Sierra

It would be really helpful to know what manufacturer and model of a machine you have. To my knowledge PAP machines may report RERA events, but they do not respond to them with increased pressure. And of course when you increase minimum pressure you are taking manual action which in turn should prevent RERA events from happening. That said I do see RERA flags in my SleepyHead graphs and I am now using a fixed pressure. They can still happen with higher pressures. If you have a DreamStation I believe there may be an option in it to change the sensitivity.

You may be interested in a ResMed article on their For Her algorithm specially developed for what they believe are the different needs of a woman compared to a man. The differences between the For Her algorithm and the standard version are highlighted in the table at the bottom of page 5. Both versions report RERA, but the For Her version is more sensitive to upper airway resistance and flow limitation. It uses single breath data to initiate a change while the standard version uses a 3 breath average and will be slower to react. The For Her version ratchets up pressure in response to apnea in close succession and holds it to a minim for the sleep session. It is more responsive to flow limitation and snoring, and less to apnea. Apnea alone will not increase pressure beyond 12 cm. It raises and lowers pressure at a slower rate. This feature may in fact be an option in the standard machine too, as there is a Response setting which can be set to Soft or Standard. The idea is to prevent arousals. As I understand it the difference between a flow limitation and a RERA is that an arousal is associated with the flow limitation.

The For Her algorithm is included as an option in the specific For Her AirSense 10 AutoSet machine. They sell at the same price, and they can be changed with the Mode setting to the standard algorithm. They can of course be used by men too, if the nature of the apnea they have is more of upper airway resistance and less of the obstructive apnea. The good part is that you can simply try it, and if it works it works. If not you go back to the standard algorithm.

Hope that helps some. Post back with your specific machine and I may be able to add a bit more...

If I am reading your Sleep Report correctly you spent the large majority of the night on your back (Supine), and most of your AHI and RDI is accounted for in that position. Next seems to be sleeping on your right side, and a somewhat proportionally lower part of the AHI and RDI comes from that position. I think that having more apnea when sleeping on your back is fairly normal. Your throat relaxes and your tongue goes back and you get a restriction or blockage.

Fred may be correct in that a cervical collar could help. At $10-15 they are much cheaper than an APAP. But other than from how you feel in the morning, I'm not sure how you could tell for sure it was working. But if you feel better, then perhaps it does not matter. You have your answer.

As I indicated in my other post, I have no experience with this mask. It is one of the ones frequently recommended for higher pressures though. Have you considered that you might not have the correct size cushion? I believe the frame for the cushion is one standard size and the small, medium, and large cushions will fit the one standard frame. I did find a sizing guide at this link. I have a ResMed F20 which I could not get to seal either at pressures up to 15 cm. I suspected the large I have was too big and I really needed a medium. Did not try that option though and went back to the nasal pillow type and a chin strap, and now even tape on my mouth. I would rather do that then try to make the full face type seal.

The other Full Face mask I tried was the Mirage Quattro. I found this "Taming the Mirage Quattro" blog, but following it to the T didn't help either. Thought I would give it to you in case there is something that might help you with the Simplus. They seem to be similar looking masks.

Interestingly I see this blog also has the Swift FX nasal pillow mask on it, and that is my most recent mask. I'll have to read it to see if I can learn something...

"Should I research more on how to set up this machine for him? What can happen if I do it wrong? Should I even consider doing this? What if my dad agrees to a study, can we still use this machine that I got as a gift?"

I jumped in and gave you a sermon and a solution but did not really answer your questions. My thoughts:

• Read the Clinical Guide for the machine. It gives you a good basic understanding of what the machine is capable of.
• The most common mistake in setting up an Auto machine is having the starting pressure too low. That can give a suffocating feeling and users sometimes just want to rip the mask off and throw it out the window. Depending on the severity of the apnea, if he in fact suffers from it, the pressure to treat it can be high. The machine can go from 4 cm to 20 cm. When you start to get up into the 14-20 range depending on the mask, it can feel uncomfortable when you are a new user. That is why I suggested starting with a lower maximum pressure. It does mean however that you will likely have to adjust it from the initial settings.
• I can't give you medical advice, but I think if I were in your situation I would do it. I saw my father in law suffer from fairly obvious in retrospect undiagnosed apnea and probably diabetes too, and he suffered quite a bit for it in his later years.
• I don't see a problem if he has a study later. You now own the machine and they can't force you to buy a new one, if the one you have is suitable. By the way I think in the Auto PAP category you have the best one on the market. It it turns out he needs more pressure or a specialized machine, then you may be in for buying a new machine. However if he uses the AirSense 10 AutoSet now, you will pretty much know that from monitoring the results with SleepyHead.

My suggestion was to use SleepyHead to view the data on your existing machine so you can make a better choice of a new machine. SleepyHead should be compatible with your old machine and there will be a wealth of data on the SD card in it.

As I posted before it would be really helpful if you posted a SleepyHead Daily Detail screenshot to see how your current machine is set up and working for you. With that I could give a better response to the question of whether or not a new machine would be beneficial, and of what type may be best.

Yes, 6-20 would work too. I like 7 cm because the EPR of 3 on ramp will cut it back to the machine minimum of 4 cm to give a very comfortable feel while going to sleep - especially for new users. Lots of air on inhale and easy exhale. It is possible after review in SleepyHead that the minimum will need to be reduced, but not likely. On the max end, yes many machines are just handed out set at 20. I think mine was originally. The only issue is that I gathered that Dad is a reluctant user, and I worry a bit about souring him on the PAP machine treatment if the machine really went up to 20 cm on the first night. I thought it might be better to under treat a bit until some results are gathered.

