Sierra

One thing you should check before jumping in is the very first Mode setting. Check to see that it is in fact in Auto mode. Here is a link to a detailed manual for this machine, which should help you navigate the options. I would download this pdf and save it. They come an go on the internet.

AirCurve 10 Manual

Increasing the maximum IPAP is the most straightforward way to address your excessive obstructive apnea. The other method would be to reduce the pressure support (differential between EPAP and IPAP). I didn't suggest that because there may be reasons why you are using a higher pressure support than can be supplied with a standard APAP. It is an option though.

In any case whether your make the adjustment yourself or go back to your provider, you do need an adjustment. An AHI above 20 is not good. I strongly suspect the machine you have can deal with it, and it just needs to be set up properly. If you choose to go back to your provider ask about increasing the maximum IPAP, and the pros and cons of reducing pressure support. The normal way of going about this is to get your obstructive apnea under control first. Then adjustments up or down in the pressure support may improve central apnea.

I did the override to set my mask pressure scale to have a range of 6 cm like yours. This is what I got during normal sleep with no EPR. There is definitely some noise to the pressure signal, and indication it does not react fast enough to keep pressure perfectly flat, but I do not see the control hunting type of response that you have. This hunting typically happens when the feedback gain is too high in a control loop. To my knowledge that is not an adjustable parameter in this model of a machine. I would agree that your unit seems to be defective, or out of adjustment. I would ask for a new machine.

About the only excuse I can think of for the machine is that your pressure is very low. 4 cm is the minimum, and perhaps the machine does not have as good a control of pressure at low values compared to higher values. That said, I still think defective. The pressure fluctuation in your unit seems to affect your flow rate. On mine it does not.

The treatment standard is an AHI of 5.0. When a sleep test is done and the results are in the 0-5 range that is considered normal - no treatment required.

That said depending on the type of apnea you are having a CPAP can bring the residual AHI with treatment down under 1.0 or even to zero at times. My wife regularly gets under 1.0. I average about 3.0 and I think only one night in 6 months have I been under 1.0.

What specific model of AirSense do you have? There is the AirSense CPAP, AirSense Elite, and AirSense AutoSet. Not sure if they all record data. I do know some AirSense machines are sold without a SD card, but you can put one in, and data will be recorded. For sure that is the case with the AutoSet. They take a 4 GB SD card, and the slot for it is located on the left side near the top. You have to pry open the flexible door with the blue tab.

That screen shot is very informative. First the good news. About 60% of the events are obstructive apnea, and you have room for more pressure. And all of the events seem to be confined to defined periods during the night. Perhaps that means they have a sleep position relationship back vs side? Or could you have been awake for the part of the night that was pretty much clear of any events?

The central events are a bit high, and it may be more difficult to address them. However, they seem to be concentrated right at the beginning of your night, and you do not appear to be using a ramp which blocks event reporting during the ramp up time. Some people tend to have central events when they are falling asleep. I notice that you get a concentration of them just before you shut the machine off in the morning too. It is cheating a bit, but you could turn on the ramp function with a EPAP start pressure of about 8 and a time of 20-30 minutes.

SleepyHead sometimes does not report machine setup accurately, but lets assume it is correct for now. It is showing you are in VPAPauto mode which does not quite match the clinical manual I have, but it seems to be the Auto mode. The pressure settings reported are:

Minimum EPAP: 12 cm

Maximum IPAP: 16 cm

PS (Pressure Support): 4 cm

The use of the terms minimum and maximum seems to confirm it is in Auto mode. However when the minimum EPAP is 12 cm, and the maximum IPAP is 16, and the PS is 4 cm, the machine is essentially frozen in a fixed pressure mode. IPAP is EPAP plus PS. There is no room for the EPAP to increase without hitting the IPAP max.

So if you are brave enough to try making a pressure adjustment, I would suggest you go into the Clinical Menu as I described above and change the Maximum IPAP to 17 cm to see what that does. It is a small increase. If that is tolerable for pressure, and provides a benefit, but does not get your obstructive apnea incidence down enough you could then try 18 cm. Note that this does not force the pressure to go up, but it gives more room for the machine in Auto to move it up. You will at least be able to see what the machine is trying to do during the night. Right now it is frozen. Keep in mind that your machine is capable of going up to a maximum IPAP of 25 cm. Right now you are not really getting any benefit of having a BiPAP machine because you are operating in the range of a standard APAP.

The other thing to watch if you go ahead with a change is your incidence of central apnea. In some people more pressure can increase central apnea. But at this point, I'm not so sure all of that central apnea is real.

I also see that your mask is working well and you do not have any excessive leaks. That is a good sign that you may be able to handle more pressure.

Hope that helps some...

With a PC it is quite easy to capture a screen of your daily report if you want to post it here. All you need to do is maximize the window to full screen and press F12. This will save an image in a SleepyHead data folder under your documents, and then in a sub folder called screen captures or something like that. When you post a message here, just left click on that file name in Windows Explorer, and drag it into the body of the message. It will upload and display with your message. Seeing what your typical daily reports look like will be very telling as to what the problem might be, and what may need changing.

