Sierra

Yes, Auto CPAP and APAP are generally the same thing. It means they adjust the pressure during the night in response to obstructive apnea events, hypopnea, snoring, and flow limitations. You set a maximum pressure that you will allow the machine to go to, and you also set a minimum pressure that the machine is not allowed to go below. When first using them, it is normal to set a wide range between the two. For example max could be 20 cm, and min could be 7 cm. Then after you use it, and look at the results as to where the pressure goes in response to your events, then it is normal to reduce the maximum and increase the minimum. A well tuned machine will likely have a fairly narrow range between the minimum and maximum. If you give us the manufacturer and model name of your machine we can tell you what type it is.

My CPAP pressure does not seem to be affected by congestion. I use a nasal pillow mask and if anything that seems to keep my nasal passages clear, if I get them clear before I put the mask on.

You should ask to get a copy of your sleep study report. One of the most important factors in the report beside the total AHI number is the portion of the total that is obstructive apnea and the portion that is central apnea. Ask for these numbers. Standard CPAP machines are very effective in treating obstructive apnea, but not so effective in treating central apnea. If you have a high proportion of central apnea you may need a different type of machine. If you have basic obstructive apnea and have any choice in the machine, I would select a ResMed AirSense 10 AutoSet For Her (even if you are male). It has the best features.

Masks are difficult. I have tried 5 masks so far, 2 full face, 1 nasal, and 2 nasal pillow types. For me, I find the nasal pillow masks to be the most comfortable. Of the two I tried, I prefer the ResMed AirFit P10 over the F&P Brevida. But everyone is different. Ask to try different masks to see what works for you, if that is possible. The common problem with a nasal, or nasal pillow mask is that you open your mouth in your sleep and air escapes out. Some learn not to do it, and others use a chin strap to help keep your mouth closed. The other option is a full face mask, but that tends to have more trouble with leaks, and some find it claustrophobic.

Hope that helps some. Any questions just post...

What is the manufacturer and model name of your machine?

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,