Sierra

On a quick look here is one USA price on the AirSense 10 AutoSet including the heated ClimateLine hose for $785. No tax and free shipping. This place also has used machines for sale too, but the price is often not much less...

ResMed AirSense 10 AutoSet Package

I use the ResMed AirSense 10 AutoSet and I believe it is the better than the DreamStation Auto. If you want the reasons I will post them for you. I have used a Fisher & Paykel SleepStyle and I cannot recommend it. The ResMed AirSense is the best machine on the market in my opinion, and the DreamStation is a second choice. I would not consider anything other than these two if you want the best.

I am assuming you are in the US? If so the common list price for the AirSense 10 AutoSet is $883, but I have seen it for less if you hunt around real hard on the internet.

In my opinion if you are controlling your AHI well with SleepyHead and know how to adjust your machine there is no need for monthly appointments. My wife has been on CPAP for 4 years now and has never been back. Her AHI is fine at about 1.2.

If I am reading your situation right, I would let them have the current machine back, and just buy your own from an on line internet store. You will need a prescription to get a new one though. I'm not sure what you are getting on a refill plan? In 6 months I have only used 1 filter and am on my original mask. Filters and mask inserts are easy to buy on line, and do not require a prescription.

Yes, masks are interchangeable between machines unless you get a specialized travel machine like the AirMini.

I don't see any clear pattern to your CA events. The first one you posted is interesting as it seems you have had two obstructive events or at least they ended with obstruction, and that prompted a CA event. One of my theories is that CA events are at least a partial control system problem. They can get initiated by a break in flow pattern. If that is repeatable then reducing the OA events may also reduce CA events.

Yes, I was aware of the events list. I believe the number in brackets is the length of the event in seconds so you can kind of tell how severe they are. I used to use it all the time, but more recently have found it quicker to set the zoom window size to about the right width and then use the left and right arrow keys to move the window along the time scale. Both ways work.

Your screenshot for tonight with Pressure Support zeroed and the pressure graph showing will be very telling. Oh, you can "Pin" the Events Flag section by right clicking in the Legend area and set it to be pinned. This is useful when you are scrolling down to see other details as you are most often trying to relate them to events.

From what I am seeing so far I am quite optimistic that you will be able to get your AHI under 5 and possibly lower without much pressure.

I thought there must be something different about your computer. I have looked at many SleepyHead posts but never seen one so scrunched down in size. I think if you drag the bar width over and increase the font sizes significantly you will be able to make it readable. It also helps a lot to use the Write a Reply button near the bottom when you are going to post a screenshot. Then you at least get the full width here rather than the narrower and narrower window.

I can't really read the second screen you posted, but yes it appears there is more OA. I have found the most effective way to reduce OA is to increase the minimum pressure. It is far more effective than increasing the maximum pressure. And as I say setting the Flex to 0 should help some too.

Yes, I would say hypopneas are preferable to full apneas, but they seem to get the same weight in the AHI. I believe there is some dispute in the industry on whether or not the AHI as a result is as good a measure as it should be.

One issue with hypopneas is that I believe both the DreamStation and AirSense machines will respond to them with more pressure. If they are really a partial central apnea without flow restriction, then that is not appropriate, as more pressure will not help. At some point down the road you may find you have to restrict maximum pressure so the machine does not unnecessarily increase it. I do that on both my wife's machine and my own.

It will depend on the sleep therapist how they react. About 4 years ago when my wife got diagnosed we ended up buying her S9 machine on line. The clinic that sold the machine at that time offered some setup and follow up as part of the service. The technician told me about SleepyHead and helped me use it to set up my wife's machine. The S9 does not allow wireless monitoring or setup. Your technician may not be so cooperative. In theory they should have Phillips software that does basically the same thing as SleepyHead, and they should have the same data as you are seeing on SleepyHead. So again in theory they should be looking at the detailed results like you are with SleepyHead. But, that is where I think it breaks down sometimes. They often only look at the summary data and don't want to be bothered by the detail. Often they only look at two things: how many hours per night is the machine being used (Compliance), and what the AHI is. And if they see 5 hours or more, and an AHI of 5 or less, they can say "you are treated", and technically they are correct.

If you have been talking to them by phone I would just ask about making the two changes I suggested. They should be able to do it wirelessly. And, you will quickly find out how receptive they are to user input. Some are good with it, and some not so much.

I am not a medical professional, just an apnea sufferer, but I believe that the tongue is part of the anatomy that causes obstructive apnea. Generally the incidence of obstructive apnea is higher when one sleeps on their back. When you are relaxed the tongue kind of sags under gravity and can restrict or block air flow. Some even go as far as sewing a tennis ball into the back of their PJ's to make it hard to sleep on their back!

The numbers look good. The good news is that you are mainly having obstructive and that can likely be fixed. However, if you can scroll up to the top and do a screen capture with the important stuff showing for graphs it would be much more informative. I pin the Event Flags so it always stays at the top, and for evaluating your setting effectiveness we need to see what you have at the top; Event Flags, Pressure, Flow Rate, Snore, Leak Rate. The other stuff is not so important at this point. If you can repost another image with these graphs showing it would be very helpful. Use the "Write a Reply" button at the bottom so the graph stays as large as possible here.

