Sierra

It sounds like you have a lot going on. I have had none of the issues you describe, but here are some of the things I have tried with the pillow issue. Prior to using CPAP I have used an orthopedic shaped memory foam pillow. It seems to minimize getting kinks in the neck, as it provides higher neck support than head support, kind of like your wedge pillow. However with a CPAP mask on, I find it is too resistant to pressure and dislodges the mask easily causing mask leaks. For that reason I have switched to a down alternative pillow, which form fits to your head neck, but does not have the same push back resistance on the mask. Costco has them for about $18 a pair.

Some people suffer from positional apnea, or restrictions caused by your head position when sleeping. I do not, but those who do report that wearing a cervical collar during sleep helps by keeping the neck more aligned.

Another issue that CPAP users of nasal masks have issues with is the mouth coming open during sleep. It is often called mouth breathing, but with CPAP pressure on your nose, it is nearly impossible to breathe through your mouth. However, if you do open your mouth and your tongue does not block the airway, you can get a major flow of air out of your mouth which is being supplied from the CPAP. That can cause a dry mouth and irritation. In your case without a CPAP you may be actually breathing through your mouth and causing issues with your tongue. Just guessing. I deal with the air leakage through my mouth by using paper medical tape on my mouth to force all air flow through the nose, and not the mouth.

Yes, in theory I have a GP overseeing my care. I have diabetes (my wife as well), so we are seeing him every 3-6 months. My wife asked to have a sleep study done as she was having sleeping issues, and he prescribed one. It was a home study, and came back as severe apnea at about 67 AHI. I was a much more reluctant candidate as I could see what she was going through using a CPAP, and I really didn't want any part of it. I was getting good sleep, and really did not have sleep issues other than I was snoring, and that obviously was bugging my wife. I finally got coerced into completing a questionnaire, and I failed that, so I got the home sleep study prescribed as well. My AHI came back as lower but still severe at 33. The study lab which was the same one for both of us, send the results to the GP recommending a CPAP, and the GP just rubber stamps it.

The way the government health care system works in our area is that the sleep study, and a two week trial of a CPAP, is fully covered at no cost. However the CPAP is not. In both of our cases the sleep study clinic offered to sell us the machines at a cost of $2400 each. After some research I found I could buy them on line for about $900 using the prescription from the sleep clinic, signed by our doctor. So we each bought one, with mine this year, and my wife about 3 years ago. At that price you get limited follow up and monitoring. That is where the do it yourself part comes in. Our GP is of very limited help. I suspect he knows very little about apena other than what it basically is.

That said, I am not complaining. I know people who have insurance and take the deluxe $2400 deal, all paid for by insurance, and I think they get short changed. Their monitoring and followup is minimal to none. They just get an auto machine set with wide min max limits and the machine does its thing. And unless the results are really bad, nothing changes.

When we bought the machine for my wife, the lady we dealt with was good enough to tell us about SleepyHead, and we have used it ever since. I frankly don't know how anyone could effectively monitor and adjust their treatment without it. One the other hand I can also make you a bit obsessive. My one criticism of SleepyHead is that it seems overly harsh on the way it rates leaks. My machine always gives me a happy face, but SleepyHead almost always is very critical. I just ignore it!

Bob,

Unless you have software like SleepyHead it is pretty hard to determine the cause of the leaks. Assuming your data is being transmitted so your provider has access to it, you may want to ask the provider to look at the detailed data for their opinion. The possible causes are:

1. Mask not adjusted properly and just generally leaks too much. Or the mask is getting old and losing flexibility.
2. You are changing position in the night and in particular when side sleeping you are moving the mask causing it to leak.
3. You are opening your mouth and air is leaking out your mouth. The chin strap should help with that.

This said, I'm not sure that 15 L/min is all that high. It perhaps can be improved, but at the same time is not that big of a problem. My 3 month average leak rate is 23 L/min.

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?