Sierra

The CA events are unlikely to be caused by body position in my thinking. They are when you simply stop breathing and there is no flow restriction. For many they can be caused by the pressure. Higher pressure tends to cause more central events. However, on this night your CA events seem unrelated to pressure. You went up to 18 cm and there were no CA events associated with that pressure rise. The CA events just before waking up often tend to be because you are waking up and going back to sleep. If you zoom right in on the two events at 4:10 and 4:40 you might learn something. The flow graph would be the one of interest. In my issues with CA what I often find is a minor OA event that is not long enough to be flagged will start to cause my breathing rate to be unstable, and eventually end up with a CA event. It is worth looking at what led up to the CA event to see what may be the cause. If you post a zoom in of each of those events I can give you my thoughts. They need to be zoomed in to the point where you can see each individual breathe in detail. It is the period of time leading up to the CA event that is most important to look at.

Your pressure increases seem to be in response to flow limitations. Those may be caused by body position. I think I mentioned before that some go as far as sewing a tennis ball into the back of their PJ's to encourage sleeping on one side or the other but not on their back.

In the scheme of things, there is not much you can do with central events, and your incidence is not that high. Limiting pressure can help, but your events do not seem to be caused by pressure. BiPAP machines have some limited ability to deal with central events. However, when central events are a much more serious issue the best machine are the ASV types. In range of cost, an APAP is about $1,000, the BiPAP about $2,000, and an ASV about $5,000. With your current numbers I see no reason that you would need more than an APAP.

Well, you have kind of a Dr Jekyll and Mr Hyde behaviour in your apnea outcomes. With the collar and sleeping on your side it looks like 13 cm is fine, but when you get into the more difficult position it seems that 20 cm is almost not enough. My thoughts are that you should do just fine with a standard APAP if the position is controlled. And the other consideration is that running up to 20+ for pressure is not going to be the most comfortable and the easiest for a mask to deal with. And, higher pressure may drive up your central apnea event frequency.

I guess one thing to consider is that a VAuto BiPAP can be set up to replicate what you are getting for treatment now with the APAP. If you are paying for the machine, I would not consider it, but if they are giving you the machine there is probably not much of a downside. I have not looked at the VAuto for some time, but it might be missing a feature or two compared to the latest AirSense machines. For example I am not sure it has the auto ramp feature, but that is more of a nice to have, than a must have.

It is hard to say if raising EPR above 3 would help much. You certainly do have periods of more flow restriction where it may help. I think overall your results have improved by having EPR at 3 cm, but it is hard to predict if more would be of benefit. If you were to get a VAuto I would suggest that you set it up to replicate what you have now. Then you could experiment to see if more pressure support is of value or not.

I agree. It takes time and patience to get the right settings. I have changed my setup 22+ times, and now think I have it pretty much right. I had a data problem with SleepyHead and the first entry at the bottom is not correct. Within that time period I changed set up a number of times.

A second check for the humidifier is the amount of water it uses. When we use our trailer and run off DC, I turn the heated hose and humidifier off to save power. It uses essentially no water when it is off.

How do you have the humidity and temperature set? I put them both in Auto.

Here is a video showing the seals inside the machine. The part on the right along with the seal is removeable and you can buy it on line for $10 or so. The one on the left if that is the issue, is more difficult. This video is suggesting you clean it, as the dark spots may be mold. Might be worth a try. There are other videos that show how to tear the whole machine down, but if you can't get the replacement seal then that is still a problem...

https://www.youtube.com/watch?v=3O7tzeLDHj4

Your leak rate chart does not suggest you are opening your mouth. Normally those events will be sudden and have a flat top somewhat above the leak redline. If anything, some of these events appear to be related to waking up and could be just sleep wake junk. If you are not comfortable with a mask then the chances of waking up are greater. It is possible you are more comfortable with the F20 and that is the reason it is giving better AHI numbers.

I have had a look for a source of replacement seals on the machine, without any luck. Here is a link to a company that sells second hand as well as new machines. If you called them, they perhaps would be able to suggest where to get parts. I could not find the exact seals on a search there. Your leak rate chart is sure showing there is a fixed leak.

https://www.secondwindcpap.com/

In any case despite the higher readings on this night, I think the machine is getting close to the best you are going to get out of it. You could try going lower in minimum pressure, but that might not bring any improvement. OA events could start sooner, and the pressure would go up anyway.

Looks very good. Flow Limitations are driving the pressure increase. If you think that is going to wake you up, then you could limit that rise with a lower max pressure setting.

All in all not a bad outcome. With what was going on your machine setup is probably pretty close to optimum. I think the 1:00 event was likely the mask coming right off your nose. With SmartStart on the machine would have shut down on high flow as it is supposed to. When it started again you were back in the Auto Ramp mode which is as it should be.

That period of time from 5:45 to about 5:55 is interesting. That is about as low a leakage as I have seen for your results. That looks close to normal, but didn't last for some reason.

On masks the financial impact was not that bad. I got the P10 as part of the initial package at not much extra cost. The Mirage FX was borrowed from my wife. The Mirage Quattro was a spare I borrowed from my son. The Brevida I "sold" to my wife when she got tired of the Mirage FX. The Swift FX has gone nearly unused except for the headgear I salvaged from it. The purge vents on the Swift were like a jet engine taking off for noise and velocity. I just could not sleep with that high velocity air flow, but the rest of the mask was great. And the AirFit F20 has been pretty much a total write off. I just could not make that mask seal, and when it leaked it would blow straight into my eyes. At the time I was in Auto mode and was using more in the range of 15 cm of pressure. Perhaps now that I'm at a fixed 11 cm it may work better. I keep it as a spare.

On your nose irritation from the F20 you may want to try some OTC 1% corticosteroid cream. Put it on in the morning to promote healing. It should not be used for more than a week or so though. Another possible solution are RemZzzs Mask Liners. Some report success with them, and even make their own with t-shirt material to save on the cost. I did not try them when struggling with the F20 I have.

Overall that looks pretty good. Even your respiratory rate is normal. It appears the pressure increases are being driven by the Flow Limitations and almost all OA events are being avoided. I don't think there is any reason to further adjust the readings at this point. I would just watch the results for a few nights to see if anything different happens.

When I was trying different masks I would test them during the day with an attempted nap so there was no worry about getting a sleep. But that is easy for me as I am retired... Mask testing and adjusting is difficult. I started with the AirFit P10, then to a AirFit F20, Mirage FX, Brevida, Mirage Quattro, Swift FX, and finally back to the P10 with Swift FX headgear adapted to work with it. Over that time I tried several different chin straps, and started mouth taping... It was a long journey!