Sierra

I use an AirSense 10 AutoSet, and I can't say I have noticed anything like that. My first thought was the EPR setting, but it seems you have ruled that out. And a pressure of 6 cm is very low. Just a stab in the dark, but what kind of mask are you using? Is there a chance your mask setting in the machine does not match the mask you are using? Also, have you tried SleepyHead to look at the detailed data that this machine captures? It should show what the pressure is doing. I will have a quick look at my SleepyHead results and post them so you can see what my machine is doing.

I am from Canada and understand what you are dealing with to some degree. I have had the home sleep study and the results indicated a small degree of central apnea. My results:

Type - Index (#/hr)

Central - 0.4

Obstructive - 17.4

Mixed - 0.7

Hypopneas - 18.8

Total - 37.3

That puts me in the severe classification (AHI > 30)

My issue has been that Auto CPAP treatment has significantly reduced the Obstructive apneas, and Hypopneas, but the Central apneas have increased. Under treatment my total AHI is about 3 with the largest portion being central, then hypopneas, and lowest are the obstructives. The hypopneas are probably partial centrals, so Centrals is likely a little understated. This said one is considered to be adequately treated if AHI is under 5.

To access your situation you need to get these kind of numbers. Ask your sleep test provider to e-mail them to you. They probably have them electronically already, or can scan them. If they won't, then ask your referring doctor to provide them. I don't believe they can refuse you, and you deserve to see the results.

When you get the results then you can start to assess the seriousness of your condition. It may not be bad at all. If you can post your numbers then I certainly will comment on them. I am not a doctor, but as centrals have been an issue for me, I have done a bit of research on it. If you have obstructive apnea to be treated, there is only so much a standard Auto CPAP can do. A BiPAP machine can do a little more, but not much. The ASV or ventilator machine can do more, but they would probably only be used if there were no other options to treat the underlying conditions.

Short story. Insist on getting a copy of the sleep report; both the first one and the second one. Do you know the name of the machine you used? ResMed make one called ApneaLinkAir, and Phillips make one called Alice NightOne. I had my test done with the NightOne. The link below is to the product brochure for the ResMed machine. See page 4 for an example of what the sleep report from it looks like. That is the report you want to get. There should also be a professional evaluation of the results and their comments should be included as well.

ApneaLinkAir

Post your message in a new thread. There is a dentist who specializes in dental appliances for sleep apnea that comments here. Perhaps he can give you some advice.

I would suggest you download SleepyHead and view your daily reports. If you post some here, we could comment on what we see. Include one when it was working well, and one when it is not. Here is an example of what one looks like:

If you are paying out of your pocket, I would ask for more detail on the sleep study report before spending the extra money on a BiPAP. One thing you really need to know for sure is whether or not you have any significant amount of central or clear airway apnea. Even a BiPAP machine is not going to be really helpful if your main issue is central apnea. When central apnea becomes a problem you can get back to back apnea events over a long period of the night. That really ramps up your AHI count.

If your apnea is all obstructive then you may only need an APAP, not a BiPAP. The way some insurance companies work is that they will approve an APAP first, and if that fails to do the job, then they will approve a BiPAP.

The DreamStation is a good machine, but my view is that the ResMed is better.

I did a little more research on prices in the USA for a ResMed AutoSet. I don't know anything about this company but their prices do look better and are more in line with the prices we see in Canada. They seem to have odd ball packages which don't include the three main components which are the machine with carrying case, a heated hose, and a mask. However, their prices when you buy them individually are still not too bad. I don't see anything about a return policy though. In any case here is what I found:

ResMed AirSense 10 AutoSet For Her - $649

ClimateLineAir Tubing - $33

Picking a mask is very hard to do without being able to trial it. And since you didn't like the cannula and mouth breathe, a nasal or nasal pillow mask is very unlikely to be tolerated. I've tried 5 different masks and only tolerated the ResMed P10 nasal pillow. I didn't like the full face ones I tried which were the Mirage Quattro (seemed big and it leaked especially into my eyes), and the ResMed AirFit F20 (also leaked and irritated the bridge of my nose). Of the face masks available from this same vendor I picked out a couple you might want to consider. They both minimize contact with the face, and potentially keep leakage away from the eyes, and put minimal pressure on the nose further up.

Amara Full View (Fitpack) - $149

DreamWear Full Face Mask (Fitpack) - $159

The fitpack packages are the safest bet as it improves your odds of getting the right size, because you can try each one. There is no fitting guide for the DreamWear mask, but there is one for the Amara Full View, so you could go for broke and just order one size which saves about $30. Here is the fitting guide.

I believe wiredgeorge a contributor here uses the Amara Full View, and perhaps could give you some tips on which mask may be the best bet. CPAP.com has these masks as well and include "free" return insurance, but they are more expensive.

In any case the total is going to be in the $800-850 range depending on the mask. Hope that helps some. But, again I know nothing about this company and it would be worth checking that out further before going ahead. They appear to be located in New York.

