Sierra

I was curious about your BMC machine as I had not heard of it before, and I did a little research on it. From what I can see it is made in China and the Luna model appears to be the latest and top of the line. The lower end model seems to include the RESmart Auto. I did find some information on the RESmart model in an older study which compared 11 different CPAP models. Here is the link to the study:

All APAPs are not Equivalent

The format of the study report is not exactly easy to read and interpret. But the BMC RESmart machine is designated as the "D2" machine. As a comparison the D8 machine is the more common ResMed S9 Auto. From what I can see in the testing, the BMC responds to obstructive apnea as one would expect, but it does not eliminate obstructive apnea as the ResMed machine does. The BMC responds somewhat to hypopnea, but not well compared to the ResMed. The BMC responds to snoring and in fact seems to be overly aggressive in raising pressure in response to snoring. Most surprising is that the BMC responds to central apnea or clear airway apnea by increasing pressure. That is not good if central apnea is an issue with the user. Pressure would be increased and it wouldn't be doing you any good. I suspect at least this RESmart machine is unable to determine the difference between obstructive and clear airway apnea, and blindly responds to them both in the same way. The reporting of the type of apnea event is likely compromised as well. The ResMed uses pressure and flow oscillation to distinguish between CAs and OAs, and only responds to the OAs. Last the BMC machine seems to over estimate the AHI remaining during treatment, while the ResMed under estimates it. So in your case that would seem to suggest the machine is not under reporting your events, and may if anything be over reporting. Not an explanation for what you are observing.

In my search I stumbled on a YouTube video on your machine which you may have found already. In any case the link is below. It outlines a method of extracting data from your machine if you have a smart phone. That may be very helpful in trying to figure out what is going on. This is the third of a 3 part series. I did not look at the other two, but this one seems good.

BMC Luna G2 Auto Clinical Settings and Icode Data Part 3 of 3

One of the things I saw in the video was that the machine has a sensitivity setting. If you find it is raising pressure too much when in Auto, you could try a lower setting to see if that helps...

In thinking about your situation a bit more I have some further comments for consideration. Your comment that you found the fixed pressure of 4 cm more comfortable than the 4-6 which I presume is a minimum of 4 cm and max of 6 cm in auto mode, is interesting. This would seem to suggest the machine was detecting some issues and was increasing pressure potentially to the maximum 6 cm (which is still very low). I couldn't find much detailed information on your machine, but in general these things respond to more than obstructive apnea. They typically do not respond to clear airway apnea at all as pressure does not help an airway that is already open. However they typically do respond to snoring, flow limitations, and possibly hypopnea. So while you may be getting low AHI, the machine may be detecting these other issues and is increasing pressure to address them. Flow limitations and snoring don't count in the AHI index.

I see that the machine has a exhale pressure relief feature called Reslex. Pressure while you are inhaling helps you breath easier and most find it very comfortable. However pressure when you exhale is what many may find uncomfortable. The Reslex feature reduces pressure during the exhale only. While this feature can reduce treatment effectivness it seems you do not need much. My suggestion for setup in Auto would be to set the Maximum pressure at say 7 cm, and the minimum at 6 cm and turn on the Reslex with a setting of 3. That should provide maximum comfort and a reasonable degree of treatment. But, it sure would be helpful to be able to view or at least see what the maximum pressure it is going to during your sleep. That way you can determine if the maximum pressure needs to be adjusted.

Hope that helps some.

Edit: One more thought. Air leakage may be masking some of your apnea events, if leakage is an issue. The ResMed in some situations does not report apnea if leakage is high.

To put things in a bit of a perspective I was diagnosed with a home sleep study with an AHI of 34 or so. I now treat it with a min-max pressure of 11.2-12.6 cm. I get a very low obstructive index of less than 0.5, but my total AHI including the central apneas is closer to 3.0. My wife was diagnosed in the 70's for AHI, also with a home sleep study, and now uses a min-max pressure of 12-14.6 cm. She has very infrequent central apnea and regularly achieves less than 1.0 for AHI.

