Sierra

After the ramp the pressure should self adjust between the minimum and maximum set pressure. Those two pressures will be displayed for about 10 seconds after you start the machine. During the ramp it should start at the Ramp Start pressure or the default 4 cm if the Ramp Start pressure is not set. It should increase slowly from the ramp start to the set minimum over the 45 minutes. If the ramp start is set at 4 cm then the EPR can't do anything because the machine will not go below 4 cm.

I would strongly advise an Auto CPAP or APAP. Yes, you likely could get away with a fixed pressure CPAP but it is going to be more difficult to get setup properly, and the difference in price is quite small. When a fixed CPAP is prescribed it is usually after an in lab titration study to determine what pressure it should be set up. With an APAP you really do not need the titration study. The machine is just set with a fairly wide pressure range and then tweaked after you gain some experience with it. SleepyHead software would be very helpful if you are going to do the setup yourself.

The machine I would recommend would be the ResMed AirSense 10 AutoSet For Her. I would suggest the For Her version even if you are male. It has an extra setup mode that can be used or not used at your choice. Ask your sleep doctor about the need for a BiLevel machine. But, unless you need pressures of more than 20 cm it would not be necessary. My recollection is that your diagnosis was likely in mild apnea zone, and should not need high pressure to treat.

Here is a link to a package from a Toronto company that I bought from. They are pretty good to deal with. They will require a prescription if you decide to order from them. This package includes all you need to get started including a choice of a few different masks. I use the ResMed AirFit P10 and find it quite comfortable. Ideally you would want to try one before buying, but if that is not an option, I would suggest that one.

ResMed AirSense 10 AutoSet For Her Package

Hope that helps some,

I had a quick look at the technical manual for the AirMini and it appears to be virtually identical to the AirSense 10 in features. I would setup the AirMini to be the same as what works on the AirSense 10. That said your 5-20 or 4-20 sounds like an out of the box setup and is not usually ideal for long term use. A wide range like that can be somewhat useful to establish what pressures you really need, but probably not an ideal setup for the best AHI results.

Having your maximum pressure set too high can lead to some discomfort, but really does not do much to the overall results. Setting the minimum too low can cause some comfort issues, and can also lead to excessive apnea events especially early during the night.

You may want to discuss the settings for your AirSense with your sleep technician to see if they could be improved. What I would look at is the Statistics Tab in SleepyHead, and specifically the 90% pressure. That pressure should be very close to what you could get away with if you only had a fixed pressure machine and not an auto adjust machine. It is also probably very close to what may be an ideal minimum pressure to use. And the maximum pressure could be as little as 1 cm above that. Say for example your 90% pressure average is 12 cm. You could set the minimum at 12 cm and the maximum at 13 cm. SleepyHead will tell you very quickly how good a job that is doing for you. If your machine keeps the pressure at minimum and your AHI is good, the minimum may be too high. If the machine keeps the machine at maximum and you are having obstructive apnea events with the pressure at maximum then it may be too low.

I look at the going to sleep ramp function as a pure comfort feature. It has little to do with your treatment effectiveness, but it can have a lot to do with how quickly you can go to sleep. What I like is to use the ResMed Auto Ramp. I then set the Ramp Start Pressure in the 7 cm to 8 cm range. I also set the EPR at 3 cm, but the Type as Ramp Only. Say you choose 7 cm, then what that would do is give you 7 cm on inhale and 4 cm on exhale until you go to sleep. Then the machine ramps up the pressure to your minimum (say 12 for example), and stops the EPR. At least that is what works well for me.

You can set up both the AirSense and AirMini with the controls on the machine. Here are some links to the manuals which show you how to set up each one.

AirMini Manual

AirSense 10 Manual

Edit: I'm not sure that SleepyHead supports the AirMini, and if so you can monitor what you need for pressures with the AirSense 10 machine, and then just use the same settings in the AirMini.

