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@Sierra, Last night I changed the settings on my Resmed Auto S9 to the ones you suggested. I was quite excited to see the results. However, the SD card did not record any data. So, I’ll have to wait another night to see how well those settings work. Darn it!

Settings...Min pressure: 6.0, Max pressure: 9.0, EPR: Ramp Only, EPR: Level 3, Sleep Quality was ON, The SD card was unlocked. The machine recorded it was used for 8 hrs

How I Felt...I woke up a bit groggy, with a slight tension in the front of my forehead, but no headache. Symptoms dissipated within an hour, but I’m feeling a bit tired.

I had this problem once before and simply unplugged and re-plugged the S9 to reset. Perhaps I need to do this every day. What do you think went wrong?

Thank you for your quick response.

I will set the AS11 to 'Auto' Mode rather than 'Auto for Her' mode.

My husband tells me that the pattern of my apneas is that I inhale, then exhale, then there is a long pause before I inhale again. Would you consider this pattern to be 'apnea on exhale' or 'apnea on inhale'?

To clarify, if I just described 'apnea on exhale' you're suggesting (1) reset the EPR to 'Ramp Only' from 'Full Time 3', (2) reduce Max Pressure from 10.0 to 9.0, and (3) continue to reduce max pressure to get a minimum number of OAs and CAs. If I've described 'apnea on inhale', what EPR, Max Pressure, and other settings do you suggest?

Many thanks!

Good Morning Sierra! Thanks for checking in. I am so appreciative of your continuing to help me troubleshoot my CPAP therapy.

I’m still using the S9 to ‘dial in’ the correct min/max pressures. I haven’t wanted to complicate matters by using the Airsense 11. As soon as I feel the min/max pressure is close to optimal on the S9, I plan to switch over to the AS11. I may try the AS11 for a night or two in order to provide you with data to help troubleshoot the problem.

Thanks for offering your suggestion about why the AS11 may be at a fixed pressure. The problem is it stays at the MAX PRESSURE, not the START RAMP PRESSURE, despite the fact that I've set a min pressure (6.0) and a max pressure (9.4). (See OSCAR data for Feb 10 below.) I have spoken with both the vendor and with ResMed customer support about the fixed max pressure, but have gotten nowhere.

On Feb 11, I mistakenly set Mask = Pillows instead of Nasal (Air Fit N30i). Would this setting account for the large Flow Limit (typically my Flow Limit on the S9 is <.20)? What effect would the inaccurate "Pillow" setting have on pressure delivered? (See OSCAR data for Feb 11 below.)

In terms of my CPAP treatment, I’ve been doing well following your protocol. I have been increasing the max pressure by .2 cm every 2-3 nights. With these tiny increments, I am able to avoid morning headaches caused by too big a jump in pressure. As of Feb 20, I’m up to max pressure = 10.0 (see OSCAR data for Feb 20 below).

Results: I got 6.5 hr sleep (vs 3-4 hrs), woke up just once last night (vs 3-7x), but awoke and stayed awake from 1-2 AM (typical not to fall back to sleep quickly). I felt moderately refreshed this morning (vs feeling very tired upon waking).

It may sound obvious to you, but your advice to observe at what pressure apneas were occurring was a key to my understanding how to determine optimal pressures. I’m still experiencing most apneas (OA and CA) @ max pressure, so I will continue to slowly increase the max pressure. I’m watching central apneas closely to see if they increase.

Two questions: Once I establish a max pressure (let’s say, 10.5), why would increasing the min pressure reduce apneas? What is a typical pressure range – 2 or 3 cm (ex: min=7.0, max=10.5)?

This forum is providing me with support and useful information to achieve effective CPAP therapy, which I’m not finding anywhere else. It would be much more frustrating and lonely without myapnea.org. I am grateful.

Your answers have been incredibly helpful. A great big THANK YOU! I will post again when I have something to report or have more questions.

Thank you for your quick response, Sierra. I have made the chart changes you suggested. The charts are much more readable. I will look into a different pillow and cervical collar.

BACKGROUND

You are correct. Here are my current settings. Resmed S9 Mode: Auto Min Pressure: 6.0 Max Pressure: 9.6 Ramp: 30 min EPR: Level 3

Some additional information:

1. I am new to CPAP therapy and have been trying to ease into it gradually so I will be able to tolerate it, even come to love it, so I can live with it for a long time. I have seen progress in the limited time I've used CPAP: no more snoring, almost no vocalizations, no more choking in dreams. However I still wake up 2-7x/night and do not feel well rested (yet).

2. In this period of adjustment, I’m working out the ‘bugs’. In 27 days of using CPAP, I’ve experienced each of the following: a. I had an ill-fitting uncomfortable mask (9 days) with large mask leaks. Now have a proper fitting mask with no leaks. b. My mask came off while sleeping c. My machine suddenly quit and had to be reset d. I forgot to insert the SD card e. I forgot to fill the humidifier f. Therefore, I have ~13 nights’ data that I think are reliable

3. I believe the CPAP machine sometimes records apneas when I’m awake. When I know for sure the time intervals when I was awake (sometimes 1-2 hrs at a stretch), I manually filter these ‘awake apneas’ out. a. 13-night average, CPAP Recorded AHI: 7.87 b. 13-night average, Manual Filtered AHI: 4.46

SETTING THE CORRECT PRESSURE

1. 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?
2. 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.
3. Is the goal for the 99.5% measure to never reach the max pressure?
4. 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.

TYPE OF APNEAS

I received my in-lab Sleep Study report yesterday. This study did not include titration with a CPAP machine. Total sleep time: 3 hr. AASM AHI: 79/hr Obstructive Apneas: 1/hr Central Apneas: 38/hr Hypopneas: 40/hr

OSCAR data from 13 nights’ at-home CPAP data (Manual Filtered) AHI: 4.46/hr Obstructive: 2.52/hr Central: 1.29/hr Hypopnea: 0.65/hr

Questions:

1. 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)?
2. Are at-home CPAP machines usually accurate in distinguishing between obstructive and central apneas?

GENERAL QUESTION

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

Please feel free to ask for clarification or more information. I am so grateful for your help.

I have had very little help from sleep doctor #1 (Nov, 2021 in-lab sleep study was useless) or CPAP Vendor. I am waiting for results from in-lab sleep study conducted Jan, 2022 ordered by sleep doctor #2, who seems to be very competent, but extremely hard to schedule time with. In the meanwhile I have been using a Resmed S9 with well-fitted Resmed AirFit N30i nasal mask, and reading all I can about CPAP treatment and how to 'dial in' the correct settings. I just received an Airsense 11, but suspect it may be defective (delivers fixed pressure when settings are on Auto, causing bad headaches when I wake up), so trying to find the best settings on S9 before I start dealing with the AirSense 11.

I would greatly appreciate some help. I was impressed with the way Sierra found personal ideal settings by following a protocol of: find lowest possible max pressure possible to achieve low AHI; narrow pressures; find a fixed pressure (if possible) with EPR on Ramp Only, lower max pressure to reduce central apneas, then turn EPR back on to Full Time Level 2. Can you help me follow the same protocol to find my ideal settings? I have 18 days of Oscar data, with last night's data posted below. Please let me know if my Oscar data is not in the proper format. I welcome your questions and your advice.