Sierra

It looks to me that you are making very good progress on the total AHI number. My only suggestion is that you may want to try lowering the fixed pressure in larger steps than 0.2 cm. I have found that 0.2 cm is a pretty insignificant change and the impact of it can be really hard to determine in a reasonable length of time. The impact gets lost in the day to day noise in the results. I think I finally resorted to making 1 cm step changes to test the impact of it, and to see if I was going in the right direction. And when I get close then I started to make smaller refinements in pressure.

On the RBD @Biguglygremlin here is the expert. He suffers from it and has tried a number of things. Hopefully he will check in and provide comments. If not, then try making a new post on that specific topic.

Your experience with the DME sounds similar to what others report. Fortunately we don't seem to have anything similar to that in Canada, or at least not in our province. But, on the other hand unless you have private insurance there is no help provided by healthcare. You are basically on your own to buy a machine, and maintain the supplies.

Most healthcare providers and insurance companies will only approve a CPAP based on an AHI value. Perhaps they thought they were doing you a favour by reporting a higher number?

AHI is the sum of all central events, obstructive events, and hypopnea events divided by the number of hours of sleep. RDI is the same thing but RERA (respiratory-effort related arousals) events are also added in. RDI is always equal or greater than the AHI. Not all health care organizations accept the significance of the RDI number. Sleep apnea is diagnosed based on a minimum AHI of 5. You cannot compare an AHI or RDI taken while using a CPAP to one taken during a sleep test. The treatment pressure of the CPAP will change the AHI (down hopefully). No pressure is used during a standard sleep test.

I am not a doctor, but my thoughts are that the high frequency central apnea events are most likely caused by your heart condition. You should ask about an ASV instead of the AirSense 11 machine. A test of your heart function is required before it will be prescribed, so you should see both the sleep doctor and your cardiologist. Here is a link to some information on a ResMed ASV. Phillips makes them as well.

Resmed Aircurve 10 ASV

Perhaps you could give some specifics. Has your husband been diagnosed with sleep apnea? Is he using a CPAP machine? What are his typical AHI numbers when using the CPAP?

You can download OSCAR to view the SD card data. Looking at the SD card data can give you a good idea whether or not the pressure is set correctly.

First, I have to say you are doing an amazing job in tracking your progress and keeping the detailed spreadsheets. In looking at the spreadsheets a couple of things jump out to me. First since Feb 28 when you increased maximum pressure to 10.4 cm the OA frequency with the exception of one night has been really good. The average is under 1.0. This suggests to me that 10.4 cm is probably enough to control most of the OA events. The second thing that jumps out is that when you were using the S9 machine with EPR at 3 cm full time your Hypopnea was much lower and looks like it is well under 1.0 compared to nearly 2 now with EPR on ramp only.

Putting this together this is what I would do. First switch the machine to fixed pressure CPAP mode. You are spending very little time at less than the maximum pressure, and gaining very little with increasing minimum pressure. You may as well go to one fixed pressure that you can control. My suggestion based on your spreadsheet data would be to try 10.4 cm for the single fixed pressure. I would try that for a couple of nights just to confirm what it does. And next I would switch the EPR to Full Time with it set at 1.0 cm. Then if everything looks OK, increase the EPR to 2 cm and then 3 cm to find out if that will reduce the Hypopnea. The objective would be to only use enough EPR to reduce the Hypopnea but not increase the OA frequency.

And then after you determine the optimum EPR (the minimum you can get away with), then you could try lower fixed pressures to see what pressure you can get away with, without OA events going up. You may be able to get away with less than 10.4 and less might reduce the CA frequency.

You asked about sleep quality and I am a poor one to ask. I was diagnosed with an AHI of 37 or so, and next to zero CA events. But with treatment the CA problem emerged. And before diagnosis I was sleeping well (but snoring!). So, I did not see a big improvement in sleep quality, but I'm sure my wife appreciates the reduction in snoring. On the other hand, my wife was diagnosed at an AHI of 73 or so. Her treatment has brought her AHI down to 0.6 and she says she has an amazing improvement in sleep quality. But, I think my sleep quality is better than hers. She insists on having daily naps while I do my best to avoid naps during the day and try to sleep between 7 and 8 hours each night.

