Sierra

A lot of questions... I will try to answer a few. We are all under atmospheric pressure which in CPAP pressure units is about 1,000 cm of water. The reason we are not crushed by this pressure is that we open our mouths and noses and the pressure is equalized from outside to inside of the body. A CPAP upsets this balance and tries to increase the pressure inside the lungs by a very small amount of 4-20 cm of water using a blower. As the pressure on the outside stays the same, the higher pressure inside the airway expands the passage. That is the whole basis of CPAP. If you think of those new style collapsible garden hoses, it is kind of the same thing. More pressure inside the hose makes it expand out and allow water flow through it.

I don't think heavy blankets would be enough to reduce any flow in significantly. Your body constantly monitors the CO2 levels in your blood to increase and decrease breathing effort to compensate. You asked about a vacuum around the outside of the throat, and yes, in theory that would work, but may be hard to achieve in practice.

I didn't read the whole thread but the issue raised by the OP is a common one.

"As of last night I began using CPAP with a nose mask. I had a rough night because I felt like I was smothering. Does anyone have any suggestions on how I can let go and give control to the machine?"

Not sure what was suggested, but I believe the most common problem is that sleep technicians do not set the CPAP machine up properly. Some just take it out of the box with the 4 cm minimum and 20 cm max default settings and give it to the user. 4 cm is way too low of a starting pressure, and if the machine goes there, or you try to go to sleep with the pressure at 4 cm most people are going to find that suffocating. As a general starting point, I think machines should have a start pressure of 7 cm for comfort. I now use 9 cm. You want to use a pressure that is high enough that you don't feel like you are suffocating if you take a deep breath, or several in a row. Often people are breathing more deeply when they first go to bed.

I agree there are issues. In the UK they do not even recognize apnea in the 5-15 AHI range as requiring treatment. Treatment starts there at 15. Some places count RERA, and others do not. I suspect one of the issues is that it is not an exact science. My wife was treated for sleep apnea before me and was diagnosed with a really high AHI of I recall 83 or so. To her a CPAP has been a Godsend and she now averages 0.66 for AHI. I was coerced into getting tested by my doctor and my wife. If did not have a sleeping problem, but I knew that I snored (so the wife said!). I was diagnosed at an AHI of 37. I can't say that at least initially the CPAP was any kind of Godsend for me. It was much more annoyance than help. And it did not help all that much as the majority of my apnea is central. But, I toughed it out, and after many different settings on the machine, 5 different masks, 3-4 different chin straps, and now mouth taping, I settled on an arrangement that works quite well. Not 100% sure that my sleeping has improved all that much, but I no longer snore, and average 0.85 for AHI.

I think some come to the CPAP solution looking for the silver bullet to cure sleeping problems that may or may not be caused by apnea. Often there are many factors. I have concluded that one should focus on the quality of sleep not the number of hours sleeping. And a quality of sleep is achieved by doing all the sleeping at night in one stretch of 7-8 hours, with no napping during the day. One site that I have found helpful is Sleepwell - It is No Dream. The project was founded by a Canadian university professor in pharmacy that wanted to help seniors get off sleeping pills for their sleep. He found that many of the falls that seniors have are related to their use of sleeping pills. He advocates using Cognitive Behavioural Therapy for Insomnia (CBTi).

If your AirSense 10 is an Auto or Elite version it will have a SD card in it with detailed data on it. You can download a software program called OSCAR which will display the detailed data and let you know exactly what is happening from minute to minute during the night. You can also go back to earlier use of the AirSense 10 and see what has changed from the past to now. The software is free, but requires a PC or Mac, and a SD card reader.

Your need for more pressure may have changed over time, and if it is in Auto mode it will increase as required. Sometimes the machine can increase pressure when it is really not effective. But, the detail needs to be looked at to determine if that is the case.

In Canada it varies widely by province. Alberta where I am has been the most recent bad boys, with a pretty nasty 4th wave. It seems we have recovered quite a bit, but there were 38 deaths reported yesterday in a province of 4.2 million. So while cases are down, the impact of the cases is still taking a toll. Saskatchewan and North West Territories are the current bad boys with the highest case rated. but, earlier on other provinces have been really bad as well. It seems that when the virus takes a hold it has to get pretty bad before cases start to decline. ICU capacity has been overwhelmed in Alberta and Saskatchewan. Ontario was hit hard earlier.

Our problem is opening up too fast with not enough of the population vaccinated. Canada as a whole has 72% of the total population full vaccinated with two doses. Alberta is at 64.9%. Our premier refused to use vaccination passports but now finally has, and as a result we are starting to catch up. I see Australia is at 53%, which is kind of low to be thinking about opening up. Our history is that we close down too late and open up too early, and there is a big price to be paid for doing that.

That sounds like an Archimedes Eureka moment!

Retired mechanical engineer. Problem is that I am retired so long that I forget this stuff...

It should be fairly easy to measure the pressure you are getting from your CPAP, especially if you have a nasal mask. You would need a length of clear plastic flexible Tygon tubing, like the kind that is used in wine and beer making. Make a loop with the tubing and fill it with water about half way. You may need some help measuring but essentially what you want to do is put one end of the tubing into your mouth while the machine is running. The pressure should drop the level of the water in the side closest to your mouth and elevate it in the other side of the U-Tube loop. Then you need to measure the difference between the two levels. 13 cm pressure should measure at 13 cm. If you want to get really fancy you could attach the tubing to a board with a ruler between the two sides to make it easier to measure.

I think inaccurate pressure is the most likely cause of what you are observing. The other issue possibly could be slow response of the machine to sudden demands in air flow. My observation from SleepyHead is that when we first go to bed and turn the machine on, we take much deeper breaths than after we settle down and go to sleep. Some machines may respond better to those deep breaths. But on both my A10 ResMed and my wife's S9, I see some significant pressure fluctuations especially when first going to bed.

An AHI of 60 is pretty high and getting it close to zero is a big improvement. If you download OSCAR and post a daily report I can have a look at it and see if there is anything that could be improved.

OSCAR will give you much more detail than MyAir. Assuming you have not deleted anything from your SD card, the detailed data from the first use of the machine should be all there to look at and compare to what is happening now.