Sierra

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.

Not sure, but here are a couple of possibilities to check:

1. Is there a SD card in both machines? I gather that some suppliers/providers are now removing the card before giving them to patients. This may disable the collection of detailed data in the machine, and force it to be sent via the cellular route to your provider. If so the solution may be just to put a 4 GB card in it.
2. There is one setting in the Clinical Menu in the Accessories category that is called Essentials. It can be set to On or Plus. Setting it to plus gives more control to the patient through the normal menu.

My machine has a card in it. I have not registered for MyAir. And I have the Essentials setting at Plus. When I go into the Sleep Report, below the MyAir line there is about 10 more lines with information on usage, pressures, AHI etc. Is that the detailed report you are referring to? I transfer my data to SleepyHead and can't say I look at the data on the machine much...

Hope that works,

Yes, getting used to a CPAP is not always easy. I also use the AirSense 10 AutoSet. My wife adapted quickly, and me, not so quickly. I think a lot of it depends on how well the mask is suited to your personal requirements. Everyone is not the same, so there seems to be no silver bullet for a mask.

Some questions:

What make and model of a mask are you using? My experience has been that a nasal pillow type mask like the ResMed P10 can actually help keep the nasal passages clear. With it, if I go to bed clear, they usually stay clear all night.

Being short of air while going to sleep or during the night can be a CPAP setup issue of there not being enough pressure. Are you using the Ramp feature? What start pressure? What are your minimum and maximum pressures set at? Are you using EPR?

As for the humidifier I use the heated climate hose, and just set the Climate Control on Auto. Temperature is set at 27 C (80-81 F). If I sleep for 10 hours I pretty much use all the water. Using it all in 6 hours seems high, unless you are in a really dry climate. I would try using the auto setting to see how that goes.

Hope that helps some,