Sierra

Since your CA events seem to have settled down a bit you could try increasing your minimum pressure to 8 cm, and also set your ramp start to 8 cm. The maximum pressure would have to be increased as well to do this, so I would suggest 9 cm max. This will allow the machine to increase pressure higher than it can now. You will be able to see if this helps with the breathing while going to sleep, and whether or not the increased maximum causes the CA events to go up. Depending on how this goes you may want to pick a pressure and go to the fixed pressure CPAP mode. As it looks now it would appear that 8 cm would be a good starting point. My thoughts would be to go to an 8 min and 9 max first to see if you can learn a bit more about what is impacted by pressure.

I have never used an O2 meter so can't really comment on your results from experience. However it looks like for the most part you are staying above 95% which is good.

Yes, leaving the EPR at 3 cm is fine for now. What you really need to do is collect some data and look at it with OSCAR. The first step would be to determine what is causing your pressure to go up.

Depending on how your machine has been set up, you may or may not have the ability to set your EPR from the user menu. You may have to go into the Clinical menu to do it. On the A11 my understanding is that you can do that by simply holding two fingers on the menu screen for 4 seconds or so. Here is a link to the Clinical Manual for the A11. It will explain the details and the options you have.

My wife has an AirSense 10 For Her and uses pressure up in the 15 cm range. Here is an example of what the Daily report screen looks like for her.

Her Min-Max is now 13.6-14.4 cm. It has been adjusted many times over the 6 years or so she has been on the CPAP. There is some advantage in adjusting up the minimum pressure as it actually prevents events from happening. When you have a low minimum pressure the events have to happen first and then the machine responds. And then after it responds with more pressure it slowly ramps down again until another event occurs. Her EPR is 2 cm and is set to full time. As a start I would suggest an EPR of 3 cm and full time as well.

If you look at the graph detail you will see that in this example she only had 1 OA (obstructive apnea) event and you can see the pressure respond up. This is because her minimum pressure is high enough that she does not have many OA events. The main factor that increases her pressure now is flow limitation and snore. A higher maximum would likely eliminate those too, but she has tried and dislike more pressure. So the current limit of 14.4 cm has been set based on her tolerance for more pressure. Since she got this For Her machine her average AHI has been 0.45 and there seems to be no reason to push the pressure higher when she finds it uncomfortable.

If you have any questions about OSCAR or the Daily report just ask. I find this daily report pulls the curtain back on what is actually happening during the night.

Pressure with a 5 minimum and 15 maximum is fairly standard. The 5 cm minimum might be a bit low for comfortable breathing while going to sleep though. It is hard to tell if the 15 maximum is too high or not. Your AHI is within the normal treatment range of <5.0.

Sometimes it is best to start with a maximum pressure that is lower than ideal until you get used to the pressure. Also on the A11 machine you can set the exhale pressure relief (EPR) to automatically reduce the pressure on exhale to make breathing easier. The reduction can be set from none to 3 cm. Starting out with 3 cm of EPR may be helpful in adjusting to the pressure.

To find out what is really going on during the night you can download a freeware program called OSCAR. It needs a Mac or PC with a SD card reader to use it. But it can tell you minute to minute during the night what the pressure is, and when you are having apnea events. It is really helpful in determining whether or not your machine is well set up for you or not. If you download it and can post the Daily report screen I can give you my thoughts on whether or not there is a potential for improvement. Your machine should have a SD card in it on the left side behind a flexible flap. If not you would have to get one. The one ResMed supplies with each machine is 4 GB.

What pressure is the A11 set at? Min? Max? What is the AHI score you are getting? It would seem that you should see your sleep clinic to have the maximum pressure reduced until you become used to the pressure.

Those are very long obstructive apnea events. However the bigger issue for that night are the frequent CA events.

Can you post that last image again in a full width window. I can't expand it enough to read the time scale. If you reply with the orange "Write a reply" button at the bottom you get a full width post window.

Your leak rate certainly has improved. Did you sleep well? I find that the better I sleep the worse my mask leaks are. I almost take it as a sign that I was not really sleeping...

The overall score is certainly good. I have not seen consecutive RERA events like that before though. Flow limitations were high at the same time. This may be the price of limiting pressure to 8 cm.

Some have some success with wearing a soft cervical collar to keep the neck straight during sleep. They are inexpensive and can be found at Walmart. Not sure about the comfort though as I have never worn one.

Again the good news is no OA or H events. Flow limitation is up when the pressure has been limited to 8 cm though. In your second clip I do see some indication of instability in breathing control. See the section circled with yellow highlighter. Notice how the breathing rate gets deeper and deeper and then more and more shallow until a CA event occurs.

It still would be interesting to see the Flow Rate chart next to the Minute Ventilation graph for some more of those periods of time where there are multiple CA events. Minute Ventilation is a measure of how much air is being brought in and out of the lungs. It will cycle when the breathing rate control system is not stable.

The basic problem is that an APAP can't directly do anything to stop CA events. The pressure from the machine may in fact be the cause of the CA events. So, about all you can do is reduce pressure. But, there is obviously a limit to how much you can reduce pressure. What you may have to do is stick with it for some time to see if this is treatment emergent central apnea that will go away after 6-8 weeks or so.

Other than the ResMed AirCurve 10, I have not heard of any of these machines. Why would they be suggesting anything other than a standard APAP or CPAP? The most common machines used in North America are the ResMed AirSense 10, or now 11, AutoSet, or AirSense Elite, or a Phillips DreamStation Auto or CPAP. Is there anything special about your apnea diagnosis? The ResMed AirCurve is normally only used when higher pressure is needed up to 25 cm, compared to 20 cm available from an APAP. Or, if breathing assistance is required with the pressure support of up to 10 cm.

What country are you in? Those seem like odd choices of machine brands.