Sierra

The best mask I have found so far has been the ResMed P10. I really like it except for one thing. The headgear is really flimsy and of a poor design. It has no adjustment feature, and seems to stretch quickly. Yes, they include some goofy little clips that you are supposed to use to tighten the straps, but the biggest issue I have with this mask is that it will not stay on my head. I find that when I use the clips they catch on the pillow and make it even easier for the headgear to move and let the mask come loose.

Has anyone found any solutions to this? I would be really nice if someone developed a generic headgear that would fit on the funny attachment system that the P10 uses. I also have a Brevida nasal pillow mask which has a much better and adjustable headgear. However I can't see any easy way of adapting it to the P10. Unfortunately the nasal pillow part of the Brevida does not seem to agree with my nose. That part works much better on the P10.

Thought I would throw it out there in case someone is aware of a good solution. The best one I have come up with so far is to use a Breathewear Halo chin strap. It helps somewhat in keeping your mouth shut, and in keeping the P10 headstraps in place.

That is the same mask as my wife uses. Opening your mouth can be a problem. It may account for your higher use of humidifier water. I use a Breathwear Halo chin strap to reduce the open mouth time.

If you look on the end of the hose it will say Climate Air Line on the grey fitting if it is a heated hose. Unless you have a heated hose, you will not be able to select the auto climate control feature.

A pressure setting of 4-12 is quite a wide range. I find that 4 cm is quite a low pressure and it can feel like you are starving for air. Assuming you need 12 cm maximum, a more normal range would be 9 cm minimum to 12 cm. The start pressure for the Autoramp should be about 7 cm.

If you want some help with how to make these setting changes, it is probably best to start a new thread.

Out of curiosity I pulled the SD card from mine. It still displayed the detailed sleep report. I then changed the Essentials setting in the clinical menu to On instead of Plus. I then lost the detailed sleep report. Seems that is likely to be your issue.

There is a link below to a good article/study on the different techniques. I think the short story is that EPR is a fixed pressure drop equal to the setting, but does not allow pressure to drop below 4 cm, so it gets limited with low mask pressures. The Flex pressure drops are modified to be flow dependent and more drop is allowed at higher treatment pressures. The net result seems to be that Flex has a drop, but it is less than EPR, except for the P-Flex, and it has less of an effect on AHI.

Pressure-Relief Features of Fixed and Autotitrating Continuous Positive Airway Pressure May Impair Their Efficacy

George, I had one more thought on this. The other issue with the SD card is that the slide switch on it may be in the locked position which prevents data from being written to it. Or the SD card may be in the slot but not fully inserted. I've done both. I have also mixed up my wife's card with my card. Not a good thing!

Once you change your Mode to AutoSet and let the A10 control the pressure, and then look at it in SleepyHead, you will get a much better idea what pressures you need. Too low of a pressure can be as uncomfortable as to high. I like to see the actual pressure reach the max pressure setting 2-4 times a night, but not flatline there. On the minimum side I like to see it reach minimum about that many times or perhaps more. It is OK for the pressure to flatline at minimum for periods of time.

CPAP can certainly help to resolve wake up issues due to apnea events. However, it adds some complexity/discomfort to the sleep process. It takes time to get comfortable with the machine, and it certainly improves over time. There can be other issues in getting a good nights sleep. I stumbled onto a website which was started by a pharmacist in Canada that believed too many people were unnecessarily using sleeping pills. He is also a University professor, and I suspect the website is probably a grad student project. He does not seem to be selling anything, and I believe he is getting government support for the project. In any case, he advocates the use of Cognitive Behavioural Therapy for Insomnia, or CBTi. Whether you suffer from insomnia or not, there are some good tips there for getting a good night's sleep. I have started following some of the recommendations made. In any case here is the link if you want to check it out.

Sleepwell - CBTi

I think you would need to look at your data in SleepyHead to know for sure. However, in my experience I typically get a really bad AHI out of the blue when I have a bad sleep for some reason, and I keep waking up.

