Sierra

The machine display turns off when you are sleeping. Not sure what would happen if you touched the round button when someone is using the machine and is sleeping. It might re-display the pressure. You will need SleepyHead to see the detail of what is happening during sleep.

An auto CPAP normally has a minimum pressure and maximum pressure, unless they are set to a single fixed pressure. When you turn the machine one, there will be a brief display on the machine. In the middle of a circle the current pressure (usually Ramp Start Pressure) will be displayed. Above that and to the right the minimum and maximum pressures will be displayed. During the night the machine will automatically adjust the pressure to what it thinks is needed, but is forced to operate between the set minimum and maximum.

The ramp is just the short period of time intended to maximize comfort to go to sleep. When the Ramp is set to Auto, it does not actually ramp the pressure up. It simply holds the pressure at the Ramp Start Pressure. Ramp start pressure has to be set at the minimum pressure or lower. The machine monitors breathing and when it decides you are asleep it then ramps the pressure up to the minimum.

EPR lowers the pressure on exhale and can be set to off, 1, 2, or 3 cm. It can be set to be on full time or just during the ramp period.

So, say for example the Ramp start is 4 cm, minimum pressure is at 7 cm, and EPR is full time at 3 cm. The machine will go to 4 cm when you start it up. However the EPR can not reduce pressure on exhale because the machine will not go below 4 cm. So the pressure will be a fixed 4 cm on inhale and exhale. Then when it ramps up on sleep onset to the 7 cm minimum, the EPR will start to function and inhale will be 7 cm and exhale will be 4 cm.

If it is set up this way, it can cause two issues. First as I said before trying to go to sleep with a fixed 4 cm of pressure can leave you feeling short of air with a suffocating type feeling. And the second issue is that if EPR starts cutting back pressure after going to sleep then the treatment effectiveness can be reduced. Apnea can occur on exhale as well as inhale and the exhale pressure is reduced. If the machine detects apnea due to the reduced exhale pressure it will push up both the inhale and exhale pressure to compensate. This results in higher average mask pressures which may be uncomfortable or cause mask leaks.

In any case if you turn the machine on, you will see these pressures on the display and it will confirm where it is actually set at.

Ask your son how it feels though. 4 cm might be enough for him. I find when the ramp start pressure is set right it feels like you are not wearing a mask at all. Breathing is as free and easy as having no mask on at all.

My son has a full beard and uses a CPAP. His mask is a full face Mirage Quattro, and he likes it. I've looked at his results on SleepyHead and he has fairly good leakage rates, despite the beard. I tried one of his spare masks and couldn't make it work. It just seemed impossible to make it seal with pressures in the 12-15 cm range. It seemed to walk around on my face, make rude noises, and blow air in my eyes. I couldn't make it through a full night with it. It is also bulky and I had a hard time keeping it in place. I have also tried an AirFit F20 full face. It had similar issues to the Quattro, but was better. I think I managed 4-5 nights before giving up on it.

That said, you are running just over 6 cm of pressure so you may find it much easier to get a seal without using too much strap tension. Hard to predict.

There is a rather unique style of mask that fits in the mouth kind of like a snorkel for swimming. You have to use nose plugs with it to prevent leakage out the nose. I don't know of anyone that uses this mask though. A link:

Oracle HC452

With that pressure setup I do wish you luck but I would feel short of air while going to sleep at 4 cm pressure. If your son feels that way, I would ask your provider about changing the the Auto Ramp Start Pressure to 7 cm, with the EPR set at 3 in Ramp Only mode. When setup that way, it would feel easier to breathe in (with 7 cm of pressure), and easier to breathe out (against 4 cm of pressure).

If the Ramp Start is set at 4 then it will hold at that pressure until he falls asleep. It will depend on how comfortable he feels with that very low pressure.

Note that with either setup the treatment pressure will be 7 cm, and treatment effectiveness would be the same. The only benefit in using the EPR during ramp is for comfort. It does not change treatment.

Dealing with central apnea is not easy. I suffer from it to some degree. I can get my AHI down to the 3.0 level, but over half of that will be central apneas. I just use a standard Auto CPAP, and actually now have it set at a fixed pressure of 12.2.

Here is what I know about treating central apnea. The usual first strategy is to keep the pressure as low as possible but still deal with the obstructive apneas. Expiratory Pressure Relief (EPR) or Flex is usually not used as it forces the inhale pressure up. Has your doctor tried minimizing the pressure? What sort of pressures have you tried?

If that fails, then sometimes using EPR may help some. The thought is that it assists breathing and helps to prevent you from stopping breathing. EPR is limited to 3 cm though and does not do that much. So, the next step is to try a BiPAP. It can add quite a bit more than 3 cm to the inhale pressure (Pressure Support). Depending on the model there can be some adjustments which change how the machine switches from inhale pressure (IPAP) to exhale (EPAP). Again that may help to keep you breathing. And again depending on the model of machine you have they may have a backup breathing feature. When it detects you are stopping breathing it attempts to assist your breathing with the pressure support. I believe ResMed calls it S mode. What BiPAP do you have?

The next step if a BiPAP fails is to use an ASV. It follows your breathing pattern and changes pressure support to assist your breathing on a breath by breath basis. I think the main difference is that a BiPAP follows the trend in your breathing, while the ASV looks at each breath and makes adjustments in real time. Here is a link to a ResMed product page for the AirCurve 10 ASV. It explains how the machine addresses central apnea. There is one precaution to be aware of though. A heart function test called the Left Ventricle Ejection Fraction (LVEF) needs to be done before an ASV is considered. If LVEF is <45% an ASV will not be used.

There is a humidity setting which can be adjusted manually if you have the standard hose. I believe all it does is adjust the amount of heat under the water reservoir.

I believe the machine has a pre warming feature as well that lets you warm up the water reservoir before you go to bed. I have never used it.

When you have a ClimateLine heated hose then the machine will detect it and switch the humidity control to automatic. I presume it adjusts the heat under the water reservoir automatically instead of manually. And you can also set an air temperature which must be controlled with the heated hose. I set mine at 27 C, and find that very comfortable.

You said you had excess water and you took care of it. What exactly did you do?

A CPAP is not automatic nirvana. One needs to understand what it is doing and how it works. It has taken me 6 months, but now I am actually starting to see the benefits.

One other thought. What size is your SD card and how long has it been in the machine? It sounds like you are only collecting summary data which is all that it stored in machine memory. You need a functioning SD card to collect detailed data for SleepyHead to read.

You must not be using SleepyHead correctly. It supports the AirSense 10, and I use it. See the chart I posted a little bit further down in this thread. You want to look at the Daily Report. You can zoom in on a particular section by left clicking on it, and then using the arrow keys to zoom in and out, and to move down the time scale. See this guide to SleepyHead:

SleepyHead Beginner's Guide

Do you know what your 90% or 95% pressure is on average? That will give some indication of the degree of your apnea.

If you plan to import the oximetery results to SleepyHead here is some information on which models are compatible.