Sierra

My recollection is that another contributor here, SnuzyQ, uses that mask, so perhaps will comment on any quirks it may have.

Do you have the heated ClimateLIne hose? Where is the machine located, elevation wise to your head when sleeping? The concern would be if there is any spot where water could pool in the hose... This issue is generally called rainout. See this link from ResMed.

Rainout FAQ

I recalled after my first post, that I once move my machine with the hose connected and the humidifier full of water. Water got into the hose and that was a problem until I got up and dumped it out!

Full face type masks can have a flapper valve in them, but to my knowledge nasal pillow masks do not. They just have a vent where air escapes out. What specific make and model of mask do you have?

I have a ResMed AirFit P10 nasal pillow mask and I have very occasionally heard what sounds like a clicking or popping noise when I am getting into bed with the machine already on. I don't recall having in mid sleep when I wake up. I frankly don't know what causes the sound in my case, and since it only occurs occasionally before sleep, I have not worried about it. I suppose it possibly could be some nasal congestion.

Do you have a heated hose and have your machine set on auto climate control? Some, and especially those without a heated hose, can have trouble with moisture in the tubing. It may cause noise. I suppose overfilling the humidifier reservoir might do it as well.

My wife uses a F&P Brevida nasal pillow mask. She sometimes has trouble with the nasal extensions collapsing. However, that happens on exhale, and it feels like a blockage making it difficult to exhale.

Central apnea can be difficult to deal with, and can have a number of different causes. I have not heard of diet being one of them. Sedative drugs like opiods can be a cause, and other medications could contribute to it as well. Your best bet is to talk to your sleep doctor assuming you have access to one.

If your machine is compatible you may want to consider downloading SleepyHead. The software is free, but you need a PC or Mac computer with a SD card reader to use it. It will give you a much clearer picture of what is going on through the night, and may prompt some questions for your sleep doctor.

What you could try is reducing the Pressure Support minimum and maximum to zero. You currently have them at 2 to 8. That would reduce the red pressure line (IPAP) in your graph to be equal to the green line (IPAP). In many people EPAP is your effective treatment pressure for apnea. At the same time you could adjust your minimum EPAP to 7 cm. That should give you a good idea what pressures you really need during the night. If may be possible, if they are well under 20 cm, you would be better running the machine in Auto CPAP mode, rather than deal with the complexity of the BiPAP mode.

Edit: Those high IPAP pressures (red lines) may be part of what is waking you up in the night.

Some comments on results - You are getting large clusters of hypopnea and Vibratory Snore during the ramp up of pressure when starting a session. These could likely be largely avoided by using a higher start pressure so the machine does not have to ramp up as much to get to an effective treatment pressure. My other previous comments about machine set up remain unchanged. I'm thinking you may be running much higher pressures than necessary because of the use of pressure support. The high leak rates also seem to follow the higher pressures.

On screen format I would still suggest clicking on the little triangle beside the current date in the top left hand corner. That will get rid of the calendar and make more room to show all the statistics and setup data. And the graphs could be shrunk in height so you can display more graphs on the screen. Click and drag on the grey dividing lines. The event tag display could be shrunk in height too. Here is an example of what I find useful for format.

My wife has been using a CPAP for nearly 4 years now. She got immediate relief from it, and has used the equipment essentially every night since. She averages 8 hours and 45 minutes a night, and has 100% compliance. I was not such a willing candidate to join the CPAP club. I got cornered by my doctor and reluctantly agreed to a sleep study, which I failed. The one night at home sleep study was horrible. The first night on the CPAP was almost as horrible. Unlike my wife I got no immediate benefit from using a CPAP. I never felt I needed one in the first place, but the sleep study said differently.

That was 6 months ago, and over that time I have gotten slowly used to it, and now can get a good nights sleep with it, and if I dare say, perhaps better than before CPAP. But that has come with a lot of effort. I've tried many things including 5 different masks, and I am at over 20 different revisions of my machine settings. If there is anything that has gone wrong with CPAP, I'm sure I have experienced it!

With that said if you can provide some more information on what you have for equipment, how it is set up and more specifics on what you think is waking you up, I and others here I'm sure can make some suggestions as to what you might try. What would be helpful would be your machine model, your mask model, machine minimum pressure, maximum pressure, start pressure etc.

In general sedative type drugs have been blamed for causing or aggravating central apnea, with opiods probably being the worst. Sleep medications are more controversial as to their effect on CA. Something to discuss with your doctor for sure.

I have heard of this issue, and as you say it is considered more of a nuisance than a serious medical condition. I think it is a basically a change of shift problem. The day shift guy that is controlling your breathing goes home before the night shift guy takes over, to put it in analogy form.

My thoughts would be to wait until your sleep study results come in. For sure ask for a written copy of the study results as there is a lot more detail on the report than can be remembered with just a verbal discussion. If the conclusion of the study is that you have sleep apnea that needs to be treated with a CPAP, you might get some relief from the therapy. A CPAP addresses obstructive apnea by keeping the airway open with pressure. With a central apnea there is no obstruction, so pressure does not help. That said, if you have the right kind of machine, it can provide a split in the pressure supplied during inhale and exhale cycle while you are going to sleep. That MAY help prevent your issue of stopping breathing when you are going to sleep. I am a CPAP user not a medical professional, so that is just my opinion. And my opinion again about machines is that the ResMed AirSense 10 AutoSet does the best job of the getting to sleep phase. It lets you use this split pressure (Expiratory Pressure Relief - EPR) while you are awake, and then when the machine detects you are asleep it stops the EPR. Treatment during sleep can be more effective with EPR off.

You should also ask your sleep clinic that did the test what they think of your condition and might improve it.

The other thing I have found helpful in keeping the mask straps in place is a satin pillow protector. They seem to be intended to be used to keep your hairdo intact, but I find they are slippery enough to allow your head to move on the pillow without dislodging the mask straps. There are some quite inexpensive ones at Bed Bath and Beyond in the US and Canada. They have a zipper to keep the cover on. Normally a satin pillow case is hard to keep on the pillow.

Rest and Renew Satin Pillow Protector

You should continue to gather more data, but just based on this one daily report I would discuss the following possible opportunities with the sleep doctor that recommended you get a BiPAP.

1. There may be a possibility you are not gaining anything from the pressure support which appears to be set at a variable 2-8 cm. Ask about simply reducing the pressure support to zero. This could significantly lower your maximum mask pressure and reduce your mask leakage problem and provide more comfort.

2. Reducing the pressure support to zero may leave you too little pressure when going to sleep. Ask about increasing the minimum EPAP which is currently set at 4 to say 7 cm.

3. If you go ahead with those changes and it reduces pressure, then next ask about reducing Maximum IPAP pressure. It looks like the highest you reach now is 16.5 cm. It may be possible to set the max IPAP to 13 cm or possibly lower. You would need to see what effect setting pressure support to zero has first before settling on a revised max pressure. The idea is to limit the pressure when more pressure is not doing you any good. It may put a bit of a limit on that pressure spiking that DreamStations typically do (the red trace on the graph).