Sierra

I have a ResMed so no personal experience. I have seen DIY foam removal instructions for the SleepStation machines. Those who do it claim it works. I would worry that it might impact the pressure and flow measurements that the machine uses to control the cpap. But, that is just speculation on my part.

I am not familiar with that brand of CPAP, and it does not appear to be supported by the freeware program, OSCAR, which can display detailed data captured on the SD card. Without that, I am not sure how to diagnose what the issue may be. Does it give you a sleep report with the frequency and type of apnea events? If so, what has your AHI been over the week? An automatic cpap will only use enough pressure as is needed to control apnea events. It is possible it is backing off the pressure because there are no apnea events to respond to. However, if your AHI is going up and is over 5 then that indicates there may be a problem.

My thoughts are that on inhale the CPAP pressure does help get air into the lungs. The higher the pressure the more help the CPAP provides. If the pressure is set too low, some will feel that air flow is being constricted and they have to put extra effort into getting air in on the inhale part of the breathing cycle. Unfortunately a lot of times the sleep techs will just leave the machine at factor default which is with a minimum 4 cm of pressure. That can set up the patient for a poor introduction to CPAP use as they will be fighting with the machine.

Things change a bit on the exhale. The higher the pressure the more effort is required to get the air out of the lungs. Using the expiratory pressure relief feature can help with this a bit. I think overall there is really no loss in muscle fitness.

How did you fix the pressure?

Is your machine a ResMed AirSense 10 AutoSet? If so, ResMed claims they ship every machine with a 4 GB SD card. Unfortunately it seems to be the practice of some dealers to remove the card. I think this is a dirty trick, possibly to keep you from looking at your own data, and therefore increasing their after care business. The unfortunate part of this practice is that all the detailed data is lost when the card is not in place. MyAir only sends very high level summary data, but no detailed data. However, you can put a card in and start to collect data. Any 4 GB to 32 GB SDHC standard sized card will work. You may have a suitable card around the home that came from a camera or other device no longer being used. The machine formats the card the first time you put one in, and it will start collecting data that night forward.

Here is a link to a Clinical Manual for more detailed help on using the machine.

If you need any help with OSCAR just ask. I still use SleepyHead which was the predecessor to OSCAR, but I don't think it has changed much.

For leakage I look for Time Over the Leak Redline to be zero or close to zero. My wife (which is where the example report above is from) averages about 2% of the time over the leak Redline and 4 L/min for average leakage rate. I average a little lower for % of time over leak redline at 1.25%, but my leak rate average is higher at about 7 L/min. Overall her long term average AHI is 0.46, and mine is higher at 0.83.

If you get OSCAR working you should find out a lot more about what is going on. You need a PC or Mac and a SD card reader to get the data from your machine into OSCAR. And, if you post some typical Daily Report screens here you can get some comments on what may be opportunities for improvement. While an AHI of less than 5 is the clinical guideline for effective treatment, I suspect most CPAP users do quite a bit better than that when their machine has been optimized.

It is hard to get good results every night. While overall I think I am doing ok, some nights are very good, while others are not so good. Here is a night from last month where my time over the leak redline was over 13% and my AHI at 1.57.

And here is last night which was as good as it gets for me. 0% of the time over the redline, and 0.0 for AHI. That does not happen very often...

I have an AirSense 10 AutoSet, but I do not use the MyAir app. I take it that a low Mask Seal score indicates high leakage rate? I will base my comments on that assumption.

I agree with the CPAP store statement that the machine compensates for leakage in most cases, but it can affect the reporting of events. ResMed calls leakage up to 24 Liters per minute acceptable. But above this 24 L/min redline it still tries to deliver the set pressure, but it suppresses the reporting of events. When you look at this using OSCAR freeware, these high leakage times of the night are shown with a shade of gray. See a zoomed in report screen below for a period of time when leakage is above 24. You can see that events can still occur, but they get flagged as UA events (unidentified apnea). I don't think they get counted in the AHI score for the night, and I am not sure if MyAir tracks them. They are still apnea events though where air flow rate is interrupted. But this graph also shows that despite the long time with leakage high the pressure is maintained.

With respect to leaks the P10 mask is pretty good as long as it stays on your head and nose. But, one issue with a nasal mask is that you can open your mouth during the night. This causes a significant leak and in addition it can cause a dry mouth and discomfort. Your leaks may or may not be due to this happening. And, it may be affecting your sleep quality. Some people use a chin strap to prevent this from happening.

In general it is good to use as low a pressure as possible as long as the AHI targets are being met. I have also found that a fixed CPAP pressure is more effective for me than running my AirSense 10 AutoSet in Automatic mode. At some point however, less pressure can be less comfortable than a higher pressure, so it is kind of a balance. Also when having issues, if they are obstructive, while going to sleep a higher ramp start pressure can be effective.

Interesting that you found some relief from a beta blocker. My biggest issue with using a CPAP has been central apnea events. Rightly or wrongly I decided that the beta blocker I was taking for blood pressure control may have been a contributing factor. It slows your heart rate down, and my theory was that it reduced blood circulation rate and upset the breathing control system. It depends on detecting the CO2 level in your blood and provides the feedback that your are breathing too fast or too slow. In any case I told my doctor about my theory, and while I think he was skeptical (he is a GP, not a sleep specialist), he agreed to cutting the dose I was taking. I was on 5 mg of Bisoprolol in the mornings. This was reduced to 2.5 mg (by splitting the 5 mg pills) taken in the mornings. I can't be 100% sure this is the reason, but I now average less than 1.0 for an AHI. CA events are still the majority of my events, but they are way lower than I was getting before.

In any case a beta blocker may help relax you, but the amount you want to relax may vary from person to person. I would just watch that CA event frequency does not become an issue. Central apnea is very individual specific.