Sierra

If you do not have the EPR turned on the pressure will be steady. When you breath out the air should flow out the vent on your mask. With the EPR turned on, the pressure will cut back a little bit when you exhale. You can see that with the blue line on the graph in my report above. The pressure fluctuates up and down with each breath during the ramp hold. Then it stops fluctuating when I am up to pressure. I have no difficulty breathing out against 12-13 cm of pressure.

You can get a small portable SD to USB card reader for about $10-$12. It would be worth it to be able to monitor your results on SleepyHead.

Not totally sure how ResMed measures snore, but it may be a higher frequency flow/pressure variation. It is probably not at a level where it would be audible to someone else, or yourself if you are asleep. Here is what a typical night looks like for me. I often see a bit of a snore when I fall asleep during the Auto Ramp portion of the night when pressure is still low, but after that it is essentially zero.

The AirMini does not use the traditional humidifier, so that may be the reason for the higher temperature.

Getting your mask to work for you is the most difficult part of CPAP. You will need to learn how to adjust your mask. The manufacturer will usually have some tips or a video.

On the mask type, you may want to ask about a nasal pillow type if that is still an option for you. They tend to be easier to adjust and more comfortable for most.

If you have a PC or Mac and a SD card reader, you may want to consider downloading the free SleepyHead software which allows you to chart your detailed data from the SD card in the machine. It would allow you to show your supplier what the machine is doing and potentially expedite a replacement. Here is what my chart looks like when using the Auto Ramp, Ramp Start Pressure of 8.4 cm, EPR at 3 cm Ramp Only. It generally gets me to sleep in 15-20 minutes.

I may have skipped over some of your questions.

"Does an APAP provide more data than a CPAP? Is an APAP machine basically a more modern BiPAP machine? Or can I run an APAP as CPAP or BiPAP?"

Yes, in some machines the fixed pressure CPAP does not store detailed data. I would not accept any machine that is not able to supply detailed data to the SleepyHead application. The ResMed AutoSet certainly does store all the data and is compatible with SleepyHead.

Both the APAP and BiPAP or BiLevel machines are state of the art design. There may be a few refinements on the current AirSense 10 (APAP) that are not on the current AirCurve 10 (BiLevel). But the BiLevel machine will also have some features that the APAP does not have. The main one is that the BiLevel will go up to 25 cm pressure instead of 20 cm. It can also provide up to 10 cm differential between inhale and exhale (pressure support). The APAP is limited to 3 cm differential. The BiLevel also has some adjustments on how it switches from inhale to exhale. Discuss this with your doctor, but I would suggest these are all moot points for you, as you are very unlikely to need very much pressure, and no where near 20 cm with a mild obstructive apnea. And it is usually better to run no differential between inhale and exhale, except during the going to sleep ramp up period.

You can run both the APAP and BiLevel (ResMed machines) in CPAP mode. Pressures are limited to 20 cm in CPAP mode. You can't run an APAP as a BiLevel as it does not have enough pressure. You can make a BiLevel behave pretty much like an APAP, but it is more complex to set it up to do that.

I think what you may be asking about is if you should get a BiLevel given that you may only get one shot at a machine each 5 years with your insurance company? First, I suspect that your doctor may not be willing to write a prescription for one if you only have mild obstructive apnea. And there may be a bit of a compromise in your comfort by using a BiLevel. For example I don't think it has the ramp only feature on the pressure differential between inhale and exhale. The APAP does.

Another thing to consider is what can you negotiate with the Insurance company. My son had a fairly generous insurance plan when he was prescribed an APAP. He talked direct to the insurance company and was able to negotiate getting two machines covered. The sleep clinic were offering the single APAP for $2400, but an on line store was offering the same APAP plus a travel APAP for less than $2000 total. The insurance company paid it. The other possibility is if you buy at a lower price and don't use up your maximum allowance, will they let you buy an updated machine in 3 years instead of 5 years?

Hope that helps some,

George, the prices of machines probably vary by country. However in Canada where the original poster is from the price difference between a CPAP and APAP is very small. The ResMed AirSense Elite (fixed CPAP) sells for $850, while the ResMed AirSense Autoset (APAP) sells for $880 Canadian. It makes no sense to get the CPAP machine. The APAP can be easily set to act like a CPAP if you want to as well.

I agree with you about using/trusting the "professionals". Some are very good and do a good job, and others not so much. At the end of the day it is us that suffers the consequences, and for that reason I feel I need to be involved and monitor my results.

I found a bit of information about increased respiration rate in seniors, and it seems to suggest that a common simple cause can be a respiratory illness like a cold or flu.

You are running very low pressures and getting good results. If it was my machine I would set it up a bit differently though. I would Use the Auto Ramp feature with a Ramp start pressure of 6 cm. I would leave EPR turned on to 2 cm but set to act during the Ramp Only. And yes I would set a pressure minimum of 6 cm. Maximum could stay at 20 but could be set much lower.

It does look like you are getting quite high snore values. I suspect if you set the EPR to turn off at the end of the ramp those snore values could go down because the exhale pressure will go up to 6 cm, while it currently is at about 4 cm all night.

But discuss that with your doctor and see if they agree and will change the machine for you. But bottom line is that you are getting good results except for the snore values.

I use the AirSense 10 AutoSet and find the ramp and EPR works very well for me now that I have it set up properly. Here are my basic settings:

Ramp: Auto (Which means it holds the pressure until I go to sleep and then it ramps up)

Ramp Start Pressure: 8.4 (This is what I find comfortable but somewhere in the 7-8.6 range should work for most)

EPR: On

EPR: 3 cm

EPR Type: Ramp Only

So what that does for me is give me an 8.4 cm inhale pressure which I find very comfortable, like I am wearing no mask at all. It also gives me an exhale pressure of 5.4 cm (8.4 minus the EPR), which I also find very comfortable. It continues this way until the machine detects I am asleep. Then the pressure ramps up fairly quickly to my minimum set pressure of 12.2 cm, and the EPR turns off. Both inhale and exhale are now 12.2 cm. I also find that quite comfortable even when I wake up in the middle of the night.

Here is what this looks like in SleepyHead. You can see that the pressure holds at 8.5 while cycling down to 5.4 (mask pressure) for about 11 minutes, and then ramps up over about the next 3-4 minutes, and then the EPR turns off. This varies of course from night to night depending on how fast I go to sleep. Just after 22:28 you can see a tiny blip on the snore chart. That is where I probably start to fall asleep. I frequently see that, but not always.

I think your machine may be faulty based on what you are describing.

You should be able to change your ramp time with the user menu. I would try changing the time setting from 45 minutes to some other time and to Auto just to see if it behaves the same. But I agree if it is working as designed it should work with a 45 minute setting for the ramp.