Sierra

You have some good questions, and I don't think your experience is uncommon for new users of CPAP. Some questions for you:

1. Do you have the AirSense 10 AutoSet model? It should say on the front of the machine, down beside where you have the humidifier water level indication.
2. Is your machine set to CPAP mode or AutoSet mode? In CPAP mode you only have one fixed pressure. In AutoSet mode you have a minimum pressure and a maximum pressure. The machine automatically adjusts the pressure depending on your needs, up and down between those two pressures. These pressures may be shown briefly on the screen when you first start the machine.
3. Do you have EPR turned on, and if so what is it set at? (1, 2, or 3).
4. Are you using a heated Climate Air hose? It should be marked on the grey fitting at the end of the hose. It is darker in colour because there is a spiral wire running down the hose that is used for heating.
5. Is your Climate Control set to Auto?
6. Is your temperature set to 27 C or 81 F?
7. What AHI numbers are you getting? That number should flash on the screen when you shut it off each morning.

Sorry for all the questions but all of that stuff makes a difference.

I will assume initially that your machine is set to CPAP mode which would mean one fixed pressure of 6 cm. In my opinion that pressure can be too low to be comfortable to some people. Switching your mask type should not make any difference. Each mask is designed to have a purge flow rate based on the dead space (size of the mask). A larger volume mask like a full face will have more purge flow, and a smaller volume mask like a nasal pillow style will have less purge flow. The idea is to control the CO2 level in the air so you are getting low CO2 when you breath in. For comfort purposes with the low air pressure you are using, you may be better off with a nasal pillow mask, like the AirFit P10. It is unlikely to help with the air flow issue. For that you most likely need an air pressure increase to at least 7 cm.

It is not that hard to make these changes yourself, and I can give you some instructions on how to do it, if you are comfortable in doing it. And comfortable with telling your doctor you have done it. The other option is to ask the doctor to change the pressure.

If it were me setting the machine up for a single pressure I would set it at 7 cm. I would turn on the EPR and set it at 3 cm. It reduces the pressure on exhale only by 3cm. So you would be feeling the assistance of 7 cm pressure to breath in, and only the resistance of 4 cm to breath out. Should make it easier to breath overall. Then I would turn the ramp back on, but set it to Auto with a start pressure of 7 cm, and set the EPR (exhale pressure relief) to function during the ramp time only. In auto it would only use the two pressure until you fall asleep. If you want to know how to do that, post again, with answers to as many of the questions above as you can. It is not really that hard. You just enter a special Clinician Menu which functions pretty much the same as the standard user menu. Many CPAP users adjust their own settings.

The SleepyHead software only displays data that is captured by your machine and saved on the SD card in your machine. To bring the data from your machine into SleepyHead you just remove the SD card and put it in a SD card reader. When you open SleepyHead and ask to import the data, it should find the data. But, no it only displays data already there, and there is no ability to make changes to your machine setup with the SleepyHead software. Until you get very familiar with SleepyHead I would not suggest making changes to your setup. Instead I would suggest using it to monitor what is going on and from that generate questions for your doctor or sleep specialist.

I like to look at my AirSense 10 data in detail using the free SleepyHead software. The software allows you to see minute by minute what your air leakage is. That should quickly tell you what the problem may be.

Could it be the machine? Not likely. Is it possible the mask type has been changed and is not correct for your actual mask. The typical nasal pillow mask, the ResMed AirFit P10 should have a mask type set at "pillows". Setting it incorrectly might change the leak report, but not sure.

You posted in a thread titled "BiPAP Machine Functionality". You have a couple of responses to it. Here is a link to your post

https://myapnea.org/forum/bipap-machine-functionality/1#comment-17300

Central apena do not respond well to APAP treatment, but turning off the EPR is certainly worth a try. Your machine simply ignores CA events and does not respond to them.

SleepyHead should run fine on a Windows 7 64-bit computer. I did a Google Image search for example SleepyHead screen shots, to illustrate what you can do with them. Here is a fairly simple one:

Basic APAP Example

This machine I believe is similar to the current Dreamstations. It has been set up with a very wide min max pressure range, and I would suggest the minimum at 5 cm is too low. I suspect this user may be feeling short of air in the night. The max of 10 cm looks OK. These machines seem to respond slowly to events and are constantly trying to reduce pressure. The result in this case is a high number of hypopnea events, and an unacceptable AHI over 5. If this were me, I would increase the minimum pressure to 8 cm. I suspect that would reduce the AHI to well under 5.

AirCurve 10 Example

This one is more complex, and perhaps more relevant to your situation. What you can immediately see is that this user is suffering from a very high number of central apnea events, and almost no obstructive apnea. This probably why they are on the AirCurve. It is using a fixed EPAP of 13 cm, and a pressure support of 4 cm. And as set up is not doing a very good job of addressing the central apnea. This person woke up and shut the machine off three times during the night, so is probably not getting a very restful sleep. Apnea events may be waking them up. What you can do with SleepyHead is zoom in on those central events and see in detail what is happening. Are they occurring suddenly or is the breathing pattern a waxing and waning. It is possible that EPAP pressure could be lowered, and pressure support increased. These machines also have some settings that affect how they switch from EPAP to IPAP (TiControl, Rise Time). They may need some fine tuning. Or it could be that this user is at the limit of what can be done with the AirCurve 10, and may need the full ventilator AirCurve 10 ASV.

