Sierra

Make sure there is a SD card in it and it is not locked. The normal card is a standard SDHC 4 GB, but it will accept up to 32 GB.

Well while the Elite does not have the AutoSet mode, it does collect data on a SD card. Combined with OSCAR that can help you manually adjust the pressure. OSCAR is freeware and needs a SD card in the machine, a SD card reader, and a PC or Mac to run the software. You can download it here. Just check that there is a SD card in the machine, as without that no data gets recorded.

https://www.sleepfiles.com/OSCAR/

While it can take a little longer when you find the right pressure it can be just as effective. I have an A10 AutoSet machine, but I now run it in the fixed pressure CPAP mode. Works well for me.

There are four different models in the ResMed AirSense 10 model line:

• CPAP - This is the very basic fixed single pressure CPAP with no SD card data recording capability
• CPAP Elite - This also is a single pressure fixed CPAP but does have a SD card data recording capability
• AutoSet - This is the fully automatic pressure setting machine with a SD card capability
• AutoSet For Her - This model includes the standard autoset mode, plus a special For Her mode that acts faster to flow resistance

It should say on the nameplate or the bottom right front of the machine which model it is. The AutoSet and AutoSet For Her are both very good machines, and in my opinion better than the newer AutoSet 11 machines.

My advice would be to walk away from that "doctor". I think this is an example of what is wrong with the sleep apnea industry. They practice by using recipes. We do this, then we do this, and then this, without really taking the time to understand what is going on.

My thoughts would be to get the prescriptions for supplies any way that works. I think you have it figured out what you need to do to treat your apnea. OSCAR will let you know when something changes.

Actually this is fairly common and not serious. When you go to sleep and when you wake up, the body must make a transition from fully automatic breathing control when we are asleep to manually assisted breathing when we are awake. This can result, in the scheme of things, fairly harmless periods of time when we do not take a breath. CPAP machines are programmed to ignore indications of apnea events when they are in the going to sleep ramp mode. This prevents the reporting of events which are not really of big concern. When the ramp period ends, automatically if you have later version of the ResMed machines, it starts reporting as usual. Unfortunately nobody, to my knowledge, has figured out how to ignore this in the period of time just before you wake up. If you look at your detailed data with OSCAR you can see this "stuff" that some call "sleep-wake junk". It is reasonable to ignore this as unpreventable.

When the Ramp Time is set to Auto, the pressure does not ramp up over time. It holds at the set Ramp Start Pressure. It stays there until the machine determines that you are asleep, and then it ramps up to the minimum pressure setting. If for example your minimum pressure is 9 cm, and you set the Ramp Start Pressure to 7 cm, then it will hold at a constant 7 cm until you fall asleep, and then ramp to 9 cm and turn control over to the AutoSet algorithm. And if EPR is set to Full Time at 3 cm, then you get 7 cm on inhale and 4 cm on exhale during the ramp time. Then it switches to 9 cm inhale and 6 cm exhale. The secret is to set the Ramp Start Pressure high enough. 7 cm should be the minimum and it may be better to be higher.

Why would you want to turn the ramp off? Many machines are set with the minimum pressure too low. It should not be less than 7 cm, unless there are special circumstances.

That looks pretty good all considered when you are using the collar. You mention that you are not using the ramp, but your device settings indicate you actually are using a ramp with the time set to Auto, and the start pressure at 9 cm. That is good. The machine should not report any apnea events during the ramp period at 9 cm as they are likely to be false.

The primary way of reducing the effort to exhale at least with ResMed machines is to set the EPR (Expiry Pressure Relief) to Full Time at a 3 cm level. This reduces pressure on exhale only by 3 cm. Not a perfect solution, but I find it helps.

I am of the view that one has to build up sleep demand during the day by avoiding napping, and any caffeine after 12:00 noon. The idea is to get one long uninterrupted sleep at night, ideally of about 7-7.5 hours.