Sierra

I have downloaded the Windows 10 version from the link below, and it works fine for me on a couple of machines running Windows 10.

SleepyHead Download

Here are some basic instructions which may have some help.

SleepyHead Basic Instructions

This is a discussion forum for the software, but it is not very active.

SleepyHead Discussion Forum

What machine do you have? The software supports most ResMed and Phillips models.

I read an article at CBC on line about a University professor in Nova Scotia that is also a pharmacist. He (or more likely his grad students) has developed a website to provide resources to address insomnia and getting a good night's sleep without or with minimal medication. His view is that too many sleep aid medications are used, and they in turn are causing falls in seniors which cost the healthcare system a lot of money. He promotes the use of CBTi, or cognitive behavioural therapy for insomnia. It is a very good website, and I have gotten quite a bit out of it. There are a number of tools to evaluate your sleeping beliefs and habits. Check out the CBTi tab in particular. Here is the link:

Sleepwell

The author of SleepyHead is Mark Watkins. The link below is to a SleepyHead forum where he participates, but has not made a comment for 5 months or so. He indicates he is taking a break from development work. I see others have suggested an Android version. In any case you could make a suggestion there.

SleepyHead Discussion Group

Another user reported something similar a while back. Have a look at that thread.

What is your minimum pressure set at? It should display briefly on the machine when you turn it on each night. The minimum and maximum will be displayed in the top right. The current pressure which should initially be the ramp start pressure will show in the middle of the circle, if you are using the ramp. The reason I ask is that out of the box the machine will have a minimum of 4 cm. Some people, like me find that pressure too low and it feels kind of like suffocating. That said, you should feel that way each night on start up too, if the minimum pressure is too low. Something to discuss with your provider.

I use the same machine and also use some free software called SleepyHead. You can view your detailed machine data with this software including the actual pressure delivered during the night. It certainly would tell you what is going on with pressure. The detailed data of all your nights so far with the machine will be stored on the SD card, so it would be a matter of downloading and installing the software, then transferring the data from the SD card with a card reader to your computer. That would let you look back and see what happened to your pressure on the nights so far. Assuming it verifies what you are experiencing it would be good evidence to give your provider to get a new replacement machine.

SleepyHead Download

SleepyHead Basics

One simple thing to check too is your power cord connections. This summer I had bought my wife a new power supply for her CPAP. It worked OK for about 4 nights and then it started to shut off in the middle of the night, many times causing symptoms like you report. It turned out to be a faulty plug on the new power supply. It was a molded connection and the wire or solder joint inside the plug must have been bad. If you wiggled it a certain way you could make the machine stop and start. I gave my supplier a copy of the SleepyHead report showing what it was doing, and they immediately sent me a new one.

Hope that helps some,

A post from Ace copied and pasted here:

"Sierra, I am a 52 year old man that was diagnosed with obstructive apnea. I also have astma, but not central apnea. I use the RESMED airsense 10 since one year approximately. The healthcare detected high blood pressure cause of apnea. And since I got the apap treatment the blood pressure has gone down. But now when I went through a 24 hour test I've noticed that the blood pressure is high during awakening. I've also noticed that I can wake up a couple of times catching my breath........ when I'm half awake, so to speak, it's almost like I have central apnea. This is quite scary, when you find yourself not even atempting to breathe. What sleeptech is writing is not to be taken lightly. The industry itself will never bring up matters like this. Obviously they want to develop their products to be as good as possible to be competitive and sell more. But during development there will be issues like this. And these "issues" can actually cost lives(!) Now to my point. I've tried with decreasing the EPR-level from the preset level 3 to 2, 1 and finally the last weeks turning it off. When the EPR turned off completely, I've noticed a very big difference. I breathe much better and sleeps better. My natural brething (respiratory effort) is normal again. If the EPR-funtion (Expiratory Pressure Relief) affects and increases the CO² levels creating central apnea we should never even consider trying out the EPR(!) As sleeptech mentioned: "should be avoided in almost every instance." Concering CO²-levels and central apnea: "I have recorded evidence of this happening." "Where I work, we only ever allow our patients to use EPR or C-Flex if they have had a sleep study with it and we can verify that it is not causing any harm. Otherwise we do not use it at all. I can think of fewer than 5 people who have actually had some benefit from using EPR/C-Flex in all my years of being a sleep tech." Please take his warnings seriously. (For comfort, setting the ramp with EPR is of no harm obviously.)"

