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Sierra

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

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.

I am not a doctor, and was only trying to help you with your APAP as it appears you have attributed your paralysis and CFS to the DreamStation. That is not very probable.

You may want to read this short article about sleep paralysis. My understanding is that during REM sleep you dream, and when you dream one of the actions the body takes to prevent you from physically acting out your dreams is inducing paralysis. Pure guess on my part, but perhaps the link between your CPAP treatment and waking up with paralysis, is that your apnea or something else is waking you up during REM sleep. Apnea is most likely to occur when sleeping on your back.

Now back to SleepyHead. I have nothing to gain by promoting it. I'm Canadian, and I recall that SleepyHead was written by an Australian and is distributed free. I have nothing to gain by promoting it. However, I use the software daily and find it very powerful in determining what is going on during the night when using a CPAP. It highlights every single apnea event, when it occurs, and how long it lasts. When you become more skilled with it, you can zoom in on events and look in detail what went on before the event, and when you woke up. In other words you can dissect your sleep after the fact. One simple thing you may learn is that your CPAP is maxed out on pressure, then you have an apnea event, and then you wake up -- possibly with paralysis in your case. Does that make sense?

Here is a screenshot from one of my recent nights. At 5:10 AM I had a series of obstructive apnea events (blue ones). The first one was when my machine was not quite at my maximum pressure setting of 13 cm. The following ones were at the maximum pressure. This may indicate my maximum pressure needs to be adjusted higher. This is the kind of analysis you can do with SleepyHead. If you want to try it, and post your screen (F12 to do a screen capture), you can post it here for comments on what may be going on.

Without being able to see your detailed data from your machine shown graphically like this, it is pretty hard to give you advice, other than my WAG that you may be waking up during REM sleep.

That sleep report is very helpful. What it shows is that while your AHI is very high at 100, it is 80% obstructive apnea, 20% hypopnea, and 0% central apnea. This indicates you do not need any special features to address the central apnea. The obstructive apnea and hypopnea should be very well treated with pressure. The issue however is how much pressure. The traditional next step would be to do another overnight sleep test, but this time the pressure will be adjusted during the night to determine how much you need. This is called a titration test. This can be expensive, and may not be available to you. The other option is to prescribe an auto adjusting machine that adjusts the pressure for you. In Canada where I am, they give you a free trial, and would likely try a standard APAP machine first which goes up to 20 cm of pressure. By reviewing the detailed data the machine captures you will quickly find out if that is enough. If it isn't then they would do a trial on a BiPAP that would go up 25 cm. Trials are very helpful because the other thing you find out beside pressure is whether or not the person can tolerate the pressure. Not everyone can tolerate up to 25 cm of pressure.

In your case it sounds like your doctor has decided you may need the extra pressure so he is prescribing a BiPAP. There is no downside to that, other than the cost. In Canada from on line places, the basic APAP machine (ResMed or DreamStation) is about $900. The BiPAP versions are about $1100, so about a 20-25% extra cost. However around the world the cost of machines varies widely depending on the country and whether your buy on line or from a clinic. Here is a link to an example of BiPAP costs in Canada. I don't think they ship outside of Canada though.

You said you are waiting for approval of the purchase. That suggests your insurance or healthcare system is paying all or part of the costs?? If someone else is paying then I would go for the BiPAP. You may not need the extra pressure, but it is there if you need it. I you are paying out of your pocket with no opportunity for a trial to see what works, then it becomes a bit harder decision.

This all said, I hope that another contributor here, sleeptech, comments on your situation. I understand he/she is a sleep technician from Australia, and probably sees hundreds of these sleep reports and has lots of experience to judge what pressure is needed and whether or not you could get away with a standard APAP. My guess would be that you probably could, but it is not 100% sure.

From what I can see there does not seem to be a direct equivalent to the ResMed AirCurve 10 VAuto machine in the ResMed Lumis line. The AirCurve 10 VAuto is the closest to a standard APAP but with more pressure. It is the least expensive machine in the AirCurve series as well. In Canada it is the same price as the DreamStation BiPAP and as before I would select it over the DreamStation, but both will work.

Hope that helps,