SleepyHead should not report anything different on the basics of your treatment compared to what the machine reports. Use hours, AHI, and AHI breakdown should be the same, as SleepyHead is just reporting on the same data that the machine has. What is does do is give you a view in more detail what is going on. One example is the mask leak data. ResMed for example sets a very low bar on what is required to get a green happy face on your display. If your leakage is less than 24 L/min 70% of the time you get the happy face. In fact that is quite a bad leak rate. In SleepyHead you can display a leak redline which is at the same 24 L/min. You can see graphically when you exceed this redline, and it is reported as a % of time over the redline. You can get the green happy face with a 30% exceedance, but I like to see something less than 1%.

Similar with respect to apnea events. You can see when they are happening. You also see, at least with the ResMed, RERA events which are typically not reported via the machine. And if you are a really keener, and look at the data in detail, you can likely see numerous apnea events which are shorter than the 10 seconds needed to report them. It can give you some insight into whether there is more going on than the machine is telling you about. And since the machine (ResMed) does not increase pressure in response to RERA events or short apneas less than 10 seconds, you can sometimes improve results in comfort by manually setting minimum pressure a little higher. It won't improve AHI because they are not included in it, but it may improve sleep quality.

Sounds good. The only change I would make is to throw out the soapy water before making coffee with it!

I can see you are in a difficult situation with your Dad. There are some legal issues and forum issues that need to be addressed first. One is that it is not legal in the US (Is that where you are?) to buy a new PAP machine without a prescription from a doctor. It is also not legal to buy a new PAP mask without a prescription (in the US). I think the mask rule is a bit silly but there is some logic to the rule that you cannot get a CPAP without a prescription. Obviously it is to ensure the prospective patient is diagnosed properly and the machine is appropriate for the needs. And even on a practical basis these machines are expensive to buy, and the potential consumer needs some protection from wasting their money on something that is not going to work. The other issue is that as bonjour mentioned most here are not medical professionals, just PAP users. I am included in that category and as such cannot give you medical advice. All I can do is tell you what my experience has been using these machines, and you will have to decide how applicable that experience is to you (your Dad).

So with that warning I will also say that the rule against buying a PAP machine in the US does not apply to used machines. It sounds like that is your case, and you already have it. And the work around to the prescription for a mask is to buy the mask parts. The vendors in the US are well aware of this somewhat silly (In my opinion) rule, and almost all of them will sell the mask in two parts -- i.e. as mask replacement parts, that are easily put together.

I use the same machine as you have. BUG has provided a link to the Technical Manual for the machine, but I could not get it to work. Here is a link that may be better. I would suggest you read the manual thoroughly so you understand how it works.

Technical Manual

The first thing I would do with the machine since it is used is to delete all the data on the SD card and the machine so it does not get mixed up with your Dad's data. See page 17 in the manual and use the Erase Data command in the Configuration section first. Then set the date and time, and Restore Defaults.

Here is how I would set this machine up if I was going to use it for myself, knowing I probably have apnea, but not knowing to what extent. In short I would be conservative with the settings, but also set up the features it has for maximum comfort. At the end of the day the biggest issue with using a PAP machine is compliance. Will your Dad actually use it? If he rejects it, and does have apnea then all is lost... So, the settings in order they appear on the machine:

• Mode: AutoSet
• Min Pressure: 7 cm
• Max Pressure: 10 cm (this may be too low and after viewing results in SleepyHead you may have to increase it)
• Mask: This has to be set to the type of mask you choose. Here is a ResMed Compatibility Table that tells you which type. If you buy a non ResMed mask then just use the generic mask type; Full Face, Nasal (covers the nose), Nasal Pillow (under the nose).
• Ramp Time: Auto
• Start Pressure: 7 cm
• EPR: On
• EPR Type: Ramp Only
• EPR Level: 3
• Climate Control: If you have the heated ClimateLine hose (has heating wire in it) it should default to Auto. Otherwise set to Manual.
• Tube Temperature: Only if you have the ClimateLine, set to 27 C or 81 F.
• Humidity Level: Only if you have the standard hose, set to 4
• Essentials: Plus (Gives you access to a bit more control and sleep data from the User Menu)
• SmartStart: On (this will start and stop the machine by just putting the mask on and taking it off. I find it convenient, but your Dad may or may not.)

The rest of the stuff you can leave in the default setting.

I would highly recommend using SleepyHead to monitor the results so you can further adjust the machine. The maximum pressure is most likely to need adjustment after you see the results. To use it you need a Mac or PC and a SD card reader to get the data from the machine to your computer. Here are some links. When you get some results then post back for some help on how to post the SleepyHead results here and some help in understanding the results.

SleepyHead Download

SleepyHead Basic Manual

As for the mask that is difficult. As I mentioned before, you will likely have to buy parts and put it together if you do not have a prescription. That is easy. Choosing one is difficult. Most who get a machine from a sleep clinic will be offered various masks to trial, and that is the best way. It is a very personal thing. So far I have tried 6 masks. Of the ones I have tried I would recommend the ResMed Swift FX. It is a nasal pillow mask and they tend to be the most comfortable to use if they fit and work for you. See this link for what you would need:

Swift FX Replacement Parts

Of these items it would be best to get the whole fit pack version which includes three nasal insert sizes for $98, but that requires a prescription. Without one you need:

• Mask Assembly Kit - $67 ( I would choose the large size of insert)
• Silicone Headgear Assembly - $31

And if you wanted to be safe for fit, I would suggest also ordering the Nasal Pillows insert in the Medium size for $19, or just go with the large and order the medium if it ends up being too big.

Hope that helps some. Post back if you have questions or need more help.