Sierra

You may want to consider using some of the tools and techniques of cognitive behavioural therapy for insomnia. You may not have technical insomnia, but could gain some tips on how to get a more effective sleep. Here is a link. There are quite a few things to check out at the site that are worthwhile. As far as I can see they are not trying to sell anything.

Cognitive Behavioural Therapy for Insomnia

I believe the For Her version of the Swift FX headgear has a shorter back strap, but the same length on the top strap.

I have similar issues with central apnea. I seem to go in stretches when my AHI and CA's are low. Then I go on a stretch where I get an AHI over 5. Last night I actually hit 7.5. I don't think they are going to get very concerned about it until you start to average over 5 for AHI.

On trying EPR off, I would focus on the obstructive events. Compare the number of OAs you get with and without EPR. My thoughts are that if I can get OA down then I can live with higher CA.

Yes, I understand that Flex uses the flow rate, and set pressure to determine how much and when to cut back or increase EPAP during the exhale portion of the cycle. What I am talking about is the "decision" by the machine to make the switch from EPAP to IPAP or back. I believe Flex tries to predict using timing when you are going to breath out or in, while ResMed uses flow rate. I didn't see flow change for 1 sec so it is time to switch kind of logic.

I used a Fisher and Paykel machine in my trial period, and while they are not very forthcoming on how they do the switch from IPAP to EPAP, I strongly suspect it is a timing based logic similar to Flex. I often found the machine trying to force me to start a new breath when I really didn't want to. It wasn't a major effect, but it was noticeable. I complained about it, and I think all they did was turn down the EPR. I find the ResMed AirSense to be totally unobtrusive in making the switch when EPR is on and even set at 3.

I have noticed something like this, but not exactly the same. What I have experienced is a dizzy feeling about 1 hour after I get up. It goes away in about another hour. I did some searching on this issue and came up with an article about Otic Barotrama Resulting from CPAP Treatment. This sounds quite a bit more serious than what I was experiencing as there was a significant hearing loss with this individual. What it does indicate however is that spending significant hours on a CPAP every day can cause a pressurization of the middle ear. That article is very technical and I don't pretend to understand all the physiology of it. But, what needs to be kept in mind is that while it is a bit similar to flying in an airplane or going up and down a mountain, it is in one essential part different. In the airplane situation you get a pressure change on the outside of the ear, and eventually on the inside of the ear after things equalize. However with a CPAP there is no equalization until the time you get up and take away the pressure. The pressure acts inside your nasal passages all night, while the pressure outside of the ear remains unchanged. So while it kind of like the airplane experience, the pressure differential lasts for hours, instead of being equalized by chewing gum or swallowing in the plane situation. Also the individual in the article had increased treatment pressure up to 20 cm. I maintain 12 cm. But many do treat at 20 cm and some up to 25 cm.

My thoughts would be to ask for a referral to an eye, ear, and nose specialist to get their opinion. I am monitoring my symptoms and have resolved that if there are no lasting effects more than an hour or so, I am not going to worry about it. I do strongly suspect that it is a pressure issue in the ear, and it slowly resolves itself each day after I get up.

I've tried 4 different chin straps: one home made with Tensor bandage and some sewing, one an on line generic that sells for $10 or less, one that I bought locally at 2 for $6 (hole cut out for the ear), and most recently the Breathewear Halo. It is probably the most secure of them all. For me putting the chin strap on last works the best. You could try taping the straps with some paper type medical or first aid tape (3M Nexcare). I use it to tape my mouth shut. It is not too hard on the skin.

Does the Respironics bipap machines have the equivalent of ResMed's Triggering and Cycling adjustments; TiControl and Rise Time?

The amount of purge air they use to keep the mask high in oxygen and low in CO2 is based on the dead volume of the mask. A larger volume mask needs more purge flow. They can't of course get rid of all the CO2, but most of it. The other issue is that the purge flow changes with mask pressure. If you use a high mask pressure you get more purge flow than if you use a low pressure. The OP seems to be using a fixed pressure of 6 cm which is very low, so the purge flow will be low as well.

The other issue if it is an APAP or auto machine is the minimum pressure. If the minimum pressure is set too low, and the machine backs off the pressure to minimum in the night you can wake up feeling short of air. It would be very helpful if you could tell us what brand and model of machine you have.

I believe the other difference in the two methods is that the Flex methods use a timed predictive technique in the switching between the two pressure levels. The EPR method is based on flow. It tries to follow what you want to do. There are pros and cons to each method.