Sierra

To perhaps give you a bit of encouragement on how things may seem bad now, there is hope with some perseverance to get things sorted out. Here are a couple of my Daily reports. The first is from my first week on the ResMed AirSense 10 AutoSet from 4 years ago. It was in Auto mode with a minimum pressure of 10.5 and maximum of 16 cm or so. The second one is from last night, with the same machine, but with the setting that have evolved over the past 4 years. It is now in fixed pressure CPAP mode, with a set pressure of 11 cm. This is not likely the solution for everyone, but it has worked for me. It does show that while the Auto mode may work for some, it is not a cure all. My wife still has hers set in Auto mode, and that works well for her. In general in Auto mode most end up with a fairly narrow band between minimum pressure and maximum pressure. Set this way, it behave more like a fixed pressure CPAP mode

The only issue I have had with the A10 water reservoir making noise is if you do not push it firmly into the machine. If it is not firmly in, then it will kind of click on each breath. Probably the silicone seals flapping back and forth.

What type of mask are you using? The most common ResMed AirFit P10 mask is very quiet. Opening your mouth with a nasal mask is a problem however and the air rushing out will be noisy. Air will go in your nose and back out your mouth. That will cause large leaks that tend to have flat tops on the OSCAR leak rate graph. It reduces the effectiveness of the machine and you can also wake up with a very dry mouth. I am also a mouth breather, and tried various things to solve the issue. A chin strap kind of works, but it also makes the whole setup more uncomfortable. My final solution has been to tape my mouth closed with 3M micropore tape. You can get it at Walmart. This works for me, but it is not for everyone. The only other solution is a mask that covers your nose and mouth. I tried a ResMed AirFit F20 and simply could not stop it from leaking and waking me up. So I now use the P10 with mouth taping.

Setting the ramp time at 0 and increasing minimum pressure can work for some, but I prefer to use the Auto ramp feature. That way you can control the start pressure independently. Where do you set your EPR? When you use the Ramp you can set the EPR to be full time or for Ramp Only. Some find that using the EPR to improve comfort during the going to sleep phase, but having it turn off after that gives the best results. For others EPR full time works best. You can only try each way and see what works for you.

I would suggest kind of breaking your attempts to improve your setup into two parts. First try to get better comfort while going to sleep, and then find out if there are any ways to reduce the pressure the machine is using to treat you after that. One way is to simply limit maximum pressure. Another way is to switch the machine to fixed pressure CPAP mode. My wife's machine is setup to limit maximum pressure, while I have switched mine to fixed pressure mode. I have issues with CA events and using a fixed pressure seems best in controlling OA's while limiting pressure enough to not cause CA events.

It would be best to post your typical Daily screenshot from OSCAR and I could provide better comments.

If you want comments on your OSCAR daily screen, just post it here. On a PC, F12 saves it. Take note in the lower right part of the screen, where it is. Then with file explorer find it and drag it into an open post. Use the orange Write a Reply screen so you get a full width post size.

What you should be looking for for the events which are causing your air pressure to go up. Also important is the type of events you are having, such as obstructive (OA) or central (CA). In general obstructive events can be reduced with more pressure. But, central events can be made worse with more pressure.

One of the things you can do to get more detail on what is going on is to download OSCAR which allows you to see in minute by minute detail what is happening with events and pressure. It requires a PC or Mac and a SD card reader. The first thing you need to figure out is if you really need all that high of a pressure. You said you had 8 events over an 8 hour period. That is an AHI of 1, and is considered very normal - essentially no apnea. Over 5 per hour is considered mild apnea, while over 15 is moderate, and over 30 is severe.

This is an example of a screenshot. Notice how the pressure (red line) stays at a constant 9 cm and then when the machine decides you are asleep it ramps the pressure up. You can see during the night how the pressure responds to flow limitations and events.

This is a common problem. From what I can see, you could benefit from some comfort setup changes. Depending on how your machine has been set up, you may be able to do this from the user menu, or if not you will have to go into the Clinical Menu. To do that you hold the rectangular home button and the round set button down at the same time for 5 seconds. I would move your minimum pressure up to 7 cm. And instead of choosing a ramp time, choose Auto. In auto mode it actually holds a fixed pressure until you fall asleep. You also need to set the Start Ramp pressure to 7 cm. These changes will give you a fixed 7 cm of pressure instead of 4 (default) until you fall asleep. After that it will switch to control the pressure based on the number of events you are having.

If a start pressure of 7 cm and minimum of 7 cm is not enough to feel like you can breath easily, then you could try 8 cm. Hope that helps some. Any questions, just ask.

That appears to be the inlet filter on the S9 and A10 machine. I don't bother to clean mine and just replace them every 3 months now. Some of the after market filters are much finer than the standard ResMed filters and need to be replaced more often.

My recollection is that the home test I did, Phillips Alice NightOne, must have a positional sensor in the device that straps on your chest. It reports what your apnea is in each position. On your back does tend to be the worst, but I recall they add the events from positions up to get your AHI.

My wife recently got a used but very new AirSense 10 AutoSet For Her. I have noticed that it has a newer software version for the Internal Modem. It has a 4G connection while my older machine has the 3G connection. This would suggest to me that the software version could potentially be upgraded. ResMed claim they do that over the air. However, mine has obviously not been updated. Perhaps the vendor has to initiate it. I don't use MyAir so it doesn't make much difference to me. But, if others use it, and have lost 3G service, there may be an option to update the modem to 4G. Here is a shot of the About, Internal Modem data of each machine:

AirSense 10 AutoSet For Her

AirSense 10 AutoSet

FWIW the 3G machine shows 3 bars, while the 4G shows 2 bars!

Yes, I would agree. But, I don't think the nose strips will make any difference. The mouth guard if it moves the jaw might make a difference.

As I have suggested earlier the first thing I would do is look at the breathing pattern when going to sleep using OSCAR. It may give you a clue as to what is happening. Below is an example of my going to sleep pattern. The green vertical cursor is probably about the time I went to sleep. There is a minor glitch in breathing but nothing like an apnea. As far as preventing them, and assuming they are obstructive apnea events, I would keep the start ramp pressure up as high as is comfortable. I have mine set at 9 cm.