Sierra

10 days is not a long time to get used to wearing a CPAP. It took me months to get a restful sleep with the mask on. I was diagnosed with an AHI of 37, and did not feel any apparent great burst of energy from using a CPAP. I think some of the benefits get a little overstated. However, I have stopped snoring, and I more often than not sleep through the night without getting up. My target is to get 7-8 hours of quality sleep.

My thoughts would be to stick with it, and it will get better for you. Do you know what your breakdown of AHI events are that make up your current 3.5? If they are mainly obstructive, there may be opportunity to reduce the AHI a little further. My wife was diagnosed around 80 and now can routinely get under 1 for AHI. I however have mostly central apnea for residual and 3.5 is a good score for me. CPAP does not work well in reducing central apnea.

I don't know much about dental appliances, but you may find this link of some basic help.

Sleep Apnea Treatment Options

I think I would try a minimum of 7 and maximum of 8 cm. It is a tight range but it will give your machine a little room to change pressure and you will see what it wants to do.

Yes, your leak rate is a little high for a full face mask. Especially if you end up with a lower pressure range or low fixed pressure you may want to consider a nasal pillow mask like the ResMed P10 or the F&P Brevida. They tend to be more comfortable, but they can get moved off your face too. I don't think the mask is your biggest priority now, but it is a problem you will have to address.

If you set up the AutoRamp, initial ramp pressure equal to your minimum pressure, EPR at 3, and Ramp Only, that will not only let you get to sleep more comfortably, but it will give you an option if you wake up in the night and cannot get back to sleep. Just disconnect the mask and turn the machine off for a couple of minutes so it will restart the ramp.

Not sure about the high respiration rate. It might be due to oxygen saturation degrading. One thing you could look at is an expanded view of those CA events to see what they look like when they happen in quick succession as they appear to. Just use the up/down and left/right arrows, or click on the area of interest repeatedly to expand the scale so you can see individual breaths. It can give some clues as to what may be causing the CA events.

Only if it is obstructive apnea. More pressure usually makes central apnea worse, not better.

If you look at the flow graph in the Daily report I posted you will see that every breath is recorded. When there is no breathing flow there is no upward (inhale) or no downward (exhale) change in flow. It is not uncommon at all to stop breathing for a second or two. The machine would not flag it as an apnea event, and as I said there were a couple of them in this graph that were not flagged. It only flags events that last 10 seconds or longer. But, you can still see that I stopped breathing. I am not a medical professional, but I don't see why that should cause you to wake up. Seems to me that is the real issue here. Not the apnea, but waking up.

Welcome to the forum. First off, I need to make you aware that I am not a medical professional. I have monitored my apnea with SleepyHead now for over a year, and my wife's apnea for 4 years. Here are my thoughts on you daily report, just based on personal experience.

• First, you have zero obstructive events. That indicates you are not suffering from lack of pressure, and may in fact have too much pressure. Your mask leaks are high at times, but not real excessive, and not your biggest issue, which is the high number of CA or central events.

• If you have taken the responsibility to adjust your own pressures I would suggest reducing your minimum pressure to 7 cm, and your maximum to 10 cm. The maximum may have to go lower than that, but that would be a start.

• For going to sleep comfort with the AirSense 10 I like to use the AutoRamp feature. To use that turn it on in the clinical menu, and set the ramp start pressure to 7 cm as well. I also like to use EPR set at 3 but set for ramp only. Set this way the machine will give you 7 cm on inhale and 4 cm on exhale as soon as you start the machine. Then when you go to sleep the machine will stop the EPR and you will be at your minimum 7 cm. Using the AutoRamp with EPR set to Ramp Only helps a lot with the gasping for air issue.

• With SleepyHead, I suspect you are using a Mac? You can show a little more useful data if you click on that little triangle beside the date to hide the full month calendar. You can also set it to not show the big pie chart which uses up space too. On a PC it is File, Preferences, Appearance, and then uncheck the "show event breakdown pie chart". This lets more useful information display on the Daily report screen.

