Sierra

To see how the EPR is set up it is easiest to go into the Clinical Setup Menu. Just press and hold the Home button and the round Set knob for about 5 seconds. This will bring up the option to go into the Clinical Menu. Just press the Set knob and rotate it to go up and down the menu like the standard user menu. In the Comfort section you will find how the EPR is set up, and the ramp as well. If you could post back what you see in the comfort section for settings I can give you a better idea if there is any opportunity for improvement. To get out of the Clinical Menu just press the Home key only, and then select go back to the User Menu.

There is always one thing that seems to be common with dogs on the bed. They only want to sleep in one spot -- the same one that you want to sleep in!

Here are some links to SleepyHead. You need a Mac or PC to run the free software, and a SD card reader to get the data from your machine SD card to your computer.

Download

Basic Manual

I have not used the Oximeters, so perhaps others could help you there. Here is the screen that SleepyHead displays which give some models that are compatible with SleepyHead data import.

From your sleep tests it sounds like you really do not need a lot of pressure to address your obstructive apnea. You may need more for the RERA events. Again SleepyHead should be helpful in identifying what your specific issues are.

As far as repeat sleep tests, I think the need for them are minimized by monitoring yourself with SleepyHead, and only going for repeat tests when/if issues are not being resolved. My wife has been on a APAP for 4 years now and has never had another sleep test after the one at home for diagnosis.

Have you considered using SleepyHead to look at your machine data in more detail? I believe the RemStar machine is compatible with SleepyHead. The Daily Report screen is often very helpful in identifying potential issues. You can post the screen shot here for comments. Your machines data card should have captured your historic data, or at least the more recent data. Some links to SleepyHead:

SleepyHead Download

SleepyHead Manual

The software is free to download, but you need a Mac or PC and a SD card reader to use it.

That is a helpful review of the mask. I have a friend that uses the nasal pillow version of the mask and he likes it. About the only negative I have heard is that the tubes coming down the side of your face can be noisy. Do you notice any noise from it?

On pressure are you using EPR? If so, I think one can get better results with it set to be in effect during ramp only. If you are using EPR full time you may get an almost one for one reduction in needed pressure by turning it off. I had EPR at 3 full time and my pressure in auto went down by about 2 cm when I switched it to ramp only. In my view the lower the pressure one can use the better it is. SleepyHead can help you figure that stuff out. It also flags RERA events which are flow restrictions which can wake you up, as well as snore, and flow limitations. If you post where you are with EPR I may be able to make some more suggestions.

It is often assumed that apnea wakes you up. I think the reverse can happen too. A poor sleep generates apnea. I have found the site at the link below very helpful to me in getting a better sleep. One of my mistakes was trying to sleep too long, and I was taking naps during the day. Now I try to avoid all naps, and get no more than 8 hours sleep at night. Another suggestion at the site is to get out of bed if you can't sleep. But there is a lot of help there. A pharmacist developed the site to try and help people get off sleep meds.

Sleepwell It's No Dream

I hated the CPAP as well, and I kind of still do. I convinced my wife to try the mouth taping by showing her the leaks she was having in SleepyHead, and I also got her to watch this video on mouth taping for a better sleep. She is now sold on it. Perhaps you could get both yourself and your husband on SleepyHead and also get him to watch the video.

Oxygen desaturation events are the outcome of apnea events of various types. In SleepyHead you can input data from an oxygen meter. You can also view Minute Ventilation on the graphs. Oxygen tends to drop when Minute Ventilation drops.

Dogs are pretty smart about learning what they can do and cannot do. Our black lab moved out with our daughter but comes back to visit frequently. My daughter lets her on the bed and on the couch. Here we do not. She will not even attempt to sleep on our bed, and she only sleeps on the couch when we are not home. As soon as the door opens she is off the couch and on the floor. She knows that the rules change when the people change...

I was diagnosed with an AHI of 37 and while there were minimal CA events, they have emerged as an issue while being treated with a CPAP. I was having trouble getting under 3 for AHI. A few weeks ago I switched from a auto range of pressures to a fixed 11 cm of pressure. It has made a pretty impressive improvement in my AHI. I averaged 1.6 AHI for December, and of that 0.45 was central apnea. So my thoughts are that if your machine was left in auto and just had the max pressure set at 10 then there may be some room for further improvement by going to the fixed CPAP mode and just using one pressure. 10 cm sounds like a good starting point, but that could be adjusted up or down based on results. My thinking is that if centrals exceed obstructive then the pressure may be a bit high. And if obstructives are more dominant then pressure needs to go up. I think the benefit of using a fixed pressure is the obvious pressure limitation, but also there is some avoided obstructive events when the pressure may be too low in the auto range. Do you use SleepyHead to track your machine performance? I find it very helpful.