The other issue is that if SleepyHead is reporting correctly (and it does not always do that, there are some minor bugs) you have the Pressure Support set at a minimum of 2 and maximum of 7 cm. I would set them both to zero for now, and then try pressure support independently in a second phase of adjustments.

I think you are doing pretty good, considering that you are just starting with CPAP treatment. And yes the goal in CPAP treatment is to get AHI below 5.0 and lower is generally better.

Major leaks should be flagged with an area grayed out like the portion near the beginning of your sleep. Perhaps the mask was removed for a short period of time? The rest of the area does not look too bad. At the left hand side bar at the bottom of the Statistics section there should be a time over the leak redline. I like to see that under 1%.

I think your machine setup could be improved for comfort and effectiveness. The minimum pressure appears to be about 5.5. I would suggest that it should be a bit higher at 6.5 or 7 cm. The graphs are also indicating that some degree of Flex (possibly called A-Flex) is turned on. It reduces pressure on exhale. While this can be a small comfort benefit it also can affect effectiveness negatively. I would suggest turning it off or to 0. That is one nice feature of the ResMed A10. You can set it to use the pressure reduction on the going to sleep ramp portion only, and have it turn off automatically when you go to sleep. That way you get the comfort effect while going to sleep and the improved effectiveness when sleeping. Depending on how the machine is set up you may be able to turn Flex off yourself. The minimum pressure change will require going into the provider menu. You probably want to discuss the two changes with your provider and ask if they will change them. The effect of these two changes would be to keep the pressure more constant during the night, avoid some of the events which are happening at the lower pressure, and potentially reduce the maximum pressure that the machine is going to.

You have a very good layout of your SleepyHead daily report except that I can't read the text and I have a large screen computer. I just had a birthday and perhaps my vision has gone past the "best before" date! I would suggest a couple of changes. If you mouse over to just right of the left sidebar the cursor should change to the double bar. Click and drag right to make the left sidebar wider. Then go into File, Preferences, Appearance tab. There is an application data font size there that can be changed. Try 12 points or whatever works. When you are in there also uncheck the show pie chart event breakdown. The pie chart is not necessary once you make the sidebar and fonts large enough that one can read the colored bars that list the events and the frequency of each. last you do not need to display as many of the graphs. They are scrunched down quite a bit. The Events Flags and others are hard to read. Again click on the gray bar between the graphs and drag them down to make the Events Flags, Flow Rate, Pressure, Leaks and Snore bigger. The rest of the stuff is less important and let them scroll off the bottom as necessary. You can always scroll down to look at them if you want.

Last, I think you went into this knowing that there may be some central apnea issues, and your one chart does show it is a bit of a problem. Hypopneas are your highest portion, and I have concluded that hypopneas are actually incomplete obstructive OR central apneas. They have just not progressed to full stoppage of air flow. So your current hypopnea index could be a mixture of obstructive and central issues, and if you look at the central apnea it may be a bit understated. I believe that is the case with my results. I do not always get under and AHI of 5, and if I don't the main problem will be central apneas and hypopneas.

Hope that helps some,

The ResMed AirSense 10 AutoSet For Her is a very good auto CPAP. The selectable For Her mode can be better for those requiring less pressure. But it can be put in standard response mode too. The humidifier is built in. About the only other necessary option is a mask, and the ResMed AirFit P10 is not a bad guess for comfortable mask. Get the Fit Pack version which comes with three sizes of inserts so you can try each and decide what fits best. The other option and is not essential is the heated ClimateLine hose. It is a nice to have, and is about $30-40 extra. You will need a prescription in the US to get the machine though, unless you buy a used one.

With humidifier the AirSense 10 is about 2" less in width, and 2" less in depth that the DreamStation with a humidifier, so the footprint is less. However the AirSense is higher. My wife uses a ResMed S9 which is lower and she can put it in a drawer of the night stand and close the drawer. I can't with the A10, but the footprint is less.

The DreamStation has a removable humidifier like my wife's S9. At first blush that looks like an big advantage -- leave the humidifier at home when you travel. But the stuff all has to fit in the same bag, so you save a little weight but the package size stays the same. DreamStation does offer an optional travel case that is smaller and is not big enough for the humidifier, and I believe comes with a smaller less powerful power supply, but I believe it is another $150 or so and does not come standard with the machine.

On that note the A10 has a removable humidifier but that has the same smoke and mirrors benefit. It only saves about 1" in length, and again you have to use the same bag. And on top of that you have to buy an option cover to use the machine without the water container. Simply not worth it.

The standard included travel bag with the A10 is very good. There are separate compartments for the machine, humidifier, hose, and at the front another compartment for the power supply and mask. We ended up with two of these bags and my wife now uses one with her S9 machine, and has abandoned the bag that came with her S9 machine package. She modified it slightly, but it works fine, and secures better on a wheeled carry on travel bag. Here is a video that gives you a bit of a look at what it is like. The heated hose fits in the back just like the standard hose they show in the video.

https://www.youtube.com/watch?v=VuUOc4DB4f4

Make sure to check on the life of the memory foam cushion and the cost of replacing it. I believe on some models the memory foam insert is interchangeable with the standard silicone one, so you can switch without changing the whole mask.