That is why I find it a bit strange that you could be diagnosed with an AHI of 46 and only need 4 cm pressure to treat it down to near zero.

I forgot to mention that I think the SenseAwake feature is a good one. It is about the only advantage that the F&P machine has over the ResMed AirSense 10 that I eventually bought. It can be a bit frustrating to wake up in the night with the machine at full pressure and you are trying to go back to sleep. The SenseAwake feature helps you in that respect. About the only way you can do something similar with the ResMed is to reach over and manually turn the machine off for a few seconds. When you turn it back on, it will go back to the ramp start pressure.

I did my trial on the newer F&P SleepStyle machine that had this feature. As I recall the purpose of the SenseAwake is to bring the pressure back to the ramp start pressure when it senses you are awake (perhaps 5 cm in your case). I think it starts to ramp back up again from there, or just sits there if you are not using the ramp, and only increases when the machine detects apnea events or flow limitations. If you are awake, at least in theory you should not have any events, so it should stay at that pressure.

That is very puzzling. I am not at all familiar with that particular machine. I did find a brief clinical manual on line. It sounds like you have figured out how to set it up. I believe you are correct in that this machine is supported by SleepyHead. The F&P SleepStyle I don't believe is supported either. However the sleep specialists should be able to view the data from it. What they should look for is the maximum pressure reached and whether or not there were any apnea events.

Without being able to see the detailed data it is hard to figure out what is going on with your current machine. I guess one possibility is that the machine is not accurately reporting the AHI. Or, the other is that you were misdiagnosed. Perhaps you should ask for a retest at their cost...

I will second what SnuzyQ has said. Tell us all the details on your machine. Download SleepyHead and have a look at your data. I'm suspicious that you must be getting a higher pressure than 4 cm. That is very low, and actually not that comfortable for most people. Here are some instruction on how to use SleepyHead.

Beginners Guide to SleepyHead

Have you considered trying a nasal pillow mask like the ResMed AirFit P10? You may find it more comfortable as it has minimal contact with your face. I recall your machine is using a low pressure in the range of 5-7 cm, and a nasal pillow should work well if you can keep your mouth closed during the night.

Your post disappeared, possibly because of some of the language. I had prepared a response to your question and previous post from 2 months ago. Here It is:

First, I am sorry you are feeling so bad. Wanting to sleep but not being able to is very frustrating. Probably two of my worst sleeps in my life was the night of my sleep study, and then the first night on the CPAP. Once I get anxious I then can't sleep.

I found your original post from two months ago. For some reason it is locked and you cannot reply to it. I am a new member here, and don't recall seeing it. I copied it and pasted it below. Here are my thoughts on your issues.

1. On the issue of wearing a CPAP there are some things that can be done to improve comfort; the mask, the initial start pressure, the type of ramp, and the minimum pressure. If you would post what type a machine you have and let us know what these pressure settings are we may be able to make some suggestions for improvement.

2. On the issue of feeling reasonably comfortable with the CPAP, but now not being able to sleep it would seem that there may be an issue of insomnia and the CPAP possibly just being one of a number of factors. I have posted a link below to a site which was formed to help people with insomnia and wanting to address it without any sleeping pills or a very minimum dose. The site was initiated by a pharmacist in Canada who became concerned that too many sleeping pills are being used and in addition to other side effects many of the older patients are using them to the extent they become disoriented, have falls, and are breaking their hips. He advocates the use of Cognitive Behavioural Therapy for Insomnia, or CBTi. There is a lot of good information at the site. In particular check out the CBTi page. There are a number of tools on the right hand side which are helpful in evaluating where you are now, and what things might need to be changed. It takes some time to work through all the material at the site, but I certainly found it worthwhile. The guy is not selling anything. Besides being a pharmacist, he is a professor at the university, and I suspect gets grants and uses grad students to help develop the site. Here is the link:

SleepWell - CBTi

"Hi. Im new to the forum. Ive been reading about people with similar issues but not quite the same so i decided to ask for help here.

Ive been using cpap for about 4 months now. I was diagnosed with very severe sleep apnea so obviously been feeling great since i started this therapy.

