Sierra

BUG is correct. Your owners manual would be a good starting point. I use pure vinegar on my mask and hose first, followed by some Dawn dishwashing detergent, and then finally a rinse to drip dry. If your machine has a prewarm feature that will remove any remaining moisture. I try to wash the parts in the morning and let it drip dry all day before using it again. The vinegar is good at removing any mineral deposits and will also act as a disinfectant if pure. I would avoid using an ozone cleaner like SoClean. The ozone can damage the machine and void the warranty. UV probably does no harm. I was negligent on replacing my inlet air filter and it got pretty dirty. I have set a reminder to replace it every 3 months. Depending on what I see, I may extend that to 6 months.

I have not tried a mask like this one, but have thought that the nasal pillow version of it may be worth a try. I believe BUG has tried this mask or a similar one and had some issues with it. I will leave it to BUG to cover them.

The masks I have tried in order are:

ResMed AirFit P10 Nasal Pillow - It works very well for me, is comfortable, quiet, and when the headgear is working the leaks are reasonable. However the headgear is a pain to keep adjusted and the straps keep slipping.

ResMed AirFit F20 Full Face - It is well made with substantial headgear, but I could not make it seal with any reasonable amount of headgear tension. Probably only used it 2-3 nights and gave up on it. It is in the spare parts box.

ResMed Quattro Full Face - My son uses this one and he gave me a spare mask. I hated it for the same reasons as the F20, but the Quattro was worse. Did not make it through one full night of sleep.

F&P Brevida Nasal Pillow - This has a better headgear than the P10 but the nasal housing is much larger in size and not as comfortable when sleeping on my side. It also irritated my nose between the nostrils. I gave it to my wife who was using a ResMed Mirage FX Nasal Mask. It had to be adjusted very tight to make it seal and she was annoyed by the marks the mask and straps were leaving on her face in the morning. She loves the Brevida and gets almost zero leakage with it.

ResMed Swift FX Nasal Pillow - I basically bought this mask for the much better headgear and a nasal pillow design similarity to the P10. It was fine except for the vents. Unlike the P10 model which has a diffuser vent on each side of the nasal chamber, the Swift has angled straight through holes. The velocity of the air coming out those vents is like standing behind a jet engine. I could not find any position when sleeping where the air velocity would not be constantly waking me up.

Sierra FX-10 Hybrid - This mask I made by fitting the Swift headgear to the P10 Nasal housing. From my post, at this link, it looks like I have been using it for 3 years now. I've replaced the silicone nasal pillow cushion once, and that is it other than periodically replacing the 3M tape that holds the splice together. I love the mask. Works great and is quiet.

For the life of me I don't understand why ResMed does not put the Swift headgear on the P10 mask. That would be a winner.

I know you have been having issues with RBD for some time. I hope this treatment works for you. On a quick look at the Mayo Clinic site, it certainly seems to have a long list of potential interactions.

Actually I have zero concern that my ResMed AirSense 10 AutoSet is not reporting AHI properly. And with AHI averaging under 1.0 I really have no room for improvement. I sleep just fine if I avoid naps during the day and don't try to sleep more than 8 hours at night. If I get to the point where I cannot maintain AHI under 5, with centrals being the dominant type, then I will consider an ASV. I am currently no where near to that point.

If you were diagnosed with a CA index of >53 then you are dealing with a very different situation. A sleep test is done with no treatment pressure, so treatment pressure is obviously not that cause of your central apnea. An ASV would be an obvious choice.

If I was to wish for a technical improvement to my ResMed APAP it would be the ability to distinguish between obstructive hypopnea and central hypopnea. Some in lab polysomnography tests can do this, but I am not aware of any APAPs that can do it. Currently the ResMed APAP responds to OA and hypopnea events with a pressure increase. CA events are correctly not responded to. The ideal auto treatment would be to only respond to OA and obstructive hypopnea with a pressure increase, while providing no pressure increase to CA and central hypopnea. I suspect that this is technically very hard to do, so they are not doing it. The flow pulsing technique they use is probably not suitable for a hypopnea situation and only works in a no flow situation.

I suspect this is a very personal thing like a pillow. My preference for a bed covering is something light, warm, and a cool room (64 F or a bit less). We are currently using a silk comforter.

For sleep issues I have found this site at the link below helpful. It advocates CBTi over a medication solution. In particular I have found the tips for the hygiene of sleep helpful. The site was started by a university pharmacy professor that was concerned about the number of hip injuries due to falls in elderly people using sleeping pills.

MySleepwell

Window got too narrow to read or type in!

