Sierra

I have leak issues with a full face mask too, and have not been able to solve them. Some report that using a mask liner like RemZzzs helps, but I have not tried that. My solution has been to use the ResMed AirFit P10 nasal pillow mask, with a Breathewear Halo chin strap over top of it. Before I put the mask on I tape my mouth shut with 3M NexCare paper medical tape. That seems to keep the leaks down, and my mask in place. For a pillow I use a softer down alternative one that is fairly inexpensive at places like Costco, and a rayon pillow cover so my head and all the paraphernalia slips fairly easily on it.

Keep working with the masks. It is not a machine problem, it is a mask issue.

Unless you wake up from the apnea you are unlikely to know you had one. I was not convinced I had sleep apnea until I had a sleep study done. It detected 33 apnea events per hour were happening, and I was unaware of it.

Setting the ramp time to Auto should not affect the pressures used after you go to sleep. Auto Ramp just goes up to the Ramp Start pressure you input, and holds there until the machine detects you are asleep. Then it ramps up quite quickly to the minimum pressure if you are in AutoSet mode. If you do not go to sleep within 30 minutes then it ends the hold and ramps up to minimum set pressure. From there it automatically adjusts up and down between the preset minimum and maximum pressures. If you don't want the pressures to be automatically adjusted during the night, you would have to change the Mode from AutoSet to CPAP. Then there will only be one set pressure, not a max and min. You still should be able to use the Auto Ramp feature though.

You do have some concerning issues that should be checked out. I would suggest asking for a sleep study to see if it is apnea. The link below gives the typical symptoms. But the bottom line is that it is apnea when you stop breathing. Sounds like you may be doing that.

Obstructive Sleep Apnea

If you are in the US I am not sure how it all works. I guess the technician that gave you the machine? In Canada we either go to a sleep clinic, or just do it ourselves.

I am not a doctor, but I did find an article which explored the relationship of OSA and glaucoma, and they do seem to be highly related. What is not so clear is if one causes the other, or are they just caused by similar factors, such as obesity. I will put a link to the article below, and I have only skimmed it. This is their conclusion:

"OSA is the major risk factor for developing glaucoma. Studies show strong association between OSA and glaucoma. Complete ophthalmic evaluation should be advised at every follow-up for patients with OSA. Glaucoma patients with obesity and progressive VF (visual field) damage even under low eye pressure (NTG) should be evaluated for OSA and other sleep disorders. OSA patients treating with CPAP therapy should undergo regular glaucoma screening and IOP (intraocular pressure) monitoring because CPAP therapy may trigger the glaucoma damage and its progression by raising the IOP."

I would read this to mean that CPAP treatment is not necessarily conflicted by having glaucoma, but that you need regular monitoring to ensure the glaucoma and other eye issues are not worsened. It would seem that a regular at least annual exam by a ophthalmologist would be essential.

Glaucoma and its association with obstructive sleep apnea

The Flex setting controls the amount the pressure is reduced on exhale compared to inhale. On the ResMed machines it is called EPR and the setting corresponds to the pressure reduction in cm of water. On the Dreamstation it is not an exact one for one pressure reduction and depends on your flow and pressure. However, generally setting it from nothing or off means no reduction, and 3 means full reduction. See the bottom of page 13 at the link below. Your provider may not have turned the Flex option on, but you could ask them to turn it on. Then you can set it. The Flex setting may reduce the effectiveness of your treatment slightly, but it is something you could use initially until you get used to the CPAP experience, and then reduce it or shut it off later on.

Dreamstation User Manual

That is moderate apnea and with the low central apnea incidence should be easy to treat with a CPAP. A maximum pressure of 6 cm is very low, and normally shouldn't cause any significant breathing effort issues. Best to talk to your doctor about the cause of the pain. Also ask about using the Flex setting on the Dreamstation to reduce breathing effort. It may be possible to treat your apnea with a fixed pressure of 7 cm and a Flex setting of 3, for maximum comfort and minimum breathing effort.

I think the AirSense 10 is superior to the Dreamstation, so first I would suggest you keep that machine. One of the best features I enjoy with the A10 is the Auto Ramp feature. Instead of it being a set time, it watches your breathing pattern and holds the pressure until you are asleep. A start pressure which defaults to 4 cm is too low in my opinion and can leave you wanting more air when you are trying to go to sleep. A start pressure of 7-8 cm is what most find comfortable. Since you have taken the step to using SleepyHead, you will be much more informed than most on what the machine is actually doing.

In my opinion a 5 cm to 20 range is far too wide. After 2 weeks with the Dreamstation, the doctor should have known that this range was not necessary for you. Based on your reported maximum of 10.5 cm over 5 days, I would suggest your maximum pressure should be set at 10 cm or 11 cm at most. It does not hurt to limit the pressure a bit, if there are no apnea events occurring when the pressure is limited. SleepyHead will tell you that. Minimum will probably be about 8 cm. But again look at SleepyHead. I like to see the minimum setting keeping the pressure from going lower for a good part of the night -- 30-40%. Limiting how far it drops can prevent apnea events and improve AHI.

Here is how I would set your machine as a first try:

Minimum Pressure: 8 cm

Maximum Pressure: 10-11 cm

Ramp: Auto

Ramp start (pressure): 7-8 cm (based on what you find comfortable while going to sleep)

EPR 3, Ramp only

The EPR will make it easier to breath when you are going to sleep and turn off when you are asleep. With EPR off, the machine should be more effective while sleeping.

If you have any questions just ask. If you want to adjust your own machine, I can give you a link to the Clinical Manual which provides the detail on how to do it. Not hard.

I also would recommend downloading and installing SleepyHead to see what is really going on.

SleepyHead Download