My reply to your post:

Based on my personal experience when I awaken during the night short of air, I believe I have had an apnea. It could be either central or obstructive. I unfortunately suffer from more central apnea events than obstructive, and increased pressure is of no benefit in reducing central events.

I have also adjusted EPR from none to 3 on numerous occasions. As I said in my post, it has had no repeatable impact on my frequency of central apnea. But also as I said I can get the same apnea normalization with less maximum mask pressure when EPR is turned off. On that part I agree with Sleeptech. It has some negative impacts but I would suggest it is in mask pressure not any impact on central apnea frequency.

With respect to impact on oxygen and CO2 levels I think you have to put it in perspective. We are talking about a pressure increase of 3 cm of water. Yes, that means more oxygen will go into the lungs, but the question is whether or not 3 cm is significant. I won't bore you with the math, but if you do it the atmospheric air pressure when the weather changes from a low pressure formation to a high pressure formation, the pressure in CPAP units changes by about 35 cm of water. That is a factor more than 10 times higher than turning EPR on or off at a setting of 3 cm. My conclusion is that 3 cm is not significant in the scheme of things. Also remember that standard atmospheric pressure is about 1030 cm of water in absolute units. A change of 3 divided by 1030 results in a very small percentage change.

You mentioned that you gained some benefit by turning EPR off. Again without going through my previous post again, I think that is quite possible in that depending on how your machine is set up turning EPR off may reduce the frequency of obstructive apnea. Have you quantified what your before and after central and obstructive apnea frequency was? I find one needs to document at least a month's worth of data to determine what the change had been.

Another thing to consider is that one of the treatments for higher than 5 AHI due to central apnea is to use a BiPAP machine. A BiPAP really only differs from an APAP in that it can use an EPR of higher than 3 cm. Yes it is called pressure support but it is really the same thing -- a split in the IPAP and EPAP pressures. And central apnea is actually treated by using a higher than 3 cm split in the pressures. Some question the effectiveness of it, but it is done. I know because I suffer from central apnea and I have investigated all options to deal with it including a BiPAP and an ASV machine.

So I will say again that I agree with Sleeptech in that there are some downsides to using EPR for someone who is mainly suffering from obstructive apnea, but causing central apnea is not a very likely one. It certainly has not been my personal observation although I wish it was. I don't think you will find credible sources elsewhere that suggest it causes central apnea either. If there are, I have missed them. If you have them, then I certainly would be interested in looking at them.

I am 68 years old and have mixed sleep apnea (obstructive and central). I am also Type 2 diabetic. But, I am not a doctor and cannot provide you with any kind of diagnosis. That said I have suffered from time to time from some of the same things you describe.

Getting dizzy when standing up is called orthostatic hypotension. I am aware of it as it is a symptom of diabetic neurophathy, and that I have to be observant of. It can also be caused by low blood pressure and many other conditions. It can be a side effect of blood pressure medications. Headaches, waking up to pee several times a night, and night sweats are symptoms of diabetes and high or low blood sugar. I have experienced them personally. Blood sugar variations can cause similar symptoms that you describe like feeling dizzy or drunk. My suggestion is to be sure to ask your doctor to test you for diabetes if that has not already been done. You are a little old to have juvenile type 1 diabetes, and not old enough to be a typical type 2, but in my opinion as a diabetic, you have enough symptoms to be tested. There are three tests for diabetes and ideally you want them all done. One is an overnight fasting blood glucose test, another is the oral glucose tolerance test (OGTT), and the last is the AIC test which estimates blood glucose over the last three months. All can be done in one lab visit. Having all three tests done is much more conclusive than relying on one single test.

Like diabetes you are not a likely candidate for sleep apnea based on your age and weight. However getting a sleep study test done is a good idea. It should be quite revealing as to whether or not apnea could be an issue.

Hope that helps some...

I took the risk. It seemed pretty simple and legit.

Wilson, I am just another user of the AirSense 10 AutoSet machine, and not a professional. So don't take this as professional advice. It is simply that of another user.

1. Yes, your APAP is doing a pretty good job in reducing an AHI of 61 down to a residual AHI of 2.5. An AHI in the 0-5 range is considered normal. That said, an APAP is normally more effective in reducing obstructive apnea than it is in reducing central apnea. What portion of that 2.5 AHI is obstructive and what part is hypopnea? In my experience I think hypopnea can be related to obstructive apnea, or central apnea. So, I always look at the hypopnea component as a bit of a question mark.