Do you know what portion of the AHI is obstructive apnea, and what portion is central apnea?

I have done two nights now with a nasal pillow mask + chin strap + tape over mouth. It seems to totally eliminate the mouth leak issue. Does not help with the mask dislodging during the night (probably side sleeping) and causing a leak. Surprisingly the tape on the mouth is about the least invasive feeling part of the whole setup.

EPR is a ResMed term for Expiratory Pressure Relief. It is simply a reduction in the mask pressure when you exhale compared to when you inhale. In theory the setting refers to the number of cm of water pressure difference. To the CPAP user it usually feels subjectively good. The higher pressure on inhalation helps you get air in, while the lower pressure on exhalation makes it easier to get air out. It sounds like a good thing, so why wouldn't you always use it? This is where it starts to get complicated, but my resolution of it is that for most, but potentially not all people, obstructive apnea occurs on the exhale side of the cycle, not the inhale. So, if you have your machine set at 12 cm for example, and the EPR at 3 cm, you are only getting 9 cm pressure on the exhale cycle and that is your effective treatment pressure preventing obstructive apnea on exhale. And, at the same time your mask has to seal against the 12 cm pressure. Now if your machine is in APAP or AutoSet mode it will increase pressure to compensate for the EPR providing your maximum is high enough. If it is not, then treatment is going to be limited, and your AHI is likely to go up.

I use the AirSense 10 Autoset machine, and this is how I use EPR. I have found that I can run about 1.5 cm lower pressure and get the same effectiveness with the EPR off compared to having EPR set at 3. But, I still use EPR set at 3 during the Ramp cycle of use. I find the EPR of 3 makes the CPAP more comfortable when I am awake and trying to go to sleep. I set the Ramp start pressure fairly high (8.4 cm currently for myself), so it cycles between 8.4 cm on inhale to 5.4 cm on exhale during the ramp period. I use the A10 Auto Ramp feature, which holds the pressure at that level until it senses you are asleep, instead of the gradual ramp up for a set period of time. And, there is a setting to make EPR effective on Ramp Only in the Clinical Menu.

This said, is turning EPR off effective for everyone? Well for my wife not so much. She seems to get less benefit than I do from turning it off. Must have something to do with when/how she gets apnea. She seems to gain less than 1 cm by turning it off.

What about A-FLEX or C-Flex used by Dreamstation. Well, it seems they don't really reduce the pressure on expiry although they use the same 1, 2, 3 setting scheme. They just shape the pressure response a bit on expiry, but the average pressure is not really reduced any significant amount. So, while I have not used those machines, I kind of think the setting may be a bit of a comfort perception thing. If you try it and like it, then use it. But, it probably does not change the treatment effectiveness like it does on the ResMed machines. Those are just my conclusions. Here is a link to an article on the differences between the machines in this feature.

Comparing expiratory relief in different CPAP machines

I have the AirSense 10, live in Edmonton, and I don't think I have the issue. But then again, I have not registered for MyAir so have no idea what data is being sent. I do see the bars and lights flashing which is supposed to mean it works, but I have not bothered to check. I use SleepyHead to monitor my results and find that much more useful. I see the following info in the Clinician Manual

"The Wireless signal strength icon displayed at the top right of the screen indicates the signal strength. Advise the patient to check the signal strength on their device. Notes:  Therapy data might not be transmitted if used outside of the country or region of purchase.  Devices with cellular communication might not be available in all regions."

There is also a method to put the device in Airplane mode which shuts off the transmission, but you should get an airplane icon on the screen to indicate it is in that mode.

Sounds to me that it could be a wireless reception issue, or there is a problem with the machine. For what it is worth, there are people who believe this feature is an invasion of their privacy and go to great lengths to disable it. From what I understand it is very difficult and requires machine disassembly to accomplish. There is the airplane mode, but that is a temporary thing, and I think it keeps prompting you to shut it off.

Have you considered using SleepyHead to do your monitoring? I find it much more functional than that MyAir application.