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Short answer: if your minimum pressure is set as low as yours the ramp does nothing really.
That is more or less correct but the parameters vary from one lab to the next. Also, different labs have different policies. Some will always split and some will never split, regardless of what happens. Where I work we try to do whatever is in the best interests of the patient.
Simple first response if you have heated tube and are getting condensation as you describe: turn up the tube temperature. The humidification level is to stop your mouth getting dry and the tube temp is to stop rain-out. It is always possible that your tube is dodgy. I had that with a patient a few days ago.
Did you use a humidifier? If it was turned up too high it may have contributed to the heat and sweating.
I tend to agree. I have a degree in this area so I do speak from a place of some expertise. Your CPAP equipment (mask, machine, tubing etc) does not need to be sterilised, just clean. Your face is not sterile, your bed is not sterile, the air is not sterile. If you sterilise your machine it does not decrease your chances of inhaling a pathogen from the air.
The only problems I have ever heard of result from people not cleaning their gear. If you keep water in your humidifier chamber and just top it up every day then eventually mould will grow in it and that can cause infection. However, if you empty your humidifier chamber every morning and let it dry there will be no problem. Likewise, if the tube dries out every day you should be fine (which is always assuming you get condensation in it to start with). The only way you will get an infection from your mask is if you never wash it and the gunk which builds up in it harbours a pathogen. If your mask is clean then, again, you will be fine. There is nothing inside your CPAP machine for a pathogen to grow on (nothing for it to eat or drink) so you do not need to sterilise the inside of your machine.
I know that some people will choose not to agree with me, and I'm quite OK with that, but that is my opinion based on a combination of my relevant university studies and almost 20 years experience as a sleep tech.
Having said all of that, do actually keep your gear clean. I have seen some pretty disgusting stuff. I have had more than one patient with pieces of food stuck in their mask. I have also had patients with colonies of live insects (usually cockroaches) living in their machines. Keep 'em clean people. If not for your own sake then for poor old me who has to clean this stuff.
It's really hard to say without full download data from your machine. Even then it may not be clear. If your leak level is the same or better with the DreamWear you may as well keep using it. You may need another study with your machine to nail down what is happening. It shouldn't be a position related thing as you obviously have an auto and it should compensate. Do you get restless legs?
Sometimes it is possible to perform diagnosis and treatment in one night and sometimes it takes 2. There are a bunch of perfectly legitimate reasons why it is not always possible to do both in one night, so it is no surprise that you were done in one night and your wife in 2. I'm not a huge fan of the one night study and the prescribe auto thing because it encourages laziness on behalf of all the people involved. I've met hundreds of patients who have wasted years of their time and thousands of dollars because they were handled this way and as soon as they got their auto CPAP no one could be bothered helping them. Also, in Australia and auto CPAP is 2 - 3 times the price of a fixed pressure machine (don't ask why, it just is). The one study and auto method of handling patients is a favourite of physicians who just want to pump through as many patients as possible with minimum effort and maximum financial reward. I think that it's only appropriate to verify if a treatment is actually working. Also, sleep studies are available for free here, which makes a difference. Anyway, taking 2 nights to do the whole thing is quite standard and probably just a sign of the people managing your wife's treatment being thorough.
For some people, sleeping with you upper body elevated can be enough for effective treatment. The only way to know if it's working, though, is to be recorded sleeping that way. If it works for you then great!
It is best to get an actual number for your leak in L/min. That stupid score-out-of-20 thing that ResMed does is pretty meaningless. the 2 main factors in mask leak are 1 - is it bothering you (obviously you know that) 2 - is it affecting the machine's ability to treat your OSA (the download data can give a pretty good idea about that). If your answer to both of those questions is "no", you have nothing to worry about. Perhaps you should look in to the Sleepyhead software everyone here seems to use. I have no experience of it but it seems pretty good.
I have patients who have ordered from this company before and it worked very well for them. I had a little look on Second Wind and you can get a new ResMed S9 auto CPAP there for US$700, or a new Respironics DreamStation Auto for US$738 (which would be my preference for a new machine) both with humidifier. Or, if you want to go second hand they have a wide range of machine with under 500 hours of usage (about 2 months) which is practically brand new for a CPAP machine. If you go that route you can get a Respironics 60 series auto with humidifier for US$300, which is very bit as good as any of the other machines and a little cheaper. Really, there is very little difference between one machine and the next. They all work as CPAP machines, so it's more down to little things like the how the humidifier works. Some humidifiers are fiddly to use or hard to clean. Bear in mind that any mask can connect to any machine, so that's not an issue. The AirSense 10 suggested by Sierra above is a bit more expensive and the controls can be a little confusing for those of us who are somewhat technophobic, but otherwise it's fine.
