Sierra

I am not quite clear what the issue is. Are your cheeks puffing up from air pressure inside your mouth? Or is the mask leaking and blowing on your cheeks from around the seal? Or, is the vent on the mask blowing on your cheeks? There is not much you can do about the vent air as that is necessary to exhale and to keep your mask purged with fresh air. One of the things you can do to get used to a CPAP is wear it during the day while watching TV or reading. Part of it is simply getting used to that "octopus" clinging to your face! Also when fully awake you are more aware of what is going on and what is causing the issue.

Getting a mask that seals well and is comfortable is the most difficult part of using a CPAP. I think I am at about mask #6. I could not get a full face mask to work for me. Either the straps were so tight that it was uncomfortable or when they were looser then it leaked and blew air in my eyes. I have found the real basic ResMed AirFit P10 nasal pillow works best for me. I also use a fixed pressure of 11 cm. Some nights I get some excess leakage, but the large majority of nights I am under the leak red line all night. With a nasal pillow mask you do have to keep your mouth closed, and I can't do that. I went through all kinds of chin straps but could not find anything comfortable that worked. I finally resorted to mouth taping. Some can't accept doing that, but it works fine for me.

This all said the first few nights of CPAP is probably not going to be all that comfortable. There is nothing natural about wearing that mask and having the hose in your way. Then when the mask leaks it is worse still. Another nasal pillow mask that my wife uses and likes is the F&P Brevida. About all I can say is to try some other masks to find what works for you.

"I have been increasing the max pressure gradually. When I have tried to set a higher max pressure too fast, I experience headaches in the morning. I also feel that if I base the max pressure on the # CPAP Recorded AHI (7.87) rather than the # Manual Filtered AHI (4.46), I may set the max pressure too high. Can you comment on this please?"

It is prudent to increase the pressure in small steps. I think 1 cm steps are reasonable, but if you are having issues, then do less than that. Pressure is typically adjusted based on when you are having apnea events. You can expand the scale by clicking on the area of interest and using the up and down arrow keys, or repeatedly left clicking. What I am seeing with the level of detail I can see, is that the large majority of your OA events are occurring at the maximum pressure of 9.6 cm. I would expect the machine would go higher but it is being limited by your 9.6 cm max pressure setting. The machine can go up to 20 cm, but that is a high pressure and not usually comfortable. The trick is to reduce the OA events with as little pressure as possible. Everyone is different, but I can pretty much stop my OA events at a pressure of 11 cm.

Can you estimate what the optimal max pressure should be, judging from the median (8.64) or 95% (9.56) measures? I realize the max pressure of 9.6 in the attached daily example is too low and acts as a ceiling for the 95% and 99.5% measures.

It is not currently possible to estimate it because your maximum pressure is being limited. If you had a higher maximum pressure the 95% pressure number is a rough estimate of what fixed pressure you could use in CPAP mode.

Is the goal for the 99.5% measure to never reach the max pressure?

The real objective is to reduce the frequency of OA events to a reasonable number. The overall AHI treatment objective is to be less than 5 for AHI, but many people can achieve less than 1.0 for AHI.

Can you tell from the Time at Pressure chart approximately how much higher the max pressure should be set? In the graph, Time at Pressure for 9.6 (max pressure) = 44 minutes.

I don't use that time at pressure chart at all. I just look at the pressure when each OA event occurs.

"Can you help me understand why the proportion of apneas is inverted between the in-lab with no CPAP (more central apneas) and the at-home with CPAP (more obstructive apneas)?"

No, the numbers you got on the sleep study are very strange compared to your CPAP treatment numbers. Normally what happens is that CA events are low in the sleep study, but then emerge when CPAP treatment at pressure is started. Your pattern seems to be the reverse. Your very high CA index in the study is a red flag. It is usually very hard to treat central apnea with a CPAP as the CPAP reduces obstructive apnea with pressure, and pressure often makes central apnea worse. I don't understand what you have. Your CPAP reported central apnea is quite good, but your obstructive apnea is too high. So, I don't understand it, but the numbers indicate you can reduce your OA frequency with more pressure. Or, if they are being induced by the head neck position, a soft collar may help too.

"Are at-home CPAP machines usually accurate in distinguishing between obstructive and central apneas?"