Changing settings is actually quite easy. I believe the AirCurve is the same as the AirSense machines. You hold down the round knob and the home key at the same time for about 5 seconds. This will get you into the clinical setup menu, and you can change pressures etc. However, I would caution you to not do that until you have a good understanding of what you want to do. The other way is to get some input here as to what needs to be done, and then do it yourself or ask your provider to do it.

The main thing to look for in the daily report in SleepyHead is the events bar. Mouse over the obstructive apnea events, and make note of what your mask pressure is compared to your maximum pressure settings. (They should display on your machine screen each night when you start up the machine.) If all of your events are happening when the actual mask pressure is at the maximum pressure settings then it would seem your maximum pressure needs to be increase. If most of the events are happening when the pressure is at your minimum pressure setting, then it may need to be increased.

Hope that helps. If you can post your daily report screen shot it would be very helpful.

It is possible you now need more pressure than your maximum pressure setting in the machine allows. When you start your machine it should display for a few seconds while it is warming up the minimum and maximum pressure setting. It will be above and to the right of the circle.

Then if you go to your sleep report below MyAir, you should see some more detailed data like Period, Days Used, etc. If that is not there then you can go into the Clinical Menu and make it available. Just hold down the Home key and the round settings keep for about 5 seconds. That will bring up the Clinical settings menu. Select it, and go down to near the bottom where you will see Options. One option will be Essentials. Select it, and then set it to Plus. Push the Home key and then select to exit from the clinical menu. That will enable the more detailed sleep report from the user menu.

Once you have it then you can select different periods like 1 day, one week, one month etc. At each period you can go further down and see what the Pressure is. This is the 95% pressure which means that your pressure is below that for 95% of the night. Now if that 95% pressure is getting up near the maximum pressure set in your machine, the machine may be limiting the pressure you need to prevent apnea events. In the Clinical Menu you can change your maximum pressure. If you are not comfortable doing that yourself, you can ask your service provider to do it. They may be able to change it wirelessly without you having to take the machine in.

The other thing to check in the more detailed sleep report is central apnea index or CAI. If the last week value is much higher than the last year, it may be increasing. If that is the case it is something to talk to your sleep doctor about. However, the general goal is to be below an AHI of 5, and if you are under that, they are likely to consider you are treated, and nothing needs to be done.

This all said, the better way to monitor your treatment is to use SleepyHead software. It will tell you in much more detail what is going bump in the night. If you are interested, post back and I will give you more detail. It is free software to download, runs on a PC or Mac, and you transfer the data by taking the SD card out of your machine and plugging it into a card reader on your computer.

Hope that helps some...

Sounds like it is just normal movement of the mask.

It sounds like you have a machine that is out of the box and has not been set up. If you need any help doing that, just ask. My wife uses the ResMed S9 Auto machine, and I manage it for her. It will work in the out of the box default setup, but it usually can be made more comfortable and effective with a few setup changes.

I feel bad about advocating the ResMed AirCurve 10 VAuto machine to you when it is not available to buy where you are. If you go with the DreamStation Auto BiPAP, here is a link to a technical manual on it. They are fairly complex to set up. If you have any questions just ask. I would also advise downloading SleepyHead and getting it set up. You need a computer and SD card reader. It will be invaluable in helping you get the machine set up properly.

Sleeptech has also confirmed what I was thinking, which was that you are unlikely to really need a BiPAP machine. If you want to go with an Auto CPAP which will be limited to 20 cm pressure, the ResMed AirSense 10 AutoSet does appear to be available in India.

If you post your sleep test results I can give a much better response when the degree and type of apnea is detailed.

In Alberta it is normal practice to do a free in home trial of the CPAP as a first step. That will quickly confirm a few things. One is how much pressure you need, and that a standard APAP is suitable. The other is more data on the breakdown of your apnea events, and the degree to which an APAP can normalize the breathing. There is no reason not to do that that I know of. In some cases treatment can increase the frequency of central apnea but it is most often temporary. Again that will be quickly determined by your machine. If you get a good APAP like the ResMed AirSense 10 AutoSet, it will wirelessly send your data to your provider and they can monitor each night. You can also monitor it with SleepyHead software, which I would advise. I would ask about doing a free trial.

The only issue I can think of may be your BC Heathcare system. From what I can see they cover the cost of the machine if your AHI indicates moderate or severe. If mild you may be on your own. Perhaps your results are not bad enough to qualify for a free machine, and the clinic doing the testing is trying to help you if the test results are only in the high mild category. Just guessing.

But like I say, your test results will be very telling as to where you stand now, and what next would be advisable. When you see your provider, be sure to ask about a free at home trial of a machine. And if there is a choice I would ask for the ResMed AirSense 10 AutoSet. Second choice would be a Respironics DreamStation Auto.