Sierra

I have noticed that you seem to not be getting much sleep at a time and there are frequent breaks during the night. My thoughts were that if you could come up with a pressure that is as low as possible to control the obstructive apnea and not generate central apneas then the next step would be to work on the comfort issue to try and get as an interrupted sleep as is possible./

Toward finding the pressure you may want to try turning off all the session switches for that night on the left and then turn them on individually one at a time and see what SleepyHead reports for apnea frequency on each one. That may help you zero in on an effective pressure providing you were really sleeping for long enough. Then you may want to try that pressure and see if you can do a full night to gather better data.

Yes, kind of, but I cheat and also use a CPAP. I use a chin strap and paper medical tape over my mouth to stop me from opening my mouth during sleep. That is in addition to using a CPAP with a nasal pillow mask however. I suspect it may help with snoring, but unless you wear a CPAP I am not sure how one could tell to what degree it helps with apnea. See this video about mouth taping by a dentist.

Mouth Tape for a Better Sleep

It sounds like you have sorted it out with the Google search but just in case here is the info on how to change the machine settings. Yes, I set my wife's machine up and also my own. Not nearly as difficult as trying to set up a "smartphone"! To my knowledge they cannot lock you out of your own machine, but they can pull a bit of a dirty trick and pull the SD card out. But, you can buy one for a few bucks and put it back in.

What is hard to find on the internet is the link to an actual clinician guide for the machine that goes into detail on the setup. This is a technical manual, not the user manual. These are pdf's that are a good idea to save as the links seem to come and go. And you have to be careful with the Dreamstation one as it covers multiple models and not all options will be on the machine you have. And if you do go into the clinical or provider manual be careful and be sure you understand what you are changing. You do not want to mess things up!

ResMed Manual

DreamStation Manual

Did you have success with the Nuance or Nuance Pro version?

You may find this link of interest on the prescription issue. It says in the US that it is a federal law that says a prescription is needed. It sounds to me that if you wanted to buy a mask from them, they would contact your previous doctor and get a prescription from them. I think your current doctor is kind of giving you the run around.

CPAP Prescription Requirements

But, you may find it easier just to buy your mask in two components. For example if you use the AirFit P10 the assembly kit is $74. The headgear for the P10 is $25. No prescription required for a total cost of $99. The complete mask assembly is $99, so the same, but it requires a prescription!

I am from Canada and a prescription to my knowledge is not needed in Canada for a mask. You do need it for a new CPAP machine though. In browsing through US CPAP on line stores I have noticed that some do require a prescription for a mask. That may be some state law requirement. My understanding is that those who get caught up in what seems to be an archaic and silly law just buy the mask parts and put the mask together themselves. I think you will find many US on line stores conveniently sell mask parts. Also on line stores tend to be much less expensive than bricks and mortar clinics. So my suggestion is to check around in the on line stores to see if you can find one that will sell a mask at a good price without a prescription or if necessary buy the parts and put it together yourself. Assembly is no big deal

I recall you were asking questions about using the AirMini for travel, and possibly full time. One thing you may want to consider is asking your insurance company if they would consider covering both the AirSense 10 and an AirMini for travel, if purchased on line for less cost than just the AirSense 10 at a bricks and mortar sleep clinic. That is what my son did with I believe Sun Life insurance. The sleep clinic wanted $2400 for an AirSense 10, and he talked them into giving him a AirSense 10 and Z-1 portable which cost about $1900 in total from an on line company. The insurance company saved $500 and he got two machines instead of one. I believe the AirMini costs about $1000 on line so the A10 plus AirMini would be about $1900 at current prices.

Periodic breathing is a more general term that describes a repeating pattern of breathing, and it is frequently associated with central apnea. One specific type is called Cheyne Stokes Respiration (CSR). Respironics likes to use the term periodic breathing, but I suspect they are reporting pretty much the same thing. I suffer from an infrequent and relatively small amount of CSR. I will post a screen capture below of what it looks like. Similar to the DreamStation it is highlighted in green. If yours is of this type and it becomes a reoccurring event then it is something that should be discussed with a cardiologist. One factor that could be causing it is reduced blood flow, but there can be many other reasons.

I have some experience in the field of industrial control systems, and it falls into what I would describe as an unstable control system problem -- not tuned properly. Something like a cruise control on your car that encounters a hill, slows down, then speeds up, but does not recover from the slow down speed up cycle, and just continues on for some time in the up down cycle. This can be the result of a time delay caused by low blood flow, or slow processing of the breathing data in the brain. Some drugs and especially opioids can cause the slow processing in the brain. I do not take them, and never have, but I do take a beta blocker (bisoprolol) for blood pressure which slows my heart rate down, and I have blamed it for some of my central apnea and possibly the CSR. I have convinced my doctor to reduce my dose of it in half and it seems to have helped some. I get CSR perhaps once every month or so.

I would not get alarmed at this point. It is just something to watch unless it becomes excessive. Here is a general article about central apnea which includes the issue of CSR. I'm hoping at this point that you will get to some pressure settings which minimize your central apnea. In some cases central apnea emerges as an issue in those who start CPAP treatment, but in 75% of those cases it goes away after a couple of months or so. Mine has not gone away, but I'm convinced it has reduced in frequency.

Yes, this is why I was recommending deferring the use of pressure support until a lowest possible pressure in auto mode was optimized. It seems that pressure support is producing some of the central apnea that you want to avoid.

When you produce your report for tomorrow with 11/15 in Auto BiPAP, you can go into the Session Information on the left and turn off the afternoon nap portion with the red/green slider switch (just like you can do with the flags). If you leave it turned on it will mess up the night portion of the report.

I have seen the Lithium ion battery packs at Costco that are intended to recharge cell phones. I wonder if there is some way to put them in series to get the necessary voltage to run a CPAP.