Sierra

Are you taking any kind of blood pressure medication? What you describe is called orthostatic hypotension. It can be a side effect of a blood pressure med, and of course other things. You have to check blood pressure immediately on standing to detect it.

OK, I would like to be clear up front. I am not a sleep professional, just another sufferer from sleep apnea. I do have more central apnea than obstructive, and have done some research on that issue. I also use a ResMed machine so have no direct experience with the DreamStation BiPAP. I can makes some suggestions to consider, but you would be best advised to run them past a professional like a sleep doctor.

On the SleepyHead reports you are getting real close to having a useful chart to look at. I probably was not clear on the event flags. You have turned them all off, and you only want to turn off the VS2 flag. There are two boxes in the bottom left of the graph area. If you click on the Flags box it turns them all off and on. Click on it again to turn them all on. Then go to the box just to the right and click on it. It will bring up a list of the individual flags. You only want to click on the VS2 flag and turn it from green to red to turn it off. After that you should click on the previous day date to refresh the screen and then back to the current day. You should now see the event flags at the top, and the summary bars of each type in the left hand detail part of the screen.

On the graphs themselves I would click and drag on the gray bar below the Pressure chart, Flow rate chart, Snore, and Leak rate chart to make them bigger. It is OK to let those other less important variables scroll off the bottom of the screen.

As for settings, the current complicating factor is that you have been restricting the flow and pressure to the mask, but the machine does not know that, and SleepyHead does not know that either. So while the machine is showing a pressure in SleepyHead that is not the actual pressure you are getting.

SleepyHead is also showing you have the machine in Fixed BiLevel Mode with a setting of IPAP at 20 cm and EPAP at 10 cm. Pressure support is the difference between the two.

Your issue at the current time is getting the machine set properly. You need to decide if you want to try doing that yourself, or if you want to wait to get your machine provider (which does not sound very cooperative) or your doctor (who may not know how) to do it.

To my knowledge I don't think your provider can lock you out of your machine. Based on the DreamStation Technical manual you should be able to get into the Provider Menu and change your settings. If you are comfortable doing that then have a look at page 4-18 in the manual at the link below. It describes how to get into the Provider Menu.

DreamStation BiLevel Auto Technical Manual

Again only if you feel comfortable with making your own changes, my suggestion to consider is changing the Mode from the current Fixed BiLevel to Auto CPAP (Auto) mode. (page 4-19) This is a much simpler mode, and easier to setup. It will limit maximum pressure to 20 cm, but there is no indication at this point that you need more than that. If you set it to that Auto mode then there should be two further options made available for you to set. They will be the Auto Min and Auto Max (bottom of page 4-19, and top of page 4-20). My suggestion would be to start with a Auto Min of 8 cm, and Auto Max of 15 cm. Leave everything else the same and exit out of the Provider Menu using the Return to Patient mode (page 4-28).

If you go with this setup then the SleepyHead charts will start to become more meaningful and you will see what pressure is doing to your type of apnea and frequency. As the machine adjusts the pressure automatically you should be able to see when you are getting more and less apnea. That will give you information on what to set the pressure at for optimum results.

As far as the mask, I would stick with the one that seals best and fits best. There is no way you want to have the mask leaking intentionally.

Hope that helps some,

If you are changing pressures on the machine you must be in the clinical menu. If you scroll down in the clinical menu there will be an Options section and a menu item called Essentials. If you go into that and select the Plus setting you will get a more detailed sleep report right off the machine that should tell you what portion of the AHI was central apnea. I think it may be still there even if the card was out.

The AHI score just counts the apneas and does not rate their severity. The total time in apnea number is a good overall number that not only counts the number but also the length of the apnea. It is not compensated for hours of sleep though. And, of course it needs the card in to see it in SleepyHead. Some summary data will be saved in the machine and recovered but for the night you left the card out, the detailed data will be lost.

As a starting point you may want to do a self evaluation to see what your potential is for sleep apnea. See links below. There are two tests that are commonly used:

STOP-BANG

ESS - Epworth Sleepiness Scale

If the tests indicate a high potential for sleep apnea then they next step would be to show the results to your doctor and ask for a referral to a sleep clinic for a formal sleep test.

If you have not already you may want to read the article at the link below. It comes from another part of the website where this forum is. In the article it suggests complex sleep apnea is more likely to occur in the non REM sleep period of the night. That may be an explanation as to why you are seeing different levels of apnea during different times in the night.

Complex Sleep Apnea

You may want to try the site at the link below. There are quite a few different tools and tips on improving your sleep without drugs or a CPAP.

CBTi SleepWell

You mentioned that you think mask leaks may be reducing your pressure, and thus improving your results. My experience with a ResMed machine is that very large leaks do not actually affect pressure in the mask at all. The ResMed machines display "Mask Pressure" which is the blue graph trend in SleepyHead. When the leaks are major they get grayed out. If you look at the screenshot below you can see that mask pressure is relatively unaffected when there are big leaks or no leaks. The machine compensates for leaks.

Now, if you block the air flow with filter materials as I believe you are trying, that may reduce mask pressure, but that is a pretty erratic way to do it. My suggestion would be to get your machine supplier to reduce the pressure if you do not feel comfortable changing the settings yourself. It is quite possible that reducing pressure or pressure support may help your central apnea frequency, but the SleepyHead reports you have posted so far are not helpful in determining what the pressure should be. Some that have all the detail on your machine settings are too small to read. Others have the left hand side cut off, and the pressure scale in the graph does not go down to 4 cm so the EPAP pressure is not displaying.

So here is an example. If you can post something like this it would be very helpful, and I may be able to give you some suggestions on pressure.

We can get there. We just need some good SleepyHead charts to work from.

Bill the most useful screenshots you have posted have shown up on line, but the window width is so narrow it is impossible to see them, even with a large screen computer. I would suggest your repost them using the big orange "Write a Reply" button at the bottom. That will give you a full width window to post them in. Here are some instructions I gave to another poster to get your layout and then the screenshot:

"First the most important screen is the Daily Tab, but it has some clutter that should be cleared to make the most of the screen space. Especially here the image seems to get squashed down quite a bit. In the Daily Tab screen the F10 key turns the right menu bar on and off. Turn it off. Beside the current date in the top left is a little triangle. Use it to turn the full month calendar on and off. Turn it off. Then under File, Preferences, Appearance, uncheck the box that displays the event breakdown pie chart. It takes up too much room and displaces other important info. In the graph portion I like to keep the Event bar pinned, and then under that Pressure, Flow Rate, Mask Pressure, Flow Limitations, Snore, and Leak Rate. You can click on the left hand scale and drag them up and down to change the order. Clicking and dragging on the grey dividing bars lets you scrunch them down or expand them.

When you have the layout optimized, then maximize the window to full screen, and just press F12. This will save an image file to the Documents/SleepyHeadData/Screenshots directory. Use Windows File Explorer to display this file directory. Left click and drag the saved file to the body of a message here. The site uploads it and saves it here."

I will post an example from my machine at the bottom using the "Write a Reply" button.

I had some of the same issues with a ResMed AirFit P10 nasal pillow mask and pressures up to 15 cm. I have finally controlled it with using a Breathewear Chin Strap and now even taping my mouth closed with 1" paper medical tape - 3M Nexcare. Solved all my issues with a nasal pillow mask.

The data you have now suggests you will not benefit from a CPAP, but if they were offering a free trial, then it may be worth trying it.