Sierra

About all I can think of until you get your next sleep study done is to try lower fixed CPAP pressures. If you are comfortable adjusting pressures, you may want to try 7 cm for a night, then 6 cm for another night to see if your total AHI goes down as the pressure goes down.

I would be interested in seeing what those areas of high numbers of CA events looks like with an expanded time scale. On a PC you just left click repeatedly and the data window closes down and expands the time scale. The purpose would be to see what the flow rate looks like when it is expanded to the point each breath can be seen, and there are still a number of CA events in the window.

Have you tried EPR at 3 cm? If you turn it on without changing what you find is the best pressure you will see if it makes things worse or better.

To optimize your screen layout, I would suggest clicking on that triangle in the date bar to close the display of the whole month of dates. Not sure if it is the same with a Mac, but in Windows you can get suppress that pie chart which adds nothing by using File, Preferences, Appearance, and then uncheck the box to display the event breakdown pie chart. This will allow more details of your setup to show.

How long have you had the AutoSet 10 machine? It may be necessary to go to an AirCurve BiLevel machine, or ASV if some adjustments on the AutoSet don't help.

You wrote the following in an earlier post:

"Then he indicated that I "didn't have sleep apnea" because I was 0.3 away from the 5.0 AHI required. Yet he said, "If you want, we can try CPAP!" Well, why would I want to try a CPAP if I supposedly don't have it? What's waking me up?"

Assuming they are offering the CPAP as a free no obligation trial, I would take them up on the offer. That is the cut to the chase option. If it works for you, then it works. To get a new machine you will need a prescription, and if you are having an insurance company pay for it, then that will need a prescription too. So assuming if you try it and it works, and they write a prescription then you are good.

The AHI measures full apnea and hypopnea. There can be other less severe events which may be waking you up, so the AHI may be understating your issues. Just a thought...

I am not a fan of the SoClean machine, so I will not try to defend the use of it. However, that said, I don't think it should cause any harmful effects to the user if the instructions are followed. It is more likely to harm the mask and hose materials, but not the person.

Ozone is a very reactive gas, and time is the best way to neutralize it. Are you using the SoClean first thing in the morning, and removing the equipment from the machine as soon as the cycle is done? If you do that, then the ozone has all day to dissipate, and should not leave any harmful residual ozone.

Perhaps others that use the O2 measurement can comment. From what I know about it, those are not numbers to be real concerned about.

We are getting there. That first graph showing the event flags, Flow Rate, Pressure, Leak Rate, and Snore is the most useful one. I would just post that one for now. The information in the other two graphs is less useful for now.

The chart could be improved by using the Flags control in the lower left corner to turn off the VS2 Vibratory Snore. Turn VS2 to red instead of green. I have never seen any use for that, and it just makes a big mess of the charts. It would however be very useful to include the bar on the left of the screen that is missing. It contains all your setting data and summary results for the night. Last if you right click on the scale of the Pressure graph, then on Y-Axis, and then set the mode to Override with a minimum of 4 cm, then it will show the whole pressure picture. Currently the bottom is cut off as it looks like it starts at 10 cm.

If you have a complete night of sleep with the old mask as well as a complete night with the new size mask that would be useful too.

The ResMed AirSense 10's AutoRamp function is a significant improvement over the old timed ramp system in the S9 machine. I would encourage you to give it a try. It is not really a ramp at all, as all it does is hold a setable ramp start pressure until the machine detects you are asleep, and then it ramps up fairly quickly to the Minimum set pressure. This is really useful as you do not have to try to guess how long it will take you to get to sleep. You just pick a ramp start pressure that feels the most comfortable to you, and that is what you get until you go to sleep. No, slowly ramping up in pressure. And if you go to sleep quickly the machine goes to the treatment mode right away instead of having to wait until the ramp timer expires.

And this can be improved even more by using the ResMed feature that allows you to use EPR on the ramp only. When you use EPR on ramp only when set at 3 cm and the ramp start set at 8 cm you will get a very comfortable 8 cm on inhale and 5 cm on exhale. Then when you go to sleep the EPR gets turned off and the pressure ramps to minimum treatment. During the ramp hold, the EPR is a harmless comfort feature. But during treatment EPR reduces EPAP, which reduces treatment effectiveness. The machine will increase pressure to compensate if the maximum allows. But, you will endure higher IPAP pressures to get the same treatment effectiveness. This can be an issue with those of us that use higher pressures and suffer from mask leaks as pressure goes up. Also some incur more central apneas as pressure goes up.

Those are very interesting charts. I've looked at a lot of different charts, but have not seen one like your first one before. You don't seem to suffer from any significant central apnea, but those periodic flow rates sure look a lot like a periodic breathing pattern that can be caused by breathing control system issues. They usually lead to high CA frequency not OA though. Your second chart looks very normal, other than the dip in O2 level which does seem a little out of proportion to the apnea event.

My first thought, is that your pressure support may not be doing you any good. In the first chart most of the time the pressure is maxed out at 15 cm IPAP, and with the 3 cm of pressure support, EPAP maxes out at 12 cm. Obstructive apnea is just as likely or more likely to occur during EPAP compared to IPAP. This means your effective treatment pressure is really being limited to 12 cm. If you are comfortable with making your own adjustments, I think the first thing I would try is setting the pressure support to zero and the max min pressure to say 15 cm and 8 cm respectively. That should allow the EPAP to go up as high as 15 cm. Maximum IPAP will not be increased above the 15 cm. You may see a significant improvement in obstructive apnea frequency with the higher EPAP pressure. Once you find out what pressure works you may be able to lower the maximum, and increase the minimum to get even better results.

The other thing you might consider is a soft cervical collar. Some people seem to suffer from positional issues that cause high frequency obstructive events only when they are in a certain neck position. The collar can help avoid that positional issue. I have not used one, so cannot offer any personal testimonial, but it does make some sense.

Hope that helps. If I can find something more about that odd flow rate pattern I will post again. You also may want to try and squeeze the snore chart on the screen. It often can give an indication of pending obstructive events.

Here are some instructions assuming a PC is used. A Mac should be similar but with the Apple equivalents.

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.

Hope that helps,

I would like to give you a simple direct answer, but with central apnea there seems to be nothing simple about it. One of the things I have noticed is that if I try to sleep too long, I tend to get more apnea, especially near the morning. I think that when you are waking up and going back to sleep that is conducive to apnea of both types. More pressure can generate more CA events. Is it possible that your machine is responding with more pressure toward the morning? It would be helpful to post a Daily Report screenshot to look at. On a PC, use the F12 key to save the file and then left click and drag the image file it saves in SleepyHeadData/Screenshots to the body of the message.

I'm not so sure 20-40 second apnea events are that short. My central events seem to range from 10-17 seconds, and the obstructive ones 10-20 seconds. I don't monitor O2, so not sure what impact it has. What are your AHI values like? Assuming your 02 meter is compatible with SleepyHead, I believe it has the ability to integrate the O2 values in with the other data so you can see what they are related to.