Sierra

1. I believe the VPAP Tx machine is a special machine that ResMed makes for titration testing. It is not one that would be prescribed to a user for ongoing use.
2. Did you get any feedback on the results of the titration testing? On the initial in lab test was there any indication of RERA events, or a RDI index value? They are helpful in determining what type of apnea you have.

In the absence of any further detail, my suggestion would still be to push for a ResMed AirSense 10 AutoSet For Her version. It has an optional For Her mode in the machine that is better for treating hypopneas and RERA events. It also has the advanced features that can be set for getting to sleep.

Here is a link that provides a deep dive into how a titration test is done and the various options for treatment. But, at this point it would be really helpful to get more detail on what the outcome of the titration test was. At this point I don't see anything that would suggest you need a AirCurve BiLevel or ASV type of machine.

Sleep Lab Titration Guide

I recall you have been using a nasal mask. Some apparently switch to a full face mask when they are suffering from a cold or nasal congestion. So far I have not needed to go that far.

It is possible that your AirSense 10 has been set up to limit the data collected and displayed. This can be done in two ways:

• All AirSense 10 machines come from the factory with a 4 GB SDHD card installed. However, it can be removed. This pretty much prevents the user from taking the card out to transfer data to a software program like SleepyHead for viewing. On the basic AirSense 10 CPAP machine this is not a big loss, as that machine does not record detailed data in any case. However, the Elite machine and AutoSet machines do record detailed data and your access to that is lost if the card has been removed. That said, the capability to store data going forward can be achieved by simply installing any SDHD card from 4 GB up to 32 GB.

• The second way a machine can be dumbed down is by setting the Essentials Option to On instead of to Plus. This is a setting in the Clinical Menu, and can be easily changed if you can navigate the Clinical Menu system, which is pretty much like the standard User Menu. This change to Plus does two things. It increases the number of items you can control from the standard User Menu, and it allows you to see a much more detailed Sleep Report.

The two menu items added are on-off control of EPR and SmartStart.

The sleep report additions are:

• Allows you to set the period the readings are averaged over
• Days used
• Days of 4+ hours
• Average hours per day
• Total used hours
• Average pressure
• Average Leak Rate l/min
• Total AHI
• Central Index

One of the differences between the ResMed automatic machines and the DreamStation machines is the response algorithm. The ResMed is known to increase pressure more rapidly and hold it up longer. The DreamStation tends to increase pressure more slowly and then act quicker in reducing pressure. I recently became aware that ResMed has quietly implemented an alternate response algorithm that is selectable in the Clinical Menu. This option was not there when the AutoSet machine was first released and it is not even mentioned in the Clinical Manual, but at some point they must have updated the firmware. It must be an attempt to do a closer match with the DreamStation machine as an option.

If you think your machine is reacting too harshly this is an option you could discuss with your sleep technician. It is the first item in the Comfort section of the Clinical Setup Menu. It is simply called Response and the options are Standard or Soft. Soft apparently reduces the time to increase pressure in response to events. While it is listed under the Comfort options, I would caution rushing in to change this without consulting your sleep clinic, as it is likely to cause some change in your treatment effectiveness. I have not tried it, so have no personal experience with it.

In your first post here you mentioned that you had bought a used BiPap on line before you got this machine. Could this be the data from the used BiPap that you bought? If you imported the data from it to SleepyHead, it could bring in your data plus that of previous users of it...

The Overview graph shows you have made a pretty significant improvement since Oct 27. One of the things I have been trying lately is using a fixed CPAP pressure. To date I have tried 12 cm, 11 cm, 10 cm, and last night 9 cm. I have been expecting to see a big jump up in obstructive apnea as I go down in pressure. So far I have not seen it. Last night at 9 cm I was under 1.0 for OA. CA was still a bit high though. I am going to try 8 cm tonight to see what happens. I saw a bit of snoring showing up last night at 9 cm so I may be getting near the limit for reducing pressure.

See my other comment on the old setups. I think you may be seeing the data from a previous machine you have used.

Is it possible that you have had SleepyHead installed on your PC and were importing data into it with an older RemStar Plus machine? You can input data from multiple CPAP machines to one profile in SleepyHead. I'm pretty sure that those entries are not from your current machine.

It is something that takes time to work out. Getting a good mask fit that does not leak, and is comfortable is probably the hardest part of CPAP therapy. And, for sure when you are first diagnosed using the equipment can raise a lot of anxiety. It certainly did with me. My first night using a CPAP was awful, and I was sure I would never get used to it. Now, 6 months later I hardly notice that I am using anything. I tried 5 different masks and have now come back to the first one I started with - ResMed AirFit P10 nasal pillow. I tried the AirFit F20 full face, Mirage Quattro full face, Mirage FX nasal, F&P Brevida nasal pillow, but in the end none were as good as the P10 for me. But each of us is different. Because I open my mouth in the night causing a large leak, I have resorted to wearing a chin strap (Breathewear Halo), and taping my mouth. It works very well. I wish I could get away with just taping my mouth, but I seem to need the chin strap as well. My wife started with the Mirage FX nasal, and is now using the F&P Brevida nasal pillow mask. It took a while but I finally convinced her to try the mouth taping trick, and that solved her mouth leaks without a chin strap. Mouth taping sounds awful, but it really isn't when you get used to it. I also think there are benefits to a nasal mask over a full face mask, as the full face mask encourages mouth breathing. Here is a video on using tape.

How to Mouth Tape for a Better Sleep

The other issue I have found with masks causing anxiety or a feeling of not getting enough air when trying to go to sleep is the starting pressure of the machine. Quite often a machine is set up for a new user with the start pressure set at 4 cm of pressure. That is very low, and so low that I kind of feel like I am suffocating for air, and that certainly causes anxiety. I have tried a few different start pressures, and have settled on 8.4 cm. To me that feels like I am wearing no mask at all. I get all the air I want without feeling it is too much. Each person will be different. However I suspect not many will really like 4 cm.

If you have a ResMed AirSense machine, I think they have the best setup for going to sleep. Instead of having a gradual ramp up of pressure they hold it at a constant pressure (8.4 in my case), and when it detects you are asleep then it ramps up to the set minimum pressure for treatment. The AirSense also has a setting that lets you use the EPR (Expiratory Pressure Relief) function only when it is in ramp mode (when you are awake). The EPR makes breathing feel much more comfortable when going to sleep, and then when you go to sleep it automatically turns off. Once you are asleep you won't notice.

Hope that helps some,

I used my going to sleep ramp period last night to listen to my AirFit P10 mask. What I heard when I was not breathing in or out was nothing. While I could feel the air purge flow from the mask vents, I could not hear it. However with each breath in or out I could hear a slight air flow sound, especially when I first went to bed, and my breath depth was deeper. However, it got less and less as my air flow in and out reduced to the normal sleeping level. It got to the point where I really could barely hear the flow. Somewhere about that time I fell asleep, so experiment over!

In any case my thoughts are that the noise my P10 mask makes is not the vent, but the air flow velocity through the nasal cones which fit into your nasal passages. And, if that thought is correct, then it stands to follow that the smaller the nose opening, the higher the velocity of air going through it, and the higher the nose level. Go, my guess is that it is the XS size mask insert that may be the source of your higher noise level. My suggestion would be to try a larger insert size if that is an option. I use the large size insert and noise is not an issue for me.

Can you give us a bit more information. How long have you been on CPAP therapy? What kind of AHI numbers are you getting? Is your mask working well, not leaking or keeping you awake at night? How many hours of sleep are you getting at night? Any naps during the day?