I looked back and read your original post here in 2017. At that time you were a new user of the ResMed AirSense 10 and were asking if there benefit in using a fixed pressure instead of an auto adjusting pressure when treating OSA while having issues with atrial fibrillation (AF). My view is that there seems to be very good evidence that treating OSA is likely to reduce the chances of further heart and stroke complications from the AF. I have not seen any evidence that constant pressure is better than a variable range. I think the answer to that would be whichever method provides the lowest AHI. In my personal experience I think one can get a lower AHI with a very tight range of pressures or even a fixed pressure, once you know what pressure is needed. The reason for this, again in my view, is that an APAP is a reactive device, and needs apnea events to trigger a pressure increase. If you have already manually forced a higher pressure that trigger event is not needed. For that reason it may reduce AHI some.

I see now that you have moved to an AirCurve 10 BiPAP machine. It is not obvious to me that a BiPAP would be all that necessary if your treatment pressure is in the range of 12 cm, as you indicated. However it can do everything that an APAP can do and more. It is my view that using a different pressure for IPAP (inhale pressure) compared to EPAP (exhale pressure) can reduce apnea treatment effectiveness, assuming you do not need any respiratory assistance. In my experience you need a higher IPAP to compensate for the lower EPAP, although there are some comfort benefits to a lower EPAP. The net result is a higher maximum mask pressure when there is a differential.

You also mention that you are suffering from clusters of apnea events. Are they obstructive events? If so there seems to be some evidence that they can be positional. In other words you get your head and neck in a sleeping position that is more susceptible to blockage. Some with that issue report having benefits from using a cervical collar. They are not costly and it may take some experimentation to get the correct size and firmness.

Hope that helps some. I have no experience with the mouth appliances, so can't help you there.

Just one further note about your high AHI. My wife was diagnosed with an AHI of near 80. She uses the ResMed S9 Auto APAP (like the one in that test report) and averages an AHI of 1.0 after nearly 4 years on it. On the other hand I was diagnosed with an AHI of about 34 and am doing well to average 3.0. The difference is that her apnea is essentially 100% obstructive apnea while mine is now probably about 70% central or clear airway apnea. So a CPAP can do a very good job even with a high initial AHI, unless the apnea is of the central variety...

I try to exercise 1 hour a day, primarily cardio, and do weights about every 2 or 3 days. I have not considered that it could have any effect on the severity of my apnea. It strikes me that doing weights is unlikely to make much of a change to the throat area. Excess body fat probably does not help though.

The first thing you should do is ask for a detailed sleep study report which should breakdown the incidences and rate of the obstructive apnea, central apnea, hypopnea, and snoring. That will give you a better idea of what capability you need in a machine. I presume at this point you have been tested and verified that you need a BiPAP rather than an Auto CPAP? The BiPAP will be capable of up to 25 cm of pressure compared to an APAP at 20 cm. Also the BiPAP will provide more than 3 cm difference in pressure between inhale and exhale.

The best report I have seen on sleep apnea machines is at this link:

All APAPs are not Equivalent

There are a couple of limitations to this report though. It is for APAPs not BiPAPs, and it was written in 2015 and many of the model names have changed. I suspect however that the basic capability in most cases has not changed, and there are a lot of similarities between and Auto CPAP and an Auto BiPAP.

Without getting into all of the models, in my opinion the two top machines in the 11 they tested are also probably the two most popular and most available machines. My comments on them:

ResMed S9 Auto - It is designated D8 of the machines tested, and the current model name is ResMed AirSense 10 AutoSet

It does an excellent job of normalizing obstructive apnea. See figure three, left hand column. It also does an excellent job of normalizing hypopnea, the right column. From figure 4 it increased pressure modestly to stop snoring (left column), and from the right column it does NOT increase pressure in response to central or clear airway apnea. That is important. Increasing pressure does not correct clear airway apnea, but many machines increase it anyway. These other machines probably have no way to distinguish between central apnea and obstrutive apnea. The ResMed does.

PR1 Remstar Auto P-Flex, Philips Respironics - It is designated D7 in the report and the current model name is the Respironics DreamStation Auto

It increases pressure to normalize obstructive apnea, but does not fully normalize it like the ResMed does (left column of Figure 3). It increases pressure to respond to hypopnea (right column), but then it cuts pressure back and does not fully normalize the hypopnea. In figure 4 left column it increases pressure rapidly and holds it up in response to snoring. The concern would be that it may increase it too fast and too high causing a comfort issue. While it makes a slight initial increase in pressure in response to a clear airway central apnea, it immediately reduces it and holds low pressure. Response to central apnea is essentially just as good as the ResMed.

So assuming you have obstructive apnea, hypopnea, central apnea, and snoring, I think either the ResMed or the Dreamstation would work, but the ResMed is the better of the two - based on this benchmark test report.

The BiPAP version of the ResMed is the AirCurve 10 VAuto. I suspect it behaves very much like the ResMed S9 tested in this report, but has the extra pressure, pressure support, and features of a BiPAP machine.

Hope that helps some. You may want to try the UK for an on line store. I have seen vendors there that will ship internationally and the prices for the equipment seemed reasonable.

One last caution if your sleep test indicates you have a high portion of central or clear airway apnea events. A BiPAP machine may help a bit to reduce them, but not a lot. A high portion of central apnea events may need a more sophisticated (and much more expensive) ventilator style machine like the ResMed AirCurve ASV. This would be something to discuss with a qualified sleep doctor.