Sierra

You may want to try the AirFit F10 For Her X-Small 63139. See this sizing guide, which I think is the right one for this mask.

https://document.resmed.com/documents/products/mask/airfit-f10/fitting-template/1017454_airfit-f10_fitting-template_row_eng.pdf

Product guide for the mask:

https://document.resmed.com/documents/products/mask/airfit-f10/product-guide/1017251r3_airfit-f10_product-guide_usa_eng.pdf

OK! I was not expecting that. Can you squeeze down the Flow Rate graph height and show the Flow Limitation to see if that changed? Have you tried the soft cervical collar yet?

Have you always been on a fixed pressure? If not then did the Auto mode not work for you? And, how about at a higher pressure. Is 15 cm the most you have used?

It is not going to help your event frequency, but one of the easy things to consider doing for comfort is setting your Ramp Time to Auto. And also your Ramp Start pressure to about 9 cm instead of 5 cm. When set this way it will start you out at 9 cm of pressure which should be more comfortable, and it will hold at that pressure until the machine decides you are asleep (up to a maximum hold of 30 minutes). Then it will ramp up to your set pressure of 15.

That respiratory rate seems a bit odd too. Your flow rate seems high, but perhaps you are taking quick short breaths. Expanding the scale out should provide more info. Compare it to when you are breathing at a more normal rate. Minute ventilation is low and fairly constant as well as Tidal Volume. Seems like you are breathing fast but not accomplishing much air transfer. Again you should ask the sleep specialist about this as well.

That is very unusual and does not look like typical Cheyne Stokes Respiration. Here is a theoretical representation of CSR.

And here is an example from my records. I think it is much more typical CSR.

If you go for a sleep specialist consult I would bring a copy of that area and ask for comments about what the cause may be. You also should bring your SD card and ask them to take a look at the results. They should have a program called ResScan to look at the data.

For now I think the best thing you can do is turn on EPR full time at 3 cm level.

And here is a clinical guide to the ResMed BiPAP if you want to compare them. The BiPAP is more complicated to set up.

AirCurve VAuto Clinical Guide

Here is a link to a manual that will help you with the machine settings:

ResMed 10 AutoSet Clinical Guide

Those are very interesting results, and something I can't say I have seen before. I would be interested in seeing the CSR highlighted green area, but expanded out so the flow detail is shown. You can do this by left clicking on the area to zero in and expand it. The up down and left right arrows are also useful selecting the right area and zoom detail. Normally CSR is associated with central apnea events - CA's, not obstructive events like you have. I see you have no CA events reported. That is good because CA events are hard to deal with.

The other aspect is that you show quite high flow limitations and RERA. This would suggest you could benefit from turning on the EPR feature, setting it at 3 cm for level, and also for full time. If you try that post your outcome again after a night or two to see if there is some improvement. It may reduce your Hypopnea frequency and RERA. However, the 3 cm may not be enough to make a big improvement, and that is where a BiPAP with up to 10 cm pressure differential may be needed.

The other thought is that some people can have those high frequency OA events when they are kinking their neck while sleeping. Those that do sometimes report relief by using a soft cervical collar to sleep with to keep the neck straighter. They are quite inexpensive at places like Walmart. I have never needed or used one however, so I am just reporting on what others have said.

And as you may have figured out you should only post one image at a time so the post does not get hung up in the spam filter here. Once you have accumulated a few posts, then you may get away with more than one image.

Here is a sample of how I have my SleepyHead set up. OSCAR is very similar, and I have not bothered to upgrade to it yet.. This is an example of a night when I had a high number of leak events. I also use a fixed pressure with my AutoSet machine, so the pressure is constant all night.

If you machine has not had a SD card in it, all the detailed data to date will be not recorded. After you put the SD card (normally a 4 GB, but up to 32 GB will work) in, it will start recording data for each night. When you have some data to display then post it here. With a PC you just need to get the Daily Report displayed, and then press F12 to save it as an image file. A note will come up briefly in the bottom right of the screen showing where the file is saved. Use File Explorer to find it and then left click and drag the image to an open post here. Use the orange Write a reply button at the bottom to get a full width window. I will post a sample of how I like to see the Daily Report page set up for the best use. Oscar will display your machine settings if you have the page set up.

It sounds like you have been through quite a bit... But, it sounds like things are under control. Welcome to the forum.

BiPAP - There is no significant disadvantage to using one, but it may not be necessary. They supply pressures up to 25 cm instead if the usual 20 cm with a CPAP. The BiPAP also allows for a differential of up to 10 cm between inhale and exhale. The APAP or CPAP usually only allows a 3 cm differential. Normally a BiPAP is not used unless you need pressures higher than 20 cm, or if you need some breathing assistance by the higher differential. Normally that would show up as a higher hypopnea incidence, high flow restriction, or RERA. With an AHI of 10 that is an indication there is room for improvement. The standard treatment goal is to be under 5 for AHI, and more ideally under 2.

I don't think there is a problem with Ambien during the study, especially if you are not having any significant central apnea events. What is your breakdown of the type of Apnea events being reported? On an ongoing basis I don't think using a sleeping aid is the way to go. There are other sleep hygiene methods that may work better with less risk. See this link for more information. The site was started by a pharmacist that was concerned about the over use of sleeping pills in seniors.

SleepWell It is No Dream

Have you downloaded OSCAR? If you have and want to post a daily report screenshot I can give you my thoughts on why the AHI may be high at 10 events per hour. Do you have a fixed pressure CPAP or AutoSet machine. I recall the most basic CPAP does not have a SD card to capture data. OSCAR is the best way to find out what is going on. MyAir really only provides summary data and is more intended as a compliance tool to see how much you are using the machine.

Hope that helps some,