Sierra

I tried to respond to your post for help on your pressure settings, but for some reason the ability to reply does not work. I would suggest posting your SleepyHead charts again in a new post. Not sure what is going on.

One question I had was about the mask you are using. One report says it is full face and the other says it is a nasal pillows mask. To get the mask leak report correct, you need to have the correct mask setting in your AirSense 10 to match the mask you are using. Or, did you use two different masks? One thing I see is that the pressure on one chart is significantly higher than the other.

That said, your main issue seems to be central apnea. Unfortunately that is not corrected with pressure, and in some people more pressure causes more central apnea. But in the two charts you posted I did not see much relation between when the centrals occur and when the pressure was higher.

My normal approach to setting pressure is raise the minimum pressure first, until it gets to the point where a good portion of the night the pressure is at minimum. This tends to lower obstructive apnea by getting the pressure up sooner in the night and avoiding some of the apnea. Next I lower the maximum pressure to clip off some of the higher pressure excursions. Part of that is for comfort, and avoiding higher mask pressures which cause leaks, and also in some cases it can reduce central apnea caused by too much pressure.

Hope that helps some, but post again and hopefully the reply function will work...

I have not had the tooth decay issues, but I use a nasal pillow mask and have issues with air escaping out of my mouth during sleep. The Breathewear Halo chin strap that I use prevents most of it, but to totally stop the mouth leaks I have gone to using 1" 3M NexCare paper medical tape. I tape across my mouth from side to side and leave it there overnight. It totally stops air leakage out of the mouth. Here is a link to a video by a dentist that talks about it.

How to Mouth Tape for a Better Sleep

I was just talking about the lock on the side of the SD card. There have been times when I left it locked and then put it in the CPAP machine. When you do that my machine at least does not record any data so SleepyHead has nothing to download.

Any chance you have had your SD card switch in the locked position when it is in your machine? I have inadvertently done that, and no data gets collected.

Those are some good tips.

Some with significant weight reduction may get off CPAP, but I think for most they are on it for life, or just live with the untreated apnea. A CPAP or Auto CPAP is most effective in treating obstructive apnea because it uses air pressure to hold the breathing passages open. It can reduce the incidence of obstructive apnea, flow limitations, and snoring. However, pressure is not really effective in reducing central apnea, because the airway is open during a central apnea event. Most but not all machines are able to distinguish between obstructive and central apnea. The appropriate response is to increase pressure to reduce obstructive, but leave pressure alone if it is central apnea.

I checked out that CPAP website if it is this one.

EU-PAP

The DreamStation Auto CPAP is a credible machine, but I would avoid the rest of the ones they have on the site. The F&P Icon is an old model and does not distinguish between obstructive and central events. The System One REMstar is an old model too. On the DreamStation be careful on the price. This one is priced without a humidifier, and that option adds £175 to the price.

The other credible machine is the ResMed AirSense 10 AutoSet that I gave you a link to. It has a built in humidifier so the price always includes it. There are two models, the standard and a For Her version. The For Her version is the better choice because it offers an optional extra response mode that can be more suitable for those needing lower pressure.

I would suggest the ResMed AirSense 10 AutoSet and the DreamStation Auto are the two top machines on the market. Of the two in my opinion the ResMed is better.

Hope that helps some,

The good news here is that CA is still zero. It is possible the hypopnea events are central apnea related though. You would have to zoom in to see what they look like.

Some things to keep in mind in this. You have made very rapid progress, and are now at the point of making some pretty small changes. When you make a small change, you probably have to try them for a week or so before you can be sure what effect they have. It is kind of like changing the brand of your golf ball, playing one hole, and then trying to decide if it is better or worse. I have been averaging about 2.3 AHI for some time now with my latest settings. Last night it was 4.3. I had changed nothing other than we added a quilt for the winter and it may have been too hot...

In general your CA is zero so that suggests at first blush that pressure is not too high. Your OA is 0.69 which all considered is pretty good. That suggests your minimum pressure is not too low. The only remaining issue is the hypopnea. I would be suspicious that along with another green band of PB indicates central apnea may be at work but not just causing a full CA. I have to admit that when I see CA low and OA low, I kind of ignore the hypopnea, or at least give it a lower weighting for concern.

I see you have moved the AHI graph up. I find that graph somewhat misleading and not all that useful. My preference is to look at each event and see at what pressure was there before it occurred. That is why I put the pressure graph right below the events, and mouse over the cursor to see the digital display of pressure above the graph. It tends to be more accurate than trying to read the graph directly.

You said "So my opinion is a range from 9.0 Epap to 10.0 Ipap, with 1 Bi-Flex, is where our next test should be."

I think that is as good a setting as any from what I have seen so far. It would be worth trying that for a few days without making any other changes to see what it produces. Perhaps just leave the settings at that and post your daily screen each day to see if there is any kind of trend to the results before making any other changes.

If you can post the results of changing maximum pressure to 6 cm and with the changes to the SleepyHead layout the results should be quite informative.

Probably too late for tonight, but I would set pressure minimum at 9.5 and leave Bi-Flex where it was. Not a good idea to change two things at once.

Probably got back to this too late for tonight, but I would suggest leaving minimum pressure at 9.5 cm, and Bi-Flex where it was before. Pressure is a major effect. Bi-Flex on the DreamStation fairly minor.