I hope that helps some. You may not be comfortable making these kind of adjustments yourself, but if you dig into the data of what is happening, then you can have a much better discussion with your doctor about potential improvements from adjustment changes. In 4 months I have made 17 adjustments to my pressure settings. I think I now have settings that are about as good as it is going to get. However, it takes time.

I understand excessive air in the stomach is called aerophagia, and does occur in some CPAP users. I have not had any issues with it while using EPR and when not using it, so no personal experience. I will give you a link to read about it. There seem to be many potential causes and many potential ways to address it. Pressure can be too low, causing you to gulp air. Pressure can be too high, forcing excess air into your stomach. With respect to using EPR, it is suggested that raising it, or setting it at 3, not zero can reduce pressure during exhale and may reduce the swallowing of air. While that might be true on a fixed pressure CPAP, an Auto CPAP like the AirSense 10 AutoSet, may respond to the reduced air on exhale if it produces any apnea events or flow limitations. It increases pressure to compensate, and effectively defeating the EPR.

In short, complex. The easiest thing to do is try using EPR at 3 and compare it to EPR turned off. Watch what happens to your AHI scores. Do they get worse? If this is not an obvious solution you probably should go back to your provider to see where you stand with pressures and what could be changed to reduce the aerophagia. Suitability of your mask should also be reviewed.

Aerophagia Causes and Resolutions

Here are a couple of real life examples of using EPR compared to not using it.

On my AirSense 10 AutoSet I adjusted pressure over time to do the best I could with an EPR of 3. To get a technically acceptable but poor AHI of about 4 I needed a maximum pressure setting of 15 cm. Now over time with EPR set at 3, but acting only during the ramp (set on auto) period of time, I have managed to get my maximum pressure setting down to 12 cm. While my AHI is still not super great because I have central apnea issue, I still have gotten it down to the 2.4 range, with the lower pressure of 12 cm. If you look at obstructive apnea events only, I do much better, with my last night actual scoring at zero for OAs! After I go to sleep I don't find it hard to exhale against 12 cm of pressure.

My wife uses a ResMed S9, and has been using it over 3 years now. I tried some time ago to convince her to stop the EPR, but she said she did not like it. So up until a couple of weeks ago she was using a maximum pressure setting of 15 cm and an EPR of 2 (that was our compromise a while ago), and getting an AHI of 1.6. While she started with a diagnosed AHI in the 70's and more than double my diagnosis, she gets much better AHI's as she has almost no centrals. Two weeks ago I convinced her to try the no EPR route again. I set her machine at EPR 3 but ramp only, with a maximum pressure of 14. Her average AHI to date with this setting is 1.1, and she even got a zero AHI in the past week. So far, my wife has not complained this time about exhaling against 14 cm of pressure. Now if she stops getting nights with zero AHI the discussion may be back on again!!

So, I gained the full 3 cm of pressure reduction with the elimination of EPR during the sleep period. My wife gained 1 cm reduction with a 2 cm change in EPR. So, it seems the hit from EPR can be a bit of an individual thing.

On the issue of getting more oxygen due to the high pressure during inhale compared to exhale, I am not so convinced. For sure it is real, but I have to question the magnitude of it. Why? The amount of oxygen in air is determined by the absolute pressure of the air, not the relative or gauge pressure that we use in CPAP. At sea level using CPAP units of pressure the absolute pressure is 1033 cm of water. So if we make an EPR 3 cm change in pressure that changes the oxygen content in the same volume of air by 3/1033 or 0.3%. Not a big number. And to put it in context our weather is changing our actual atmospheric pressure in the order of 35 cm of water from a high pressure event to a low pressure event. That means oxygen content is changing just due to weather as much as 35/1033 or 3.3%. That is a much higher impact than using EPR.

That said, I encourage using EPR, but only during the ramp period where it does not compromise the treatment of apena when you are sleeping.

SleepyHead should work with your Air Curve 10. Here is a link to a SleepyHead manual. I gave you the download link in the other post. You need a recent version of Windows or a Mac.

SleepyHead Beginner's Guide

What I like about SleepyHead is that you can step through the events from a night, and zoom in to see in great detail exactly what happened around the event, like Mask Pressure, Flow rate, snoring, flow limitation, etc... It also does a good job of tracking each critical change you (or your provider) has made to your machine settings. It gives you a good summary of your statistics in a number of different ways. There is the odd minor bug, but nothing critical that I can see. I use the AirSense 10 with it, and also track my wife's S9.

The AirSense 10 Auto For Her is actually the APAP machine. It has an option to run in the For Her mode. It responds to apnea events in a way that is said to be more suitable for women. But, it can also be run in the standard mode. I think it makes sense even for men to get the For Her version of the APAP. It is just another available option, with no downside. Same price.

There are masks for women as well, although that may be more cosmetic (colour) than different. Some masks may have a smaller headgear, and come with different cushion inserts if they are intended for women. If you go for the AirFit P10 I would also suggest the For Her version. The headstraps on these things tend to stretch. I know the colour is different, but it would be good if the headstraps are a little smaller too.

Try to avoid getting a fixed pressure version of the machine such as the CPAP or Elite version. There is little difference in cost between them and the full AutoSet version. Some info on the AutoSet For Her version at the link below:

AutoSet For Her