Sierra

There are two types of nasal masks; nasal, and nasal pillow. And there is the odd exception or two as to what setting you should use. Here is a link to ResMed's compatibility list and settings for masks. That is a long shot anyway.

For a reader I just use one of those small portable things that plugs into my USB slot.

Sounds like they are playing a little difficult with the sleep report. I would suggest you make an appointment with your doctor, ask to see the report, ask for his/her opinion as to what it means, and also ask for a copy.

My wife and I are now both on a CPAP. She was diagnosed nearly 4 years ago in the high severe range - around 80 I think. When she went on the machine she noticed an immediate benefit, and has used it every night since getting it. I was tested after I failed a screening test and then failed the sleep test with an AHI in the lower severe range - 37. I had no trouble sleeping before the machine, and did not suffer from any extreme sleepiness. So I did not see an obvious step change. Now after 6 months I am seeing more benefit. My wife's apnea is essentially all obstructive apnea and she averages about 1.0 for AHI under treatment. I am doing well to get under 3.0 due to my higher portion of central apnea. My wife also appreciates that I no longer snore too!

I did a quick check on BC's health care treatment of apnea. It is better than Alberta. We have to pay for our machines out of our pocket if we do not have private insurance plans that pay for it. I see in BC that if the severity is moderate (AHI 15-30) or severe (AHI >30) it looks like they pay. But, you may be on your own for cost if mild (5-15). We had to pay for our machines, and there is a wide variation in what they cost depending on where you get them. I can help you out with some suggestions on where to go for a better price if it comes to that.

In any case step one is to get your sleep report(s). That will provide a lot of guidance on what you are up against, and what your options may be. There are at least 5 different types of central apnea, and various types of treatment methods depending on the type you have. Here is a short report on it, if you have not seen it before.

Central Sleep Apnea

Oh and the other important part of the sleep study report is the oxygen desaturation levels. The problem is not really that we stop breathing, it is that oxygen levels go down when we stop. That causes the problems. The report should say to what degree that is a problem for you.

Hope that helps some,

OK, here are a couple of screen shots which show the flow rate and mask pressure. The first one is right after the machine starts up, and I am breathing heavier and more irregularly than normal. You can see some jaggy noise in the mask pressure trace, probably indicating that the pressure control is hunting a bit trying to hold the desired pressure. The big wave is the EPR pressure response to inhale and exhale. I use EPR only during the Auto Ramp portion of the night, and let the machine shut it off when it detects I have gone to sleep. The second screen capture is a few minutes later after my breathing has become more regular (but I am still awake). You can see some jaggy noise here and there, but generally it is pretty smooth. In any case this is what you can see if you use SleepyHead to display your detailed results. It is a free download. All you have to do is take your SD card out of the machine and upload the data with a card reader. It should be easy for you to compare your mask pressure response to what I am getting.

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.