Have you zoomed in on those times/events in the night when you are getting a concentration of events and the PS is peaking in response? I just do it by left clicking in the area of interest until I can see the individual breath flow curves. The left right and up down arrow keys also work to fine tune it. If you zoom in you may be able to see what the machine is doing or not doing to address those events.

The bottom line is that the ASV seems to be working for you, if you can keep AHI under 5. I'm curious. What was your original diagnosis AHI?

I forgot to add in my original response that I have used the ResMed warranty. I bought a 12 V DC to 24 V DC power adapter for my wife's S9 CPAP so we could run it from the 12 volt system in our RV. It worked fine for about 4 nights and then started going off and on during the night. I called CPAPOutlet.ca where I bought it and they immediately sent me out a replacement, along with a prepaid shipping label to return the defective one. I suspect the problem was a bad connection in the molded plug -- a manufacturing defect. Warranty is useful for those infant mortality type of failures.

And since you originally asked, I was looking at some ResMed information and I see that they claim the design life of their CPAP machines is 5 years. The warranty however is 3 years as you know.