This is what obstructive apnea looks like in a SleepyHead report when it occurs. Last night I had a series of 4 OA's in quick succession. After the first one in particular you can see the wild flow rate fluctuations and mask pressure fluctuations. Mask pressure is set at a fixed 12.2 cm, but it went as low as 8 cm and over 16 cm. I was probably gasping for air. Keep in mind that you can have an apnea just when you are going to sleep, not just when you are sleeping.

Another solution may be to use a heated ClimateLine hose and run the humidity on auto. The heated hose will cost about $40 though.

One other thought came to mind. Is it possible that you have somehow initiated a mask fit test? That will ramp pressure up to your maximum set pressure.

Ken it does seem possible that your machine is defective if you are sure it is set up they way you say. There is one more pressure that is in the mix though. That is the Ramp Start pressure. That defaults to 4 cm, but can be set higher up to as much as the minimum treatment pressure. When functioning properly the machine should go to that ramp start pressure in a few seconds. Then it should ramp slowly over the 45 minute ramp period of time to your minimum treatment pressure.

I have the ResMed AirSense 10 also but have it set a little differently. I use the Auto Ramp feature which holds the pressure at the Ramp Start Pressure until it decides you are asleep. Then it ramps up to the minimum treatment pressure. I also have my EPR (Expiratory Pressure Relief) set at 3 cm and set to be active only during the ramp. The EPR stops when I get to the treatment pressure. Using EPR during the ramp lets me set the ramp start pressure higher so I can get the benefit of the EPR reduction on exhale while keeping the inhale benefit of higher pressure.

But, I think I would first check with your sleep technician to see if the machine is defective or improperly set. If you want to check the settings yourself see the manual at the link below. Instructions to find what your settings are start on page 14.

AirSense 10 Manual

Your respiration rate is a little higher than mine which is at about 19 median and 22 for 95%. I'm not sure of the significance of that. I'm 69 and have no known heart disease.

Your AHI is excellent. Perhaps if anything your pressures may be a little too high. Also reducing the maximum pressure from 20 which is the machine default may cut off some of those pressure spikes that the Dreamstation likes to make. I would ask your sleep specialist about running a minimum of 10.5 and a maximum of 12. It might provide for a more comfortable sleep if the pressure runs a little lower.

I also see that there is periodic breathing flagged at 21:55 or so. You may want to expand that out (keep left clicking in that area), and take a screen shot to show your cardiologist. It can be a symptom of heart issues. Your Statistics page should give you a running summary of how frequently periodic breathing is occurring which would be useful to report to the cardiologist as well.

That is about all I can think of. Looks like a pretty good sleep report overall.

Is your machine the AutoSet version? It will say AutoSet on the front near the bottom beside the humidifier reservoir. The AutoSet is capable of adjusting the pressure during the night between a preset minimum and maximum limits. If you don't have the AutoSet then the pressure will be a single fixed value, which is 7.0. It is also possible to set the AutoSet version to CPAP mode and then there is only a single fixed pressure. They could have done that. The actual setting should be displayed in the top right of the display when you start it up. If it is not an AutoSet or is an AutoSet in CPAP mode there will only be a single number, not a minimum and maximum.

The AHI is OK, as anything under 5.0 is considered acceptable treatment. However, most will try to get the AHI lower than that. With no central apnea that is usually possible. I struggle to get my AHI under 3.0 as I have significant central apnea frequency, which is a clear airway event. CPAP pressure does not resolve them. Obstructive apnea is resolved with pressure, and your son appears to have nearly 100% obstructive apnea. AHI can be very variable from night to night, so I wouldn't get get concerned until you have at least a week of data. If it is averaging 3.0 or so after a week, that may indicate a pressure change is required. It doesn't hurt to limit the pressure a bit at first until your son gets used to it.

If the EPR is active during sleep it will be reducing your effective pressure as well. Turning EPR off would likely reduce AHI without increasing the 7 cm set pressure.

Hope that helps some,

You may want to consider switching the EPR to "Ramp Only" mode, if your machine allows it. My view is that EPR does no harm when you are awake, and it can provide some extra comfort in getting to sleep.