Sierra

It would be best to start with posting a screenshot from SleepyHead. You need a PC or Mac with a SD card reader. The software is a free download. There is a basic manual at this link. Basically what I do is look to see what is happening and what events are occurring at higher pressures. If there are more CA events there, then there may be a benefit in lowering pressure. However it is not really that cut and dried. If you see breathing instability with waxing and waning cycles in flow, as well as ups and down in Minute Ventilation, that can be an indication of central related instability. That instability can in turn cause hypopnea and obstructive apnea. About all you can do is zoom in on events that occur at higher pressure and try to figure out what the initiating factor is.

On the low pressure side it is usually simpler. Look for areas when you are getting OA events. If it is when the pressure is at minimum or near it, then there tends to be benefit in increasing minimum pressure. A higher minimum can avoid those events, instead of letting them occur to trigger an auto response to increase pressure. This is a bit of an iterative process and I find it takes a minimum of a week at one setting to determine if it is an improvement or not.

But it would be best to post a SH chart for comments. With the Daily Detail at full screen just press the F12 on a PC and a screen shot image will be saved to a directory which will display briefly in the bottom right. To post it here, open a new message with the Write a Reply button to get a full width window, then drag the saved .png file from Windows Explorer to the open body of the message.

This is the best I could do on a quick look...

https://tinyurl.com/y8frsflf

Like this?

https://www.amazon.ca/Sewing-Button-Elastic-White-Black/dp/B00WM5ICI8/ref=sr_1_2?ie=UTF8&qid=1548709096&sr=8-2&keywords=Buttonhole+Elastic

Because you mention EPR and CSR reporting I am assuming you have a ResMed machine? If you post the specific model of machine I could make more specific comments.

In any case your situation sounds similar to mine. I am not a medical professional, but I use a ResMed AirSense 10 AutoSet, and my apnea has been mixed central and obstructive. At the worst the CA to OA ration has been as high as 5 to one. However, overall I have been managing to keep AHI under 5. What has worked for me is do everything possible to keep pressure down. As you have found out, turning off EPR helps because the machine does not have to raise IPAP higher to address apnea that is occurring during or in the transition between IPAP and EPAP (inhale and exhale). I still use EPR at 3, but on Ramp Only. Next I narrowed the range between max pressure and minimum pressure by keeping the maximum as low as possible and by only increasing the minimum. When it got to the point where they were nearly the same, I simply switched to a fixed CPAP pressure. When I was using EPR and a wide max min range, pressures were going as high as 15 cm, and I was seeing lots of CA and some CSR. Now I have gone 6 weeks with a fixed pressure of 11 cm and AHI has a median of about 1.7. I posted a while back about my journey to fixed CPAP mode in this thread. I have been trying to determine if a bit lower or higher than 11 is better, but so far I have not found anything better. Once you go to fixed pressure about all you can do is try small steps and see what you get.

Increasing CSR indications can be a signal that there are some heart issues affecting blood circulation. It is something you should discuss with your GP if they continue.

SleepyHead is very useful in determining when and at what pressure during the night you are having central apnea and CSR events. I also find if you look at the Minute Ventilation value it is good indicator of breathing stability. Central apnea and CSR are most often the result of breathing instability when asleep. You can see it as a roller coaster ride effect in Minute Ventilation.

Hope that helps some,

As bonjour posted SleepyHead is far better than something like DreamMapper. It is mainly used to monitor how much you use the machine and report the higher level basics.

SleepyHead has the ability to report data from more than one machine. If you install it now and setup SleepyHead with your current System One machine it will import all the data on that machine from the SD card. That detailed data will be simply lost if you buy a new machine and start using it. With SleepyHead you can just switch machines, start using the SD card from it, and SH will add the new data as you accumulate it, without losing the old machine data. That will allow you to make an easy comparison as to how your treatment has progressed over time, and how the treatment with the new machine compares to the old machine.

The starting point would be to complete a quiz to find out if you are at risk for sleep apnea. You can find many on the net, but here is a link to one from Phillips who make PAP machines.

Sleep Apnea Quiz

I found a bit of info on how apnea is dealt with in the UK. I think the good news is that if you are formally diagnosed they give you a machine on trial for free essentially for a month and you get to keep it if it works. Not sure how much choice you would get to what kind of machine it would be though. Getting diagnosed might be an issue too. See this link on Diagnosis. The last paragraph is a bit concerning and says:

"Current evidence suggests treatment is most likely to be beneficial in people with moderate or severe OSA. However, some research has suggested treatment may also help some people with mild OSA."

Since you are in the mild category for severity, I'm not sure where that leaves you. Perhaps there is discretion if daytime sleepyness is a big issue. But, it may kind of depend on where you want to go with it. If you want PAP treatment and it needs a Moderate severity to get one, then you would probably want to push for a in lab sleep study, as it most likely will result in a higher AHI.

It also appears you may have some choice in where you get your sleep study done. I believe this is a list of approved clinics and hospitals. Perhaps one thing you could do is "shop around" and see if you can find out what machines they would fit you with if you meet the diagnosis criteria.

I think some do it, but I find it hard to imagine how one would sleep on their stomach with a PAP mask. I guess having a pillow shaped like a toilet seat might work. Most I talk too sleep on their side and let the mask project out off the side of the pillow. Before PAP I used a memory foam orthopedic shaped pillow, but I found it was too stiff and pushed back too much on my mask. I now use a much softer down alternative pillow.

There is always a lot of friction between the marketing department and the engineering department in a company. Sounds like ResMed is no exception. I also wonder if some of their products are not constrained by patent issues. I read the article I found on the ResMed Origins and found that much of their energy over the years has been consumed by legal battles with Respironics and others over patents.

Interesting idea. Are you saying the elastic band is two cm wide and it has button holes in it and you cut it to length to make a headgear strap?