Sierra

I use the 3M Nexcare Sensitive Skin tape, and find it does not irritate my skin at all. 3M claim it is designed especially for those with sensitive or fragile skin. See info at link below:

3M Nexcare Sensitive Skin Tape

Edit: Correction! I just looked at an unopened package of the tape I am using, and it is marked Nexcare Gentle Paper Non Irritating Tape. I suspect it is the same as the sensitive skin tape... Here is a link to a description. Looks virtually identical to me. Perhaps US vs Canadian marketing??

Nexcare Gentle Paper Tape

On a closer look, the tapes are not identical. The Sensitive Skin tape is blue. The Gentle Paper tape is white. The Gentle Paper is made in the US, and the blue stuff not specified. The Gentle Paper is a Micropore tape.

I suspect either one would work. I have only tried the white Gentle Paper type and it works fine. It is also available at Walmart here for a good price!

I am not a medical professional and can't offer you any medical advice. About all I know is that the causes of headaches are often difficult to pinpoint.

With a diagnosed AHI of 40 and it being now controlled with CPAP to the 0.5 level, certainly suggests it must be well optimized from an AHI point of view. That said some find it helpful to track their CPAP treatment with a free software program called SleepyHead. It provides very detailed data tracking and display. It may show some opportunity for comfort improvement, such as lowering pressure or setting limits differently. If you are interested post back and I can help you with it. The software needs a PC or Mac computer with the capability to read a SD card.

It may not apply to you, but I read an interesting article today that found there was an optimum amount of sleep one should try to get and there are negative symptoms not only if we sleep too little, but also if we sleep too much. I suspect that sleeping too little includes getting a poor quality sleep as well as just a short sleep. The recommendation was to get 7-8 hours per night. Here is a graph that indicates what happens when we sleep too much or too little. STM is short term memory, and the others are obvious.

The article at this link:

In Search of Sleep's Sweet Spot

Do you still have the Dreamwear nasal mask? My suggestions remain the same. You may want to consider going back to the nasal mask, with a chin strap, and with mouth taping. Mouth taping is not as bad as it might sound. Have a watch of this video.

How to Mouth Tape for a Better Sleep

I think this clearly shows that 10 cm combined with EPR is not good for controlling central apnea. It does show that 10 cm does control your obstructive apnea pretty well. I think you have a couple of options at this point. One would be to turn EPR off or to Ramp Only and see what that does. The other option which might be more informative would be turn EPR off or to ramp only and set minmum pressure to say 8 cm and maximum to 10. That would give the machine the option of keeping pressure lower, but not over 10 which may do some good in preventing CA. But again at this point I don't think EPR full time is doing you any favor.

I believe the only thing that the mask setting does is allow the machine to compensate for intentional mask leakage and as a result produce accurate inadvertant mask leakage numbers. I would set it at full face and not worry about it.

But, if you want to dig into it further what you need to do is compare the Pressure-Flow Curve of your mask to the masks that ResMed says should use the Full Face mask setting. You can find the list of masks that ResMed has that uses this FFM setting at this link:

ResMed Mask Device Compatibility Chart

And you can find the Pressure-Flow curves for your mask here, and that of the ResMed ones when you do a search for their user manuals.

DreamWear FFM Manual

Do you not have an option of just buying the machine at a good price on line and getting all or most of that cost covered by your insurance company? That is what my son did in Alberta with Sun Life. That cost of $2480 from as sleep clinic is pretty consistent with my experience in Alberta. I was quoted $2400 and they would only supply a poor F&P SleepStyle. They would not supply a ResMed.

My suggestion is that if you are committed to monitoring your own results using SleepyHead there is no benefit in using a therapist. My experience in Alberta is that they provide next to zero support and ongoing monitoring, and your will be much better off if you take personal interest in your results.

Yes you can easily transfer your settings from the DreamStation to the ResMed.

How have you been doing for treatment with the DreamStation? If you have been doing well, there is no reason not to believe you will be able to seamlessly switch to a ResMed. The only current issue I can see is that with the ongoing Postal Services strike issues you may have to pay something extra to get the machine shipped with a courier company to avoid delivery delay.

On risk over the long term, I would expect like Alberta you always have the option of going back to your GP to get another referral if you are not able to maintain good results on your own with SleepyHead. I am currently maintaining under an AHI of 5 with my machine despite some central apnea issues. However, if I get to the point I can't then that is what I will do. I would ask to be referred to a different clinic than my last one, as I was not happy with the service they provided.

One of the things I do is to try and get my nose clear before I put the mask on. Early on I bought a container of the Walmart generic equivalent of Otrivin nasal decongestant. This type of drug cannot be used continuously or it loses effect. So what I do is only use it once occasionally at night only and in one nostril only. It helps to get cleared up before going to sleep or shortly after. I find with a nasal pillow mask once you get your nose clear it stays clear overnight.

One thing to keep in mind is that with apnea and in particular complex apnea with a significant portion of central apnea one night to the next night variability can be quite high. In statistical terms standard deviation is very high. It takes many nights to see if there really has been a change in the average results when you make a change in treatment pressures. As an example I will post my last 3 month Overview from SleepyHead. I suspect my apnea severity and yours are not all that different, so my guess is that your long term ability to control AHI is likely to be quite similar in variability. This Overview includes my last three changes to treatment which in the scheme of things are pretty small.

Sep 26 - Oct 10 - Pressure at 12 min and 12.2 max essentially fixed - AHI 2.34

Oct 11 - Oct 17 - Pressure in CPAP mode fixed at 12.2 - AHI 2.64

Oct 18 - Nov 6 - Pressure at 12.2 min and 13 max - AHI 2.49

So on average pretty subtle changes. However over that time AHI has been as low as 0.6 and as high as 7.0. So I guess my point is that don't take one or two bad nights as a trend. You need quite a few nights at a setting to see what it will do in the longer term. I think it makes sense to make changes fairly quickly at first, and then after you get close to the optimum settings, then slow down and be patient to see what is happening. Hope that helps some. You have come a long way from the first settings you had, and have made excellent progress!

It sounds like you may be swallowing air. It is a potential issue with CPAP treatment and is called aerophagia. See this link for more information about what may cause it and the possible resolutions.

Aerophagia Causes and Resolution

If you would like some help with this, it would be helpful to provide some more information about your treatment. What make and model of a machine are you using? What are the pressures set at? What AHI were you diagnosed with, and what is it now with CPAP treatment? What type of mask are you using? Sorry for all the questions but without more info it is hard to help.

Some of us use a free software program called SleepyHead to look at results. That could be very helpful to you if you are able to use it. It requires a PC or Mac and a SD card reader. Ask if you want more information on it.

I only have experience with Micropore and it works well. Suspect the Duropore may be less common outside of a hospital and may be more difficult/expensive to get, but that is just a guess. According to 3M the Micropore can tolerate some moisture, but on dry skin the Duropore has more adhesive strength. See this link.

I find the Micropore has just the right amount of adhesion. Stays in place providing you wash any oil off, and is reasonably easy to remove in the morning without leaving any residue.