Sierra

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.

Welcome to the forum Marlie. Feel free to ask questions about your CPAP treatment. Sometimes there are easy solutions, and other times it takes a bit more. If you are not sure how your CPAP is working and want to dig deeper I think using software like OSCAR is a good start (providing your machine supports it). Most ResMed and Phillips machines do. If you have any questions about it, just ask.

While your AHI has gone up a bit, the overall results look pretty good. Your hypopnea is low, which has been high before and the flow limitations look closer to normal. RERA is gone. CA events are up some, but sometimes when waking up that can happen. Some call it Sleep Wake Junk.

I noticed that since Dec 3 the pressure has been switched back to fixed CPAP mode. This is OK and does not seem to be having a big impact on apnea events as your OA component is zero. However, having it in Auto mode gives more information when trying new machine settings. You can see when the machine thinks you need more pressure. When you get flow limitations it may increase pressure some to reduce them. Being in Auto is a good flag to determine whether or not the pressure is set high enough. While it may be of benefit going to fixed for the long term, for now it would be better to leave it in Auto. To some degree having a machine in Auto is like getting a sleep lab titration test each night if you look at the OSCAR data each day. My long term setting is a fixed pressure, but my wife is using a fairly narrow band between min and max in Auto.

On masks the P10 is a very minimalist nasal pillow type. The weakness has been the flimsy headgear, but I see that ResMed claims to have improved it and the method used to adjust it. My wife uses a slightly less minimalist nasal pillow mask called the Fisher & Paykel Brevida. It has a little better headgear, but it is kind of personal preference between these two. Have a look at them both if the clinic has them.

Going forward I would suggest putting the machine back in Auto with a minimum of 15 cm and max of 20. And I would increase the EPR to 3 cm. I know that didn't work out before, but I think the cervical collar is making a big difference and EPR at 3 may not have been the cause of the poor results. So I would try it. If this works then I think the next step is to start reducing the minimum pressure in 1 cm steps to see at what point OA events start to become a problem again. The 15 cm may be higher than necessary, but it is a good safety net until the EPR setting is finalized. Reducing pressure may also reduce the CA event frequency.

The way things are looking now I don't think you need a sleep lab titration test nor a BiPAP machine. However, if the Tachypnea does not not go away with the increased EPR then I think you should see a specialist doctor about it. Probably start with a pulmonologist.

These results look pretty good. Since the EPR of 1 cm did not do bad things and your hypopnea seems lower, I would try EPR at 2 tonight. Leave everything else the same.

If you switch to the P10 the only thing you need to change is the mask setting to Pillows.

If you go into the Clinical Menu and scroll down you will come to a section called Options. Under that if you set the Essentials to Plus instead of just On, the User menu available without going in the Clinical Menu will be enhanced. In the enhanced User Menu you can set both the Humidity and Temperature to Auto. And while you are in the Options section you may want to turn the SmartStart On. I use that so my machine starts automatically when I put the mask on. It is just a convenience feature.

And when I was checking the Clinical Manual I found this illustration. It shows pretty much exactly what you were getting and was being flagged as CSR. I knew I had seen this pattern of breathing somewhere but couldn't find it. Here is the illustration. The important part is that you were not having true CSR, but just rapid frequency OA events. This now appears to have been solved with the cervical collar...

Your mask type is selected correctly, so I am not sure what would be going on. Yes, the P10 is a nasal pillow mask, and does not cover the mouth. I do have issues with opening the mouth. It tried a few different chin straps but finally settled on taping my mouth shut each night. It is not for everyone, but I find it quite comfortable. See this video: How to Mouth Tape for a Better Sleep.

Do you have a heated ClimateAir tube? If you do there is an Auto mode you can use to set the humidity and temperature. It still uses lots of water. I suspect my maximum limit for a night without running out of water is about 9 to 9.5 hours.

Yes, if you think things are relatively stable I would try 15 cm minimum, with EPR at 1 cm full time.

I'm sure I have made this comment before, but the first thing I would do if I was having suspected transitional sleep apnea events would be to document that I am actually having an apnea event while going to sleep. With OSCAR it should be fairly easy to do that. I don't know how one could treat this condition until one confirms that apnea events are actually occurring, and what type they are; central or obstructive.

Too bad about leaving the SD card out. I do that every once in a while too. Not sure what to make of the leak rate not going to zero. Are you sure in the machine menu that the mask type is set to full face? If it is an actual leak it would almost have to be damage to the mask somehow. I see that ResMed recommends replacement of the memory foam seal once a month. That would be expensive as I recall they want a good price for it. I only replace the silicone seal on my P10 mask once every couple of years. The other possibility is some damage to the vent system on the pivot point, or misalignment of the parts... But, as I say the leak is not high enough to interfere with effectiveness of the machine. Here is an example of what the leak chart looks like on my machine.

If you think things are fairly stable at these settings it may be time to try adding back in some EPR. I would suggest an EPR setting of 1 cm to start with. And, you will have to switch the type back to full time. The hope would be that it may reduce hypopnea some without causing the OA frequency to go up. It reduces pressure on exhale, so you will get 15 cm on inhale and 14 cm on exhale.

It is not a big deal, but one of the things I have noticed in your leak rate graph is that it seems to never go down to zero, but instead never goes below about 12 or so. I can think of a couple of reasons for this.

One is that the mask type is set wrong in your machine. Your first post indicated you were using an AirTouch F20 full face mask. OSCAR is reporting that you have the machine set to Full Face which is correct. However, I have found that SleepyHead and possibly OSCAR do not always report the equipment status correctly. So you may want to check in your Clinical Menu that the mask type is really set to Full Face. If it is set to a nasal pillow type mask this could be a source of leak rate error. The reason for making this setting is that the mask type determines how much of a purge leakage there will normally be for the mask. The purge flow on a full face is higher than for a nasal pillow because of the difference in volume of the mask.

If this is not the problem then about the only other alternative is that you have a fairly significant fixed amount of leakage. If you can find it, then that would be good. But, as long as your leakage stays under the redline, it should not impact the machine's ability to control apnea. It may be a source of irritation though, that may make sleeping more difficult.