To give you some idea what it takes to get the machine optimized here is a screenshot of my statistics since day 1 with my A10 machine back in 2018. I kind of went through phases where I reduced the gap between min and max pressures. and then switched to a fixed pressure with many attempts to determine the best tradeoff pressure, and then finally to try EPR at 2 cm. I should probably try EPR at 1 cm but have not done that yet. As you can see, it is a long and winding road to get to some kind of optimum setting.

Welcome to the forum. It would seem that something must have changed. In most a reduction in weight would reduce the probability of sleep apnea.

First, what make and model of a machine do you have? If it is compatible what you may want to do is download OSCAR so you can look at the detailed sleep data to see what is happening all night long. Instead of just seeing a summary of data, you can see all the events, and when they occur. OSCAR requires a PC or Mac and a SD card reader to get the data from the SD card in the machine (assuming it has one).

Here is an example of what a report looks like. This is one from about a week ago when I had a higher number of events. I do suffer from both OA and CA events, but they are primarily central events.

Ed, yes you certainly can adjust the machine assuming you have a AirSense 10 or 11. Just change the mode from Auto to CPAP. Then you can select the pressure that worked with your S6. You do have a choice of using EPR (Expiry Pressure Relief) which reduces pressure by a set amount on exhale, or not using it. The other choice is to use it during the ramp portion of the sleep so you get the pressure relief while going to sleep and then it stops reducing on exhale when you go to sleep. The ramp in the A10 or A11 can be set to Auto. In that mode the machine will hold the pressure at an adjustable setting for the best comfort, and then increase it to your set pressure when you fall asleep. I find it works really well.

I started out with my A10 in auto mode but over time I narrowed the range between min and max pressure to the point it was nearly fixed. I found that worked best for me. For the last year or so, I just moved it to the CPAP mode and run it at a single fixed pressure. This has worked the best for me of all settings I have tried. My current settings are a ramp start pressure of 9 cm, and a treatment pressure of 11 cm. This is combined with the EPR set at 2 cm and full time. I used to use it only during the ramp, but found if I used it full time the hypopnea frequency is reduced.

I recently had cataract surgery where an artificial lens is put in place of the natural lens in the eye. For the first time in my life I am essentially eyeglasses free 95% of the time. That said, I would strongly discourage undergoing this type of surgery for someone just wanting to go without glasses. The natural lens and eye is far more efficient at using light, adjusting for distance, and seeing well at night. Some people do it and some surgeons offer it, but I would strongly discourage going that way.

The surgery I had did not correct for astigmatism, and now I am investigating the use of Lasik to correct the astigmatism in one eye. I think it is a safe and reasonably reliable procedure. There are three types that I am aware of; Lasik, PRK, SMILE. Each has pros and cons. The major con of the Lasik is that a layer of your cornea is cut to create a flap which folded back to allow the laser surgery on the layer below. Then the flap is folded back into place. It heals but never fully. Lasik is not recommended for those involved in contact sports as rough contact with the eye can dislodge the flap. PRK which is done without a flap is usually used. Some doing Lasik use a knife to cut the flap, while others use a different laser which is said to be more accurate. Surgeon experience is a big factor, so I would shop for the most experienced surgeon with the very best equipment. Don't choose based on price and wait time.

And the last thing to consider is a future cataract surgery. Almost everyone needs it at some point. The scars and irregular shaped cornea left by Lasik make it more difficult to measure the eye topography to calculate the IOL power you need for lens replacement. It may be worthwhile to consult with a cataract surgeon first to get their recommendations on laser surgery. They may have some suggestions as to what type is easiest to deal with when it comes time to do cataract surgery. Getting the power correct with cataract surgery is much more difficult that getting it correct with eyeglasses or contacts. It is a one shot deal. You get it right or you don't.

When I had cataract surgery in one eye, but not the other I found using a contact in the non operated eye was best. I tried out about 6 different types of contacts. I found big differences in the comfort level of different contacts. For me the Costco Daily lenses were the most comfortable. They are CooperVision daily lenses. Not all contacts feel the same in the eye. My second best feeling contact was the Alcon Total 1. Costco is very good about letting you do free trials with all the lenses they carry.

Hope that helps some,