2. An APAP tries to normalize obstructive apnea and obstructive hypopnea by keeping the airway open with air pressure. That physically usually works, but it can have some side effects. Mask discomfort is usually the worst one. I have tried 5 different masks and finally settled on a nasal pillow mask. That said masks are very personal and I really can't give you any advice other than to keep trying ones to the extent you can. What I can say is that about the second worst sleep I ever got was my first night with an APAP. The worst night was when I did the at home sleep study. Both terrible sleeps. But, I have slowly gotten used to wearing a CPAP at night and the benefits are now outweighing the initial discomfort and the effect it had on my sleep quality. In short, give it some time. And if a mask is not working for you, ask your supplier to suggest another. You also mention that you have obstructive apnea that is not well controlled with pressure. That is unusual. You may want to ask your general practitioner to refer you to a specialist to see if there are other reasons for obstruction. In my understanding of risk factors, your age and BMI should not put you at high risk of OSA, so there may very well be another reason.

Some general comments. You said your AHI went up to as high as 129 at certain pressures. I would ask your sleep doctor or sleep tech what the reason for that could be. In some people central apnea goes up when pressure goes up. It would be helpful to know if that applies to you. At the same time you could ask if it is a pressure in the 10-20 range that you have been prescribed, and could be a contributor to your residual AHI if the machine runs you all the way up to 20 cm.

Many people who suffer from apnea track their results on SleepyHead. It can be very informative as to what may be affecting your sleep quality, and how well the machine is working for you. If you are interested I can post some more information on it. In my opinion as a user, the ResMed supplied MyAir applications is not very good. SleepyHead is much better.

Hope that helps some. Any questions, just ask.

Sleeptech makes a lot of good comments and is obviously very experienced. However, this is one subject where I partly agree, but not 100%. I believe the main problem with EPR or Flex is that it reduces EPAP (exhale pressure). Apnea can occur on the exhale as well as on the inhale. So if you have an APAP that is set up and working reasonable well, and then turn on EPR at 3, then it will reduce your EPAP by 3 cm. That is most likely to increase apnea, which will in turn cause the APAP to increase the treatment pressure. The net result will be an increase in maximum mask pressure, which may cause discomfort or mask leaks. But, your apnea incidence is likely to remain unchanged albeit with a higher IPAP (inhale pressure). A problem can occur if your maximum pressure is set such that the APAP cannot compensate for the EPR. Then apnea incidence is likely to go up.

I would suggest it is controversial whether or not EPR, and especially Flex actually increases oxygen uptake and as a result may cause some central apnea. I have tried with and without, and can see little difference. This said there are some instances where EPR or Pressure Support in a BiPAP can actually help with the breathing effort, and may reduce central apnea. I believe this only works when the body is slowly reducing breathing effort, and the APAP or BiPAP somewhat compensates for this by switching quickly back and forth between IPAP and EPAP pressures. It is kind of like artificial breathing, but the effect is pretty modest. It is more effective in a BiPAP where the pressure support can be increased above the 3 cm limit of EPR.

What does this mean? For me the increase in IPAP and thus mask pressure is real when I use EPR. I can reduce maximum pressure by about 2 cm when EPR of 3 is turned off. But, especially when going to sleep there is a definite comfort benefit in using EPR. What I do is use the AirSense 10's auto ramp feature to set a comfortable start pressure, and set the EPR at 3, but for the ramp only. After I go to sleep and the ramp ends, the EPR ends. Pressure then ramps up to my minimum, and I don't notice it when I am sleeping.

So in short I think EPR is good for ramp only for most users, but it is not a big risk to use it full time especially if your maximum pressure is low. But if you want to minimize mask pressure, then turn it off. Treatment of central apnea is more complex, and EPR or Pressure Support may help if carefully tuned.

You also may want to prepare yourself for a diagnosis of Mild Apnea. In Alberta CPAP treatment is considered the gold standard for mild apnea, but a dental appliance may be an option. They tend to be quite expensive if not covered by insurance. As I understand it BC Health does not cover the cost of a CPAP if you are in the Mild category (AHI 5-15). They only cover for Moderate (AHI 15-30), or severe (>30). If in this category, I would inquire about options to do a CPAP trial.