Costco sell some nice dog beds. I don't know how you could get any sleep with two goldens in the bed. They are big!

As for your husband has he tried the mouth taping? I finally convinced my wife to use mouth taping as her leaks (from the mouth) were keeping me awake. Unless one is on higher pressure I think the nasal pillow and mouth tape is a better idea than a full face. They are hard to seal.

Hope that helps some, Any questions just ask.

I have a question for you. What are the common prescription and over the counter drugs that could cause or aggravate central apnea?

Sounds like you are a candidate for the Inspire technology. Only $40,000 to $60,000...

To my knowledge the Remstar Auto is an earlier version of the DreamStation. The AirSense 10 would offer the same or more advantages over the one you have as it has over the DreamStation.

As I said it is hard to guess what advancements the new ResMed machine might have. There really is not much wanting. I think the next big step is artificial intelligence, but I doubt it will have that. Perhaps, but not likely.

Here are the release dates of the ResMed machines:

ResMed S9 - March 2010

ResMed AirSense 10 - August 2014

That is 4 years and 5 months apart. AirSense 11 would be perhaps January 2019 if they follow the same frequency...

Is there anything you don't like about your current machine? They generally last 5 years or longer before they wear out.

In the Auto CPAP category, I think there are only two machines worth considering. One is the ResMed AirSense 10 AutoSet For Her (As BUG correctly predicted!) The other is the Phillips Respironics DreamStation Auto with a humidifier. It depends on where you are, but in Canada the cost of an Auto machine is very little more than a fixed pressure CPAP, so I would not go with a fixed pressure machine. I would get a heated hose if you can swing that in your coverage.

The advantages I see in the ResMed model over the DreamStation are:

• A quicker more persistent response in pressure to apnea events. The DreamStation can be slow to increase and quick to decrease.
• The ResMed has an auto ramp feature which only keeps the ramp on until you go to sleep. The pressure does not ramp up, it stays at the adjustable start pressure.
• The ResMed EPR function can be set to be on in the Ramp mode, and off during the treatment mode. There are some treatment efficiency benefits to that.
• The auto ramp with ramp only EPR makes for a comfortable going to sleep experience.
• The ResMed For Her model includes an optional mode which can be more suitable for women and those using lower pressures (<12 cm). The machine can be set to use it, or just run in the standard mode.

This all said, ResMed is getting overdue to release a new machine. There may be an even better one just around the corner. I have no inside information on that, and am just guessing based on when the A10 model was released to replace the S9. I'm not sure what I would ask for improvements though. The current machine is pretty good. A humidifier pre warm up button on the front panel would be nice. You currently have to use the menu to set it. They should include the For Her mode in both models for those that want to use it, but prefer the black housing...

Some comments on your situation:

• The normal progression of CPAP treatment when CSA becomes a problem is to move from an APAP machine to a BiPAP, and if that fails to an ASV. I recall that there are studies which have shown that the move from APAP to BiPAP in about 60% of the cases caused CSA to get worse, not better. I think the treatment path is largely driven by insurance company rules. Start with the cheapest machine and move up when they fail.

• Your ST machine is kind of crude ASV where it is trying to help you breathe and has a backup trigger when your are not making a good effort to breathe. The ASV takes that one step further and locks on to your actual breathing rate and assists you breath by breath to keep breathing. Making the ST type work can involve a lot of trial and error to get the settings right.

• I think there can be an opportunity that slips through the cracks in treating CSA, and it is the most basic -- fixed pressure CPAP but at a low pressure. Some people can be very sensitive to pressure and a CPAP using too much pressure can cause more problems than it solves. That is the direction I have gone with some success. I use a low (relative to where I was in Auto mode) fixed pressure with no EPR, so IPAP=EPAP. It seems to be working. My biggest contribution to AHI now seems to be hypopnea events, which I suspect are central in nature.

• Have you used SleepyHead to examine your flow date in close up detail? A lot can be learned by examining the flow, mask pressure, and minute ventilation relative to when events are occurring. You can also see if Cheyne Stokes respiration or periodic breathing are a problem.

• Could there be any medications which could be contributing to the issue? I have convinced my doctor to cut my dose of a beta blocker for blood pressure in half. These drugs tend to slow the heart rate and I suspect potentially contribute to CSA as a result of lower blood circulation rate.