Now, since last thursday, every time i put on the mask, boom, im not sleepy anymore. I would have it on for maybe 4 hours and nothing. I would take it off and then i could fall asleep in less than 15 minutes. I slept without the mask on thursday friday and saturday, and I obviously felt like shit the entire weekend, like sleepy and groggy all the time, like i used to before.

Anyway on sunday i read i shouldnt do that, so i was like well yeah makes sense, lets try to sleep with mask on or lets not sleep at all. The thing is, in a few hours its gonna be 48 hours since i last slept. I can be almost passing out from sleep yet when i put the mask on, boom, not no more.

Questions: am i going to be awake for the rest of my life? What might have caused this?

Important info: the mask feels comfortable and if i showed you my results youd see it was going great before this. I would like to avoid taking pills. Please dont tell me "for some people it takes years to feel comfortable using cpap", i believe this isnt just a "comfort" type of issue since i had been using it successfully for the past 4 months and nothing had changed. My doctor isnt exactly the most professional doctor there is, so even though ive tried telling him about this, he hasnt been of much help. I need yours.

Thanks in advance."

First, I am sorry you are feeling so bad. Wanting to sleep but not being able to is very frustrating. Probably two of my worst sleeps in my life was the night of my sleep study, and then the first night on the CPAP. Once I get anxious I then can't sleep.

I found your original post from two months ago. For some reason it is locked and you cannot reply to it. I am a new member here, and don't recall seeing it. I copied it and pasted it below. Here are my thoughts on your issues.

1. On the issue of wearing a CPAP there are some things that can be done to improve comfort; the mask, the initial start pressure, the type of ramp, and the minimum pressure. If you would post what type a machine you have and let us know what these pressure settings are we may be able to make some suggestions for improvement.

2. On the issue of feeling reasonably comfortable with the CPAP, but now not being able to sleep it would seem that there may be an issue of insomnia and the CPAP possibly just being one of a number of factors. I have posted a link below to a site which was formed to help people with insomnia and wanting to address it without any sleeping pills or a very minimum dose. The site was initiated by a pharmacist in Canada who became concerned that too many sleeping pills are being used and in addition to other side effects many of the older patients are using them to the extent they become disoriented, have falls, and are breaking their hips. He advocates the use of Cognitive Behavioural Therapy for Insomnia, or CBTi. There is a lot of good information at the site. In particular check out the CBTi page. There are a number of tools on the right hand side which are helpful in evaluating where you are now, and what things might need to be changed. It takes some time to work through all the material at the site, but I certainly found it worthwhile. The guy is not selling anything. Besides being a pharmacist, he is a professor at the university, and I suspect gets grants and uses grad students to help develop the site. Here is the link:

SleepWell - CBTi

"Hi. Im new to the forum. Ive been reading about people with similar issues but not quite the same so i decided to ask for help here.

Ive been using cpap for about 4 months now. I was diagnosed with very severe sleep apnea so obviously been feeling great since i started this therapy.

Now, since last thursday, every time i put on the mask, boom, im not sleepy anymore. I would have it on for maybe 4 hours and nothing. I would take it off and then i could fall asleep in less than 15 minutes. I slept without the mask on thursday friday and saturday, and I obviously felt like shit the entire weekend, like sleepy and groggy all the time, like i used to before.

Anyway on sunday i read i shouldnt do that, so i was like well yeah makes sense, lets try to sleep with mask on or lets not sleep at all. The thing is, in a few hours its gonna be 48 hours since i last slept. I can be almost passing out from sleep yet when i put the mask on, boom, not no more.

Questions: am i going to be awake for the rest of my life? What might have caused this?

Important info: the mask feels comfortable and if i showed you my results youd see it was going great before this. I would like to avoid taking pills. Please dont tell me "for some people it takes years to feel comfortable using cpap", i believe this isnt just a "comfort" type of issue since i had been using it successfully for the past 4 months and nothing had changed. My doctor isnt exactly the most professional doctor there is, so even though ive tried telling him about this, he hasnt been of much help. I need yours.

Thanks in advance."