Sierra

I gather from another post made by the OP that his doctor gave him permission to change the pressure settings.

The system must be different in the US compared to Canada. I'm not even sure there is really any such thing as a "sleep doctor" here. Typically the general practitioner approves getting the sleep study which is typically done at home. This is done through a sleep clinic that as far as I can see only employs sleep technicians. The sleep test results are read by some phantom doctor who is apparently independent from the clinic. The results are sent to the GP who rubber stamps the prescription. From there the sleep tech sets up the machine, and does all the adjusting. They are the ones who in theory monitor the results through the cell phone system used by the newer machines. It sounds like you get more service provided in the US.

I did a bit of a search to see if I could find anything more on what is considered an acceptable leak rate. I found this video at the link below which gives you a quick tour of the user menu system. Near the end they state that the acceptable leak rate is 24 L/min. However, you will not see this extra sleep report data unless your Essentials option is set to Plus in the Clinician Menu. Hope that helps some.

ResMed AirSense 10 Menu Video

When you go down to see your provider with the machine ask them to change the Essentials option to Plus. That will give you a more detailed report from the machine with an actual average leak rate. Then ask them to give you some guidance as to what an acceptable leak rate number is. You should have more to go on than just a happy face or non happy face.

I doubt that there is anything wrong with your machine. In 4 months I have only gotten the red unhappy face for mask fit once. However I have had many nights with high leakage rates based on SleepyHead. I don't use My Air so can't comment on those numbers. ResMed turns on the red unhappy face when the 70th percentile leak exceeds 24 L/min, which is pretty high.

When you look at the Sleep Report on the machine are you getting the additional data on your actual leak rate? If not you can go into the Clinical Menu and make one change to allow you to see the more detailed reporting. Push the round button once to bring up the display. Then push the round button as well as the home key at the bottom, both at the same time for about 5 seconds. This will bring up the Clinical Menu Settings. Highlight that by turning the round knob, and then push it in to go into the settings. It works basically the same as the normal user menu - rotate the knob to navigate or highlight options and then push it in to select. So, rotate the knob until you see a menu items called Essentials under Options. Select it by pushing in the round knob. You will be given two options. One is On, and the other is Plus. Select the Plus option. To get out of the clinical menu press the Home key, Select Exit Clinical Menu, and you are back to the normal menu. Now when you go to the Sleep Report you should get some additional data showing below the happy face stuff. First you can select different date ranges from one day to one year. One number they give is the Leak rate average for the selected date range. But the complicating part is that this leak rate is the 95% rate. not the 70th percentage they use for the happy face... That makes things a bit confusing as they are not comparable...

What is good? About all I can say is that I am happy with my current leak rate and it shows up as in the 16-19 L/min range on the machine report.

Hope that helps some. Again, I don't think there is anything wrong with your machine. Your mask may need some adjusting though if your leakage rate shows up higher than 25 L/min or more.

You may find the article at the link below helpful in understanding CSA.

Central Sleep Apnea

In treating CSA with a CPAP there are two basic machines used beyond the basic CPAP. One is the BiPAP or two pressure level machine, which you already have. They can help a little bit with the pressure support feature (5 cm in your case). It provides a minimal improvement in your breathing efficiency. I am not familiar with the Respironics machines, but the ResMed AirCurve 10 VAuto machine has some additional features which allow you to fine tune how the machine switches from IPAP to EPAP pressure (13 cm and 8 cm in your case). If the machine switches quickly and at the right time, it can also help your breathing efficiency. Not sure if your machine has those features, but it would be worth discussing with your sleep technician. The next step is an ASV machine or Adaptive Servo Ventilation. Those machines monitor and lock on to your breathing pattern. When they detect shallower breathing they provide forced ventilation to compensate on a breath by breath basis.

Hope that helps some,

What is the breakdown of your events? What portion is central apnea, and what portion is obstructive apnea?

Why would your machine want to use a higher pressure and not improve your AHI? If it is an auto machine it will not only respond to apnea events but it will also respond to snoring and flow limitations. It is possible that your pressure of 15 cm is enough to stop or significantly reduce the apnea events but not enough to stop the snoring or flow limitations. So, your machine wants to keep increasing pressure to stop the snoring and flow limitations. I have the pressure set on my wife's machine just high enough to reduce the apnea to the AHI range of about 1.0. However SleepyHead shows she still has snoring and flow limitations. She prefers that to suffering with a higher pressure.

Actually many people adjust their own settings, including most users of SleepyHead. In Canada many people get essentially shut out of using a sleep therapy technician because they end up buying their own machine and when you do that then they will not help you. My impression is that times have changed in the CPAP business. In the old days it was normal to have the sleep test done in an overnight clinic and you came out of that with an apnea diagnosis (or not), and severity. The next step was to do an overnight titration test to determine what your magic pressure setting is. Then they would give you a fixed pressure CPAP set at that pressure and would adjust from time to time if they were diligent with the follow up. Now the cost of an auto machine is virtually the same as a fixed pressure machine. And the machine essentially does a titration test every night. For those that are engaged and monitor their results with SleepyHead, it is a small step to use those results to fine tune their machine settings.

This is the response I gave you in your other post on your issue.

Is your machine an auto CPAP like the AirSense 10 AutoSet? If so, you should be able to set a minimum and a maximum pressure. Unless you use software like SleepyHead which you can download for free, you will be flying somewhat blind. With SleepyHead I like to watch what the pressure does during the night and observe when the apnea events are occurring. If the majority are not happening when the machine is limited to the maximum pressure, then you don't really gain much by increasing the maximum pressure. In fact you will likely gain more by increasing the minimum pressure. I find after a lot of monitoring I end up setting the minimum pressure only 1 cm below my maximum. So if you have an auto machine, you could try a max of 15 and a minimum of 14 and see how that works. An AHI of 1.0 is pretty darn good, so it it were me, I would not torture yourself with high pressures if you can get your AHI to 1.0 with lower pressures. And if you use SleepyHead you might want to start with the minimum set somewhat lower, and then adjust higher as needed.