Sierra

The SoClean device generates ozone which is in turn used to sanitize the CPAP equipment. Ozone contains three molecules of oxygen instead of the usual two molecules in the stable form of oxygen. Ozone is toxic and an irritant to the respiratory system. We can easily smell it and it is kind of like chlorine from bleach. SoClean claims that the ozone breaks down to ordinary oxygen in about 2 hours. Is there any chance that you were using the cleaned equipment shortly after cleaning it before the ozone has had a chance to break down to oxygen? I don't use one of these things because I don't believe it is necessary. I also would be very worried that the highly reactive ozone would deteriorate CPAP components over time. However, if I was to use one, I would think it is best used in the morning right after you stop use of the CPAP, do the clean and then let it air out for the rest of the day before you use the equipment again.

SoClean is a bit evasive about the fact they are using ozone which is toxic to clean the equipment and calls it activated oxygen. I think they made that term up to avoid using the correct name which is ozone. Here are a couple of links to read to learn more about ozone and what SoClean says about it.

Ozone - Wiki

SoClean's take on using ozone

SoClean claims it is safe to use. However I would suggest it is not all that safe unless you allow sufficient time for all the ozone to dissipate and break down. In ozone form it is toxic.

As George says different individuals respond differently to CPAP therapy. My wife who was diagnosed with an AHI in the 70's felt almost immediate benefits. I was diagnosed about 3 years later with an AHI in the 30's. I have been on CPAP for about 6 months now and am finally seeing some net benefits. My suggestion is to focus on comfort as much as the numbers. If you are not comfortable you will not sleep well. Getting a good mask is usually the hardest part. There are some things you can do with the machine as well. Assuming you have a compatible machine, I would encourage you to download SleepyHead which is a free CPAP data monitoring program. It gives you a lot more information than the machine does. Then either by doing it yourself or by asking your provider, you can adjust the machine to your own needs. Even the auto machines need some help to be as effective and comfortable as they can be.

I think what this experience shows is that the AHI is not a perfect measure of apnea severity. If you google the subject one can find may papers criticizing the AHI system, but it seems to never get changed. Currently it is just a count of the total apnea and hypopnea events divided by the sleeping hours. So, it assumes all events are of an equal weight in the overall severity. Seems to me that hypopnea events which are a flow reduction of 50% should only be given a 50% or so weight compared to a full apnea. And currently apnea duration is not considered. It would seem that apnea and hypopnea events should also be weighted by their duration. I can see in the old days this might be a little more difficult, but this is 2018 and with computer technology this is not very hard. It would seem to be time to make a change to the severity weighting system. In your case it would bring the number down, but it would seem you still do have an issue with flow restriction, and CPAP is a very effective treatment.

That seems unusual to have so many hypopnea events compared to central and obstructive. Hypopnea is an interesting measure, and is more complex than it first appears. It is a reduction of air flow of 50% or more but not 100%. It can happen due to physical obstruction or blockage. Or it can happen due to your body simply deciding to breathe more shallow. The former hypopnea is an obstructive apnea that does not full develop into an apnea. The latter is a central apnea that does not develop into a full stoppage of air flow. One has the airway blocked, and the other the airway open. CPAP pressure does not help when the airway is already open. This would seem to suggest since low pressure is so effective in your case, that your problem is partial obstruction. Perhaps that is why you had such a high total index at diagnosis, but now it is so easy to treat. With most people the condition progresses to full blockage at least some of the time.

In my case I have concluded from looking at the detail in SleepyHead that my hypopnea is actually partially developed central apnea. Increased pressure in my case is not very effective in reducing hypopnea as it is not a blockage issue, but really a breathing control system problem.

I think the conclusion in your case is that it is probably real, and easily treated. It must have something to do with your physical anatomy. Any other breathing issues like COPD, or smoking?

Out of curiosity what types of events does your machine report? Does it give you a number for clear airway or central apnea?

That information is quite helpful. Based on that one night it would appear your main problem is central apnea (clear airway). CPAP pressure does not prevent central apnea so you can't prevent them by simply increasing pressure. The airway is already open. In my experience central apnea is very erratic. Some nights you have it, and other nights you do not. When you get to download SleepyHead and zoom in on the Hypopnea events you may find that they are very similar to the central apnea events, and just do not progress to the point of apnea, so do not get flagged as CAs.

Yes, I do think that a poor sleep causes increased AHI. A lot of the focus of CPAP therapy is the other way around. The assumption is that apnea causes you to wake up. That is probably true, but I also think that a poor sleep with frequent arousal events and semi-sleep can also cause events that either are apnea or get falsely flagged as apnea.

If you have not already I would suggest you read the posts in another recent thread here about central apnea occurring just before waking up. It covers a couple of different types of central apnea, one which is periodic and the other which may be just sleep-wake-junk (SWJ). The former is more serious in my opinion, and Respironics may flag it as periodic breathing. The SWJ has to be manually picked out by zooming in with SleepyHead and looking at each event or series of events to see what it is.

Are you using FLEX and if so at what setting? You may want to experiment with different settings. I think that the DreamStation may have an adjustable rise time associated with the FLEX that you could try changing as well.

I use a ResMed AirFit P10 nasal pillow mask. The straps on it are essentially non adjustable and I had trouble keeping it on. I now use a Breathewear Halo chin strap that I put on second after the mask. I find it does a good job of keeping the mask in place. I also tried a Nike swim cap that was made out of nylon and lycra (not silicone). It worked even better in keeping the mask on. However it was a bit too small for my head and I would wake up each morning with some pretty significant marks on my forehead, so I abandoned that idea.

Hope that helps some,

You may want to consider a mask that minimizes contact with the face. I saw from your previous posts irritation from mask fit has been an ongoing problem. I also saw you are in South Africa and choice of masks may be limited. One option may be to order one from the UK or have your daughter buy it and then send it to you. Here are a couple of full face masks that are sold in the UK which fit UNDER the nose rather than over the nose, which may work for you.

DreamWear Full Face Mask

The DreamWear mask comes with a fit pack which means there are different size inserts which you can try to see which fits you best.

Amara View Full Face Mask

The Amara mask does not come with a fit pack. However under the Download tab you will find a fitting chart that you can print out and determine what size you need.

Note that I found this vendor on a very quick Google search, and these prices may not be the best available in the UK. They do say they ship internationally though.

Welcome to the forum. Some questions:

Do you have a copy of your most recent sleep study? If so, what was the breakdown of apnea events. What was the proportion of central apnea events to obstructive apnea events? When you get numbers in the 8+ range same question. What portion of it is central and what portion is obstructive and hypopnea? Do you know what your minimum and maximum pressures are? And what is the highest pressure it gets up to during the night?

The best way to figure out what is going on would be to download SleepyHead and look at your detailed results with that software. SleepyHead supports most of the common machines. The software is free. What make and model do you have?

Sorry for all the questions, but it is hard to make suggestions without knowing some of the background and detail. I don't think the problem is your mask insert size. If it feels comfortable and doesn't leak, it should have no effect on the AHI.

The image below is an example of what you can see with SleepyHead.

I should also have posted a clip of what I think Sleep-Wake-Junk looks like. See image below. This type of central apnea concerns me much less than the ryhthmic stuff. In this clip, I think I woke up due to mask leakage (grey area) and then the CA events were the result of going to sleep and waking up and simply not breathing.