This said, you may need significantly less pressure than even the settings I suggested. You may want to discuss the issue you are having with your sleep doctor or technician. It appears you are quite sensitive to pressure induced central apnea. It may be possible that you will be better off with a fixed pressure (which the AutoSet can do) of 7 cm or perhaps even less. But, you can try the lower settings I suggested and if you keep getting high CA frequency and zero to low OA, then keep reducing the max pressure. That is the way I would do it for myself, and in fact have done so. I am sensitive to CA events and used to have the machine in Auto with pressures up to 15 cm. Now it is set at a fixed 11 cm.

Hope that helps some,

As I think you have found in your research, sleep onset apnea is not all that uncommon. I only had to go back 11 days to find a night where I had a central apnea just after going to sleep. See the SleepyHead screenshot below. I went to bed at 1:09 AM (much later than my normal). At about 1:16 my ResMed machine decided I was asleep and started to ramp up the pressure to my normal fixed 11 cm. You can tell from the flow rate fluctuations that breathing was very regular indicating I was asleep. Then about 1:17 it appears my mask started to leak significantly. Perhaps I rolled over. The breathing indicates that I probably awoke or at least partially awoke. About 1:18 the pressure relief on exhale stopped as it should and I was then on the full fixed 11 cm, and looking like I was going back to sleep again. Except that at about 1:18:15 it looks like I stopped breathing. By 1:18:35 the machine declared this was a central apnea event that lasted 17 seconds. Regular breathing started again, and another mask leak change occurs which may mean a position change. This is followed by two more mini apnea events which did not last long enough to be counted. The pressure pulse would suggest they were central apnea. After that a regular sleep pattern followed with no events until about 2:10.

Long story, but the point you may want to consider is that the apnea event caused a minor disruption to my sleep, but it certainly did not keep me from going to sleep. My thoughts are that a critical question that you might want to ask your doctor is WHY would an apnea event prevent you from going to sleep? Apnea sufferers sleep through apnea events all the time, including ones just as they are going to sleep. So the unanswered question would be why it seems to disrupt your sleep so drastically that you can't go to sleep...

I can think of a couple of explanations. Are you using a nasal mask and is it possible you are opening your mouth during your sleep. The air rushing out your mouth can give you a dry mouth by morning.

The other possibility is that your humidifier is not working. What kind of machine do you have? Are you using a heated hose? How is the humidity control set up? When you remove the humidifier reservoir in the morning is it quite warm?

Your first check should be to verify he has a ResMed that stores detailed data on the SD card. If it stores detailed data and have a cooperative sleep specialist you should be able to take the card to be read using ResMed software called Rescan (or something like that). It does basically the same as SleepyHead or OSCAR. However, if you have OSCAR and have the data on a PC or MAC you can do a screen capture and post the data here for comments as well. Here is one of my SleepyHead Daily screen shots from back when I first started CPAP.

Some comments on this chart:

1. The leak rate was not great and near morning at 6:20 I had some quite large leaks. In general I like to keep the time over the leak redline at less than 1%. Large leaks that get grayed out can cause the machine to stop reacting to events and when the leak stops you can get a burst of events.

2. The red and green pressure lines are inhale and exhale respectively. What you look for is the events at the top and compare them to the pressure. If the pressure is maxed out and you are still getting obstructive events it can mean that the pressure is not being allowed to go high enough. The other thing to look for is where central events are occurring, if any. Too much pressure can cause central events, while not enough can cause obstructive events. So it can be a tradeoff setting. I now currently use a fixed pressure of 11 cm as I was getting too much pressure at times in Auto. You can see an example of that toward the end of the night where pressure was causing numerous centrals with pressure getting as high as 15 cm.

That is the very brief basics. Hope it helps some. Post a screen capture if you want comments. After you do the screen capture just left click on it and drag the file to an open post here that you are composing.

I was sleeping quite well before I was diagnosed with sleep apnea, so I can't say it has made a huge difference. I do sleep through the whole night without getting up much more often now.

Here is a link to a not for profit website that provides information to help people with sleep issues. The motivation of the project by a university professor was to help people find alternatives to sleeping pills. I have found many useful tips at the site.

Sleepwell It's no Dream