Sierra

The AirSense EPR is probably not really intended to assist in breathing stoppage as its main purpose. It is unique in that it can use EPR during the going to sleep and then turn it off when you go to sleep.

The next step up from an APAP like the AirSense is a Bilevel like the AirCurve 10. There are various models but what it provides over the AirSense is the ability to provide more than 3 cm of EPR or Pressure Support as it is called on a Bilevel. With a higher differential between inhale and exhale it can assist breathing more when the person is not doing it themselves. Depending on the machine this pressure support can be variable in that it detects when you need more or less pressure support. In the AirCurve line there are some that have a S mode which provides a back up breathing assistance at I believe a fixed 25 bpm when it detects no breathing. These machines also have some settings that let you control how the switch from inhale to exhale pressure to fine tune the breathing assistance.

Then there is the AirCurve 10 ASV model which is an adaptive servo-ventilator machine. It monitors every single breath and assists on a breath by breath basis to maintain breathing. Here is a link where you can find more info on the various options. It is pretty high level however, and you have to get into the technical manuals to see what they really can do. Phillips Respironics probably have similar capability machines. Sometimes the bells and whistles differ a little.

ResMed Sleep Devices

When you get your sleep report you should discuss these options. However if your apnea is in the mild category, they are not likely going to want to consider anything more than an APAP. In that category I would recommend the ResMed AirSense 10 AutoSet for Her. The For Her version as an additional option mode which may be of use to a male or female, and the price is the same. You can select the For Her mode, or standard APAP mode.

On portability the standard AirSense model is quite portable, and what I would recommend using. They come with a nice carrying case that holds everything you need, and has a strap to attach it to the top of a rolling bag. We have a Z1 Travel Auto CPAP but don't use it, as it has too many compromises for my liking. In my view, a travel CPAP is a solution in search of a problem. A CPAP is considered a medical device and you can carry it on a plane in addition to your normal carry on limits. That is why it is handy to have one that attaches to your carry on rolling bag.

Hope that helps some,

If you still have your CPAP, as I suggested to Joe, you may want to look at the data on SleepyHead to see if you can figure out what is going on during sleep. It does record a lot of data. It should be still there on the SD card, even if you are not using the CPAP now.

What mask do you have now, and what masks have you tried?

Your pressure graph is covered up, so it is hard to tell what is going on. It looks to me that you have set your Pressure Support minimum to zero, but the maximum is still 8 cm. If you set them both to zero, then it should force the machine to push up your EPAP pressure more. It looks like you are having mask leak problems related to the higher pressure based on your time over the leak redline.

No, I did not take the data to my doctor. I just concluded that this full face mask (Mirage Quattro) was not the one for me. For what it is worth, I don't think these events flagged by ResMed as central apnea events are real apnea events. It is just the waking up and going to sleep process. Some call it sleep wake junk. And that is kind of what it is - Junk. That said if it is happening all the time it is not going to be helpful in going to sleep.

If your machine is a ResMed like the AirSense 10 AutoSet it certainly is supported by SleepyHead. The older S9 model is too. To run SleepyHead you need a PC or Mac with a SD card reader. Assuming your ResMed has an SD card in it, all the data will be on it, so you can go back and look at it.

SleepyHead Download Site

SleepyHead Beginner's Manual

How do you have your CPAP set up to go to sleep? Do you use the Auto Ramp? EPR On? EPR Full Time, or Ramp Only? These are the features that may help you get over this going to sleep apnea issues.

I now see you are not using the ramp feature, so the data you have collected should show all of what is happening. But, once you see what is going on, then you may want to set the ramp features. It is far from a sure thing to help you, but worth a try. It should improve the comfort level. If you need any help just identify your specific model of ResMed and I may be able to answer your questions. And while the machine may not flag the apnea events, you will still be able to zoom in and look at your actual flow rates to manually identify a stoppage in breathing, even if it is only for a few seconds. All you do is left click on the area of interest. With each click it zooms in further until you can see every breath.

When you say you made the minimum pressure to Zero, do you mean you set minimum and maximum pressure support to zero? I think that would be the only way in Auto BiPAP mode to prevent the pressure support (red line), and just let the EPAP (green line) address your apnea.

When you switched to CPAP mode it appears your pressure settings were overridden, and you were getting a constant EPAP pressure of 5 cm. This clearly shows you need quite a bit more than 5 cm to address your apnea. But if you had set it at 13 cm or so, it potentially could have worked quite well.

When you change the mode to CPAP there should be a cmH2O icon - Pressure setting become available in the setup menu. It may default to 5 cm if you don't actually set it.

I think it is normal for body temperature to drop some at night. It helps you sleep. When we are too hot that usually results in a poor sleep. However, your drop does seem excessive. How are you measuring it? It can be hard to get an accurate reading of body temp.

I really doubt that the CPAP could be causing that much of a drop. That said I use a heated hose on my CPAP with automatic humidity control and a delivered air temperature set point of 27 C (81F). I suppose that may help prevent excessive cooling, but since I have no temperature measurements I don't know.

More or less blanket covers are the usual way to control temperature to maximum comfort. I believe 18 C (65 F) is considered to be an ideal room temperature for sleeping, so blankets are required at that temperature for most.

Joe from time to time I have had issues going to sleep. However for me it seems to be associated with my CPAP equipment. When I first started using a CPAP or try a new mask that doesn't get along with me, I can have issues. Here is one such event captured in SleepyHead which is a free software that one can use to display CPAP machine data. This was an attempted 45 minute afternoon nap to test out a mask that did not work well for me. I doubt I was asleep for much if any of the time displayed. However the machine recorded many CA or central apnea events, possibly as I went to sleep briefly and woke up again. This was using a constant pressure at machine start up.

Now here is last night's going to sleep period where I am using the Auto Ramp feature of the ResMed AirSense 10. I also am using an EPR of 3, which turns off once the ramp/hold period is over. Notice that the breathing pattern is much smoother and no apparent apenea events. However they would not be flagged, as ResMed suppresses the report during the hold/ramp period. I think the other part of this is the EPR function where the exhale pressure is 3 cm lower than the inhale pressure. This may assist breathing and avoid some of the sleep wake irregular breathing issues. Notice that at some point the breathing becomes quite regular (probably asleep), then the pressure starts to ramp up, and when it reaches set pressure the EPR stops, and the mask pressure stops cycling up and down.

If your machine is compatible with SleepyHead you may want to use it to look at your areas of difficulty and see in more detail what is going on.

How effective is the treatment for you? Are you getting low AHI numbers? I'm just wondering if you may be still having some residual apnea events.