Scary night...

I have mild OSA, and have only started using an APAP (ResMed AirSense 10) three weeks ago. I'm still working through the basics (mask fit, etc.) and have not made any changes to the APAP settings except humidity level. My settings are as follows:

My first few nights were okay, (AHI < 3), then I had this night:

Needless to say, it scared the ____ out of me. The pressure was maxed out at 16, I was having events all over the place for 5 hours, and I never woke up. Two days later I made a homemade chin strap and used an old mail-order MAD in conjunction with the APAP:

Here's a quick summary picture of my experience so far:

Based on my observations so far, I don't think using the APAP is helping; it may even be making things worse. I plan to keep using the MAD every other day until my follow-up appointment with my doc, which is coming up soon. I know this isn't a lot of data, but I'm thinking at this point that a proper MAD will do a lot more for me than the APAP. Thoughts?

I wouldn't give up on your CPAP just yet. There are a few things that seem a bit abnormal. First your setup clip shows a full face mask. Is that correct? If you have a full face, it does not make a lot of sense that you would need a chin strap. Some wear them, but mainly to keep their mouth closed so air does not leak out when using a nasal or nasal pillow type mask. Your graphs do not show the leakage rates. It would be helpful to see if leaks are an issue. For the leakage graphs to be accurate the mask type has to match what you have for a mask.

Getting the pillow right is important. That is kind of personal and I suggest you try different types. The main purpose is to keep your head reasonably aligned so you are not kinking your neck, and also so there is room for the mask. I use a down alternative pillow and that works for me. Some people find they get a lot of help from a drug store cervical collar to keep their head neck aligned. Your rapid sequence of obstructive events one night that are not there another night kind of suggests this may be an issue. They are $20 or so at Walmart or other drug stores. I see no harm in using the MAD, but it really should not be necessary.

I would suggest your machine is not really set up for comfort the best. The minimum pressure of 4 cm is very low, and most people feel they are suffocating when using 4 cm as a start pressure. You also do not seem to be using the A10's AutoRamp feature, which I think is the best feature this machine has. I would also discourage the use of EPR when you are sleeping. The machine can be set so that it uses EPR while you are awake and then switched to no EPR when you go to sleep. EPR can reduce the effectiveness of the machine.

Here is how I would suggest setting up the machine for more comfort. To make some of these changes you have to go into the Clinical menu. That is quite simple. Just press and hold the rectangular Home key and the round Set key at the same time for 5 seconds. When you are in there you navigate the same as in the user menu. With what you have I would suggest the following settings:

• Minimum Pressure: 8 cm, you are currently at 4 cm which is too low for any comfort or effectiveness
• Mask: Confirm or set it to match what you are using for a mask
• Ramp Time: set it to Auto
• Start Pressure: 7 cm, you are currently at 4 which is too low
• EPR: On, you currently have it on which is ok
• EPR Type: Ramp Only, this will shut EPR off after you go to sleep
• EPR Level: 3, you currently have it at 2. Setting it at 3 is more comfortable, and it will go off after you go to sleep

When set this way, your machine will give you 7 cm on inhale, and 4 cm on exhale, which most find very comfortable. It will hold at this setting until you go to sleep. When you go to sleep the reduction in exhale (EPR) will stop, and you will go to 8 cm for inhale and exhale. You should not notice this, as you will be asleep by then.

That is about it, but when you are in there it would be good to go a bit further down in the menu to Options and make this change:

• Essentials: Plus, This will give you a more detailed sleep report right on your machine.

Hope that helps some. Here is a link to a technical manual that has all the details. If you do not feel comfortable making these changes yourself then ask your sleep tech to make them for you.

Once you get a handle on how the machine is reacting with the revised settings, and possibly using a cervical collar to help with what might be a positional issue while sleeping, you may want to revisit the minimum pressure setting. One can normally gain some reduction in AHI by trying higher minimum pressures. This will help to prevent unnecessary OA events, that trigger the machine to increase pressure.

Hope that helps. Any questions just ask.

Thanks for the response, Sierra. I really appreciate it. Here are the answers to some of your questions/comments:

--I do indeed have a full face mask. I have always been a mouth breather, so I assumed that would be the obvious choice. Of course I never considered that having air forcefully blown up my nose would make it easier to breathe. :)

--I checked the machine settings, and the ramp time is actually on auto.

--The chin strap is to make sure that the old MAD stays put; in the past I've actually opened my mouth enough in my sleep that my lower jaw slipped out of it entirely. I'm still using the MAD every other night and getting fewer AHIs and lower pressures on those nights.

--I switched pillows because I couldn't sleep comfortably on my back all night, which is what I'm being forced to do with the mask I have. The new pillow is more comfortable, but my AHIs are higher. :(

I have an appointment with my doc in a few days; I plan to take my laptop in and discuss my results so far. I don't have any problems changing the settings myself; I just want enough data for a reasonable decision and and an agreed-upon course of action before doing so.

I'm thinking of doing the following test: Odd days with the MAD, chin strap, pressure=4, and EPR=on (the closest I can get to no APAP at all while still getting readings). Even days with min pressure=7, max=10, and EPR=ramp only (pressures based on med & 95% when using the MAD with the APAP). This should help determine whether the MAD or the APAP works better when used alone.

My doc looked at my OSCAR data and agreed to my experiment. We'll try it for three weeks and then assess the results. I've already changed my machine settings for the first night. We also agreed that I would change back to the old pillow. We'll see what happens...