First just to clarify my diagnosis and treatment, I was diagnosed with an AHI of 37.3. Of that 0.4 was central apnea, and 17.4 was obstructive apnea, with the remainder hypopnea. Clearly untreated I had dominant obstructive sleep apnea. However when I first started treatment with an APAP in auto mode this drastically changed. Unlike my wife who was diagnosed up around 80 for AHI and went immediately to <1.0 for AHI, my outcome was very poor. I can't go back to all the details because SleepyHead "ate" my early data, and all I have left are some random screenshots. I recall AHI's as high as 13 or so. My ratio of CA to OA events went to about 3 to 1. This is a classic case of treatment emergent complex apnea. This is not uncommon at all. I have seen estimates that 6.5% of people treated for obstructive sleep apnea get this treatment emergent complex apnea with high central apnea. That is a large number of people when you consider how many get diagnosed with sleep apnea. Fortunately in most this emergent condition goes away in 6-8 weeks. I was not one of the ones where it went away. I seriously considered at that time going back to my doctor to request a prescription for a VAuto BiPAP or full ASV. But with help from forums and my own research I persevered with changes to my ResMed APAP. If my SleepyHead stats are correct, I have used over 40 different setups searching for an answer. Now with the machine in fixed CPAP mode and a relatively low pressure of 11 cm, and 2 cm of EPR I am finally getting good results with average AHI <1. Still not quite as good as the results my wife is getting (still in Auto mode), but pretty close. My conclusion is that a simple CPAP, set up properly, can be very effective in addressing treatment emergent complex sleep apnea.

I notice that you keep saying an APAP cannot distinguish between central apnea events and obstructive events because it cannot supply missing breaths. That is kind of mixing apples and oranges. Distinguishing between central and obstructive events is done very well with a ResMed APAP. Providing assistance for missing breaths is not a feature of an APAP, and is a totally different issue. The AirCurve VAuto can do that on a very crude basis, and of course as you know the AirCurve ASV does it in a much more sophisticated way on a breath by breath basis. And there are certainly types of complex or pure central apnea that do require an ASV. So far I have not found it necessary in my treatment emergent type of apnea though. If someone requires a significantly higher pressure to control the obstructive portion of the apnea, this fixed pressure option may not be effective. A BiPAP is not likely to work either, and an ASV will be necessary.

I run my APAP machine in fixed pressure CPAP mode. I don't want the machine to be chasing central hypopneas, or adjusting pressure at all. All I want is a fixed pressure high enough to treat most OA events. That is one of the secrets in treating complex apnea with a CPAP or APAP in CPAP mode.

You are correct, and are probably referring to the work done by Robert Thomas, M.D., Associate Professor of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center. He has written an article in the blog section here.

Complex Sleep Apnea

A quote from the article:

"I also remember noting that bilevel positive airway pressure (BILEVEL) was often resulted in worse responses than continuous positive airway pressure (CPAP, including auto CPAP). In fact, in patients with NREM dominant sleep apnea, auto CPAPs seemed to “chase” changing breathing patterns with pressures that went up and down during sleep, resulting in even poorer results than use of fixed CPAP."

He also describes the experimental treatment which essentially reduces the mask ventilation to increase the CO2 levels.

Altitude can play a significant role in central and complex apnea. People living at higher elevations can have significant issues with central apnea. I worked with one poster here that had a permanent home at a lower elevation but vacationed at a high elevation lake in Mexico. His machine worked at home but not in Mexico with the same settings. My recollection is that he didn't want to keep changing his machine so he bought an AirCurve ASV.

I live at 2000 feet so not high altitude compared to places like Denver but I notice a significant lowering of AHI when I vacation for a couple of weeks at sea level. I am also convinced that my AHI also changes with weather here at home and suspect it is likely to be changes in atmospheric pressure.

One thing for sure. Complex apnea is complex!

Can't agree. I had treatment emergent complex apnea with a very high ratio of CA to OA events. A ResMed AirSense 10 AutoSet in fixed pressure CPAP mode works just fine for me. My total AHI over the last 285 days is 0.83. The CA component is still dominant at 0.52, compared to the obstructive index at 0.27. This compares very favourably to the total AHI of 3 to 5 I was getting in APAP mode. Now it may not work for every type of central apnea and complex apnea, but it does work for me

I think you are misunderstanding my point. I am not saying that ASV's don't work in treating central apnea and mixed apnea. Clearly they do. What I am saying is that with certain types of central apnea such as treatment emergent complex apnea, a simple CPAP can work well too, and an ASV is not necessary. And further if an APAP is not working well on treatment emergent complex apnea, then a move to a BiPAP may be a mistake. Anything that increases treatment pressure can make it worse. A change to fixed pressure CPAP mode may be more effective.