Sierra

OK, there is quite a bit going on there. A couple of OSCAR tips. If you click on the black triangle beside the current date you can hide the full month calendar which lets more of the details on the left panel show. And, at the bottom of the left panel there will be a list of the sessions in the night. Beside each one is an on off switch that turns red or green. I use that switch to suppress garbage sessions like the mask testing you were doing at 21:00. This lets the rest of the night show in more detail.

Out of this the session from 1:10 to 5:20 when you were on your side looks pretty good, and 13 cm seems to be enough pressure. However the session in the recliner on your back was not so good. Looks like that position will need a lot more pressure.

I think I would leave the minimum at 13 cm for now and let things settle out a bit before trying more changes. The Standard response is bringing pressure up quicker to control events which is good. If there is a pressure that you do not want to go above for comfort reasons then you may want to lower the maximum pressure to what you can tolerate. It may cost you with a higher AHI especially when you sleep on your back. I have a maximum set on my wife's machine set for that reason. Flow limitations would drive the pressure higher than she likes if there was no maximum to limit it. Her long term average for AHI is 0.48 so this seems to be an acceptable compromise for her.

I gather you are trying to test the AirSense 10 machine and this is not data from a real person?

If the machine is set with a minimum of 16 cm and max of 20 as it shows while in APAP mode I don't understand what would be reducing the pressure. I don't see the leak rate graph, but if the leak rate was really high perhaps the pressure would fall because the machine cannot produce enough flow to keep the pressure up. When the leak rate goes too high, some of the data display and event recording is suppressed.

It would be helpful if more data was allowed to show on the left panel. Under File, Preferences you can turn off the Event Breakdown Pie Chart. And by clicking on the black triangle beside the date you can suppress the full month calendar display. It also appears you have multiple sessions. There are red/green on off switches beside each session. You can turn off the sessions not of interest to get a little simpler display.

Getting the right mask tends to be personal to each individual. It can take some time, as it is basically trial and error. If they will give you masks to try that makes it more affordable, as some places will not let you return a mask. In any case here is a link to ResMed document which shows how each mask should be set up in the CPAP. As far as I know this setting only impacts the leakage rate calculation. I believe it only shows ResMed masks so if you have something else you have to choose the mask that is closest in design.

Mask/Device Compatibility List

Your results last night were not bad considering you were having mask issues. It looks like you had one or two OA events right before you woke up and that may be sleep wake junk. You can expand the scale and see what the breathing pattern was like when it happened. If it is sleep wake junk it tends to have no defined pattern and a lot of noise.

So you have a choice. You could leave minimum at 14 and work on mask testing, or you could try 13 cm to see if that is low enough to start seeing significant numbers of OA events again. The general idea is to keep lowering it until you are seeing significant numbers of OA events, and then bring it back up just enough to get rid of them.

One other issue that I have noticed is that "Response" is set to "Soft". This will result in a more sluggish pressure response to Flow Limitations and OA events. My wife's machine is set at "Standard", and since I am in fixed CPAP mode this option is disabled for me. I noticed that your machine was showing a much more sluggish response to flow limitations than my wife's machine. So before you lower the pressure to 13, you may want to leave it at 14 cm and change your Response to Standard. When you are closer to the minimum pressure needed a quicker response may get pressure up faster to avoid some of the events. Something to try to see what happens. Just make that change only if you do it, so the outcome is not confused with a pressure change.

If you feel you are not getting enough air with a certain mask the best way to deal with that is by increasing your ramp start pressure. I believe you are at 9 cm now, but it can be set as high as your pressure minimum. What I do is put the mask on and take repeated quick deep breaths. I increase the pressure to the point where I can feel no air restriction from the mask when doing this. It should feel like you are breathing normally with no mask on.

Check page 24, and further, of the Clinical Manual for some information on these seals. You probably can only visibly inspect and clean them. Another possibility would be the seal between the reservoir and lid of the humidifier. Again probably all you can do is inspect for damage and clean. Parts might be hard to find. I see this one part at CPAP.com for sale. Your clinic may have parts also.

https://www.cpap.com/productpage/resmed-airsense-aircurve-10-humidifier-air-outlet

I have had to replace the whole humidifier reservoir on mine as the plastic catches broke.

If your machine is 5 years old you may want to think about a new one once you have settled on whether or not you need a BiPAP. The normal replacement cycle is about 5 years. ResMed now have the AirSense 11, but it really does not have much for improvements. I believe OSCAR supports it. And I believe it supports 4G for the MyAir system.

https://www.cpap.com/productpage/resmed-airsense-11-autoset

Another place to look for leaks is the two connections from the machine to the humidifier. There are a couple of silicone seals in there that can possibly leak. I find that when the humidifier is not firmly inserted into the machine, these seals seem to flab back and forth with each breath causing a clicking sound. In any case a place to check for leaks.

A tip when getting the mask fitted. The P10 cushion comes in three sizes. Try to get the largest one that still seals properly. If the mask prongs are too small it will go too far into the nose and cause more irritation. You want to cushion to sit more on the nose rather than in the nose. But, it still has to seal. When you buy this mask on line it usually comes as a "Fit Pack" which includes the cushions for all three sizes so you can try them all. Not sure they will offer you all the cushions to take home. If not, try as above to get the best fit.

That is fine. It should not impact pressure and other settings. Just remember to switch the mask type to Pillows. It will be interesting to see what it does for leaks. I would check carefully all the hose connections to see if there could be a leak, and also inspect the tubing to see if there could be a hole in it somewhere. That leak graph you are getting is suspicious as it never goes to zero. The machine measures the total air flow and subtracts the design vent flow (compensating for pressure) and that is what is displayed as the Leak Rate.

I am afraid I don't know much about the ASL 5000. I just use a software program like OSCAR to view my data.

I am not quite sure what you question is. When you are in AutoSet Mode the pressure should stay between the MIN and MAX, unless EPR reduces it on exhale only. Are you using OSCAR to view the data? If so can you post a screenshot of the Daily results? On a PC just press F12 and take note where the image file is saved. Use File Explorer to find the file and then left click and drag it into an open message here.

AHI is up but it is mainly due to an increase in CA events. OA and H are fairly low, and Flow Limitation looks good. I think it is time to try a lower pressure to see if it will reduce the CA events. I would suggest reducing your minimum to 14 cm and leave everything else the same to see what happens. I suspect the pressure is not far off what it needs to be, but you can only find out by trying it. If CA events are going to be an ongoing issue the basic objective would be to find a pressure where both CA and OA are lower and about the same. Hopefully the total will be lower.