Both my sleep study and that of my wife's were done with at home kits - Phillips Alice NightOne. We have no reason to think that they were inaccurate. I was diagnosed with an AHI of around 37, and my wife at 83. Interestingly her AHI under treatment with a ResMed S9 is 0.58. I suffer from central apnea and I cannot get that low. But, with my latest adjustments I am getting 0.86 for AHI.

"Can you tell from flow rate patterns with some certainty when you are awake or asleep?"

That is not easy to do. If you expand the flow rate chart so you can see each breath you should see that each breath is regular and almost identical to each other when you are asleep. Another clue is the leak rate chart. Leaks generally occur when you are asleep. If you see the leak rate chart trending around zero it is a hint that you may be awake.

All in all, I would stick with my previous suggestion to increase the maximum and minimum pressure to see if things improve. I expect they will. Do it in steps that you are comfortable with. Post your Daily report with the increased settings and I can comment. The first chart you posted with the pressure, flow, etc is enough. At this point you are mainly interested in the event chart and what the pressure is at when events occur.

Your layout is fine, except that the font sizes are so small that I cannot really read the numbers. But from what I can see, it looks like you have it in Auto mode with a minimum pressure of 6 cm and max of 9.6 cm? It appears that you are getting a large number of obstructive events when the pressure is at maximum. The first thing I would try is to increase the maximum pressure to say 11 cm and see if that improves things. Minimum could probably go up to 9 cm to narrow the control band some. Some people have issues with the head and neck position causing a rapid succession of OA events. You may want to try a different pillow, or some use a soft cervical collar that you can get at Walmart.

If you go to File, Preferences, Appearance you can set font sizes there. And, if you can post an updated Daily Report I may be able to see more. Also if you left click on the vertical scale of the pressure chart you can manually set it to 15 cm max. Then it will be easier to read the actual pressures. If you need to go higher you can change the scale later.

Hope that helps some to get started.

The issue with a CPAP is that they are not the most comfortable thing to use. They usually become more uncomfortable if you need a higher pressure or if pressure is changing by a lot during the night. And, if pressure is too low they are uncomfortable too. A setting of 4 cm to me makes me feel like I am suffocating. The pressure needed to control the apnea is the over riding factor of course, but within the range it is controlled the hope is there is a sweet spot where the pressure is not too low or too high. I have found that once I found the pressure I needed I have switched my machine to a single fixed pressure instead of letting the machine adjust pressure during the night in Auto mode.

I think if you can control apnea at 4 cm pressure, you may want to consider a fixed pressure of 6 cm or so -- whatever you find comfortable. But, to tell if you can get away with no pressure at all, you would need to get a sleep test. There are take home versions that are a lot more convenient and comfortable to use than the in lab tests.

You may want to download OSCAR and look at the data yourself. If you really are having no apnea at lower pressures it may be worthwhile to get another sleep test.

If you mean a Central AI of 1.0 that is fairly high. If Central AI is a significant % of your total AHI that is a bit of a concern.

rob12345 said: "What mask do you use? What are your AHI normally. How long have you had Cpap. Do you feel fresh when you wake I feel tired"

Running out of width. I use a ResMed AirFit P10 nasal pillow mask, but I have modified the headgear on it. See this post. What masks have you tried?

I have had lots of trouble with central apnea events. Initially I was getting AHI's in the 7-8 range. Once I got pressures in a narrower range I got the AHI down to about 3. Next switched my machine (AirSense 10 AutoSet) to a fixed pressure CPAP mode with EPR set to Ramp Only. This brought my AHI down to about 2.1. My next change was to turn the EPR back on with it set at 2 cm full time. AHI came down to 0.85 or so.

I do feel reasonably fresh when I get up providing I get about 7.5 hours of sleep. But, that said I never really did feel that apnea affected my sleep a lot. It certainly did make me snore and disturb my wife though.

But, each person is a bit different. The starting point is to figure out what your main issues are. Having no, or minimal central apnea makes it easier. Mixed central and obstructive apnea is much more difficult.

The machine disables the recording of events while the ramp is in effect. However if the ramp is turned off then it records everything from the time the machine starts.

If you download OSCAR you can take the SD card out of the machine and view all of your data since day 1. The software requires a SD card reader and a PC or Mac.

If you go into the clinical menu you can set it to show an enhanced sleep record on your machine. Under Options, set Essentials to Plus. This will give you some more detail, but OSCAR is much better. See this link.

ResMed A10 Clinical Guide

This display is from SleepyHead which I still use. However, it has been replaced by OSCAR which is essentially the same.