Sierra

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.

I was expecting to see a little more detail than that, such as the portion of the AHI that was central, obstructive, and hypopnea. My home study was done with a Phillips Alice NightOne. See an example of a report from the NightOne at this link. You might want to ask about getting a test using the NightOne.

An AHI of 5-15 is considered mild sleep apnea. It is typically treated in North America, but in the UK, unless they have changes, the NHS does not prescribe treatment for apnea in the mild range. One of your test was just under the AHI of 5 threshold and one just over. Do you have any more detail on your test results such as the breakdown of the AHI to CA, OA, and hypopnea events? Do you have any other symptoms of sleep apnea? The STOP-Bang Questionaire is often used to determine risk.

Well the good news is that hypopnea went down as well as flow limitations, and you only had 1 obstructive event. The obvious issue is the number of central apnea events, and more concerning is that with a few exceptions they don't seem to be happening when the pressure is higher. You have a couple of options, but I would suggest not doing them at the same time. First would be to reduce maximum pressure down to 8 cm. The other option would be to reduce the EPR from 3 cm to 2 cm. EPR seems to affect different people in different ways. One possibility is that the higher EPR has caused the central apnea events to increase. Central apnea can be caused when the CO2 and O2 oxygen control system is not stable. A higher EPR could decrease stability. I have central apnea issues and I have settled on an EPR of 2 cm, but I really did not do enough testing to determine if that is ideal or not. I do average under 1.0 now for AHI so I am not motivated to mess around with it more. How is your comfort level with the pressure? EPR should help with that.

It might be informative to see what the breathing pattern looks like when you zoom in on those CA events. Sometimes they are just caused by waking and going back to sleep. Other times they are a regular pattern that ends in a CA event. Here is an example from my records of the latter. It also may be helpful if you could scrunch down the graphs to fit Minute Ventilation in as well. I limit my leak graph to 50 to save space. If you hit 50 it is bad and you don't need to see the detail... You can also click and drag on the horizontal grey bars to get more in as well. Minute Ventilation is a good indication as to how regular your breathing is. If it cycles up and down like shown below, it is not stable. Ideally it would be a flat line.

It seems that Flow Limitation is pushing your pressure up. This indicates you could benefit from changing EPR to full time, and increasing it to 3 cm. I would also suggest the same as my previous post with pressures; ramp start at 7 cm, minimum pressure at 7 cm, and max pressure at 10 cm.

Masks are hard. I have tried the AirFit F10 nasal pillow, Mirage FX nasal, Mirage Quattro full face, AirFit F20 full face, Swift FX nasal pillow, and now I am back to my first mask, the AirFit F10. If you can keep your mouth closed I think the F10 is a good mask.

Welcome to the forum. You are correct in that 4 cm is too low a pressure to be comfortable for most. It appears your machine was not really set up as from the factory it is set from 4 cm to 20 cm. A more reasonable setting to get started would be 7 cm min and 10 cm max. You might need a higher max later, but 10 looks like it would be fine for now, and may reduce the aerophagia (swallowing air). It looks like you are using the ramp set to Auto which is good. I would set the Ramp Start Pressure to 7 cm as well. It appears your EPR (expiratory pressure relief) is either turned off or set to Ramp Only. I would set it at 3 cm and for Full Time. EPR may also help with the aerophagia.

Your apnea events are all central apnea along with some hypopnea events. Turning the EPR on my help with the hypopnea. The central events are a bit more concerning. Central apnea (CA) events are not obstructive, and the airway is actually open. For that reason more pressure does not prevent them and can actually make the frequency worse. There is a condition called treatment emergent central apnea which you may be suffering from. It is your body's reaction to the pressure of cpap treatment. In most cases this goes away after 6-8 weeks of treatment. For now I would hope that is the case. Limiting the pressure may also help. There is no real need for a higher pressure as long as the obstructive apnea events do not go up. In any case I would try these new suggested settings first while you collect some more data.

Hope that helps some. Any questions, just ask. You can improve your OSCAR layout a bit by clicking on that black triangle beside the date to suppress the month calendar let some of the more important stuff show. The other thing you may find helpful is to right click on the Leak Rate scale, Dotted Lines, and then check off the box to show the Upper Leak Rate Threshold. It is a good guide as to when the leak rate is excessive.

Interesting. I didn't know it could do that!

Strange. As I write this I see your original post starting this thread was 14 hours ago, my response 12 hours ago, and your last response 2 hours ago. I have no idea what the points are about...