Sierra

SnuzyQ may be referring to my comments about how sleep apnea diagnosis and treatment happens in Alberta. It is frankly a bit dodgy in some ways. Yes, everyone gets a sleep study, diagnosis, and initial prescription at no cost through the provincial health care system. The study is typically done at home, and the prescription is for an APAP without any titration study. I have no problem with that as an APAP is virtually the same cost here as a CPAP. I would dread the US DME system where you have to get an in clinic sleep study, then an in clinic titration study, and then it seems a battle with the DME to avoid getting a CPAP instead of an APAP. And if the CPAP doesn't work, then a rinse and repeat with the in clinic studies to move to an APAP. In Canada, or at least in Alberta, we cut to the chase and go straight to an APAP typically of your choice, right from the home sleep study. BUT, and it is a big BUT, in Alberta at least, you or your insurance company has to pay for the APAP and mask. I believe in Ontario the provincial health care system pays up to 75% if you buy from an approved vendor, but in Alberta the health care system pays nothing. This said, it is not all that bad, as I have found Cadillac insurance is very expensive, and if you pay your own way, it can be much less expensive in the long run. Plus you can buy what you want. The only thing is that you have to go it alone for support for your machine. For those that can use SleepyHead and do it, it is fine. You can buy the whole initial package for about $850 CDN on line, and SleepyHead is free. For someone who wants the sleep clinic to look after them, the same equipment package costs $2400. So yes, to some degree we are left to our own choices. Pay the $2400, or do the support yourself -- at least in Alberta.

As far as medical records go I have no concerns at all. Alberta has an electronic record system, and I think were first out of the gate with that. Ontario tried to copy it, but bungled it big time and ran up a huge cost (debt). Don't know if they have it fully working yet. It is too bad that our medical system was not federal instead of provincial. I think there could be huge cost savings. But things are looking pretty good in Alberta. I believe they are close ( a year of so) to giving patients on line access to their own medical records. Now it is restricted to doctors, pharmacists, and other health care providers. I'm sure my current medical records show I have been prescribed an APAP and am using one, but that is it. It certainly does not contain detail like pressure settings and compliance. The compliance thing seems to be a US concern. Big brother watches to see if you are using your CPAP, and if not cuts you off. I am not aware of any such big brother process in Canada, but some province may do it.

I am not all that familiar with DreamMapper, but I think it is just giving you summary data. SleepyHead does that too, but the real value is the minute by minute graphical plots of a number of variables during the whole sleep session. These are displayed with the Daily Detail chart. See this example for a Dreamstation, which is actually a BiPAP machine, but an Auto CPAP will be quite similar. Notice the red pressure trace and see how the DreamStation keep peaking it up during the night and back down again. The results this individual is getting are quite good, but they potentially could be improved with some pressure adjustments to reduce the pressure variation during the night. It also looks like hypopnea events are primarily occurring when the pressure is lower. In any case this is the kind of detail you can see with SleepyHead. It can be very helpful in determining what may be causing your arousal events, and what adjustments could be made to reduce them.

DreamStation SleepyHead Screen Shot

Your pressure range of 5 cm to 20 cm is very wide, but not unusual for an initial guess for setup. Most will find that 5 cm is too low and when you start there each night, some feel short of air, or a claustraphobic feeling. More often 7-9 cm is a better start point. And narrowing up the minimum and maximum pressures can make the experience more comfortable, and at the same time improve AHI.

SleepyHead will run on Windows or Apple, and all you need to do is remove your SD card from you machine and plug it into a card reader to get the data into SleepyHead. Not all that hard. Your sleep provider or doctor should have software from Phillips similar to this, and can view the data as well. However, what they can do, and what they actually do are often different things...

It does sound like you may have a defective machine. Some thoughts on the issues:

1. You mentioned that prior to the incident the machine stopped shutting off when you took your nasal pillow mask off. In the Clinical Guide troubleshooting section (see page 32) they mention that if you use a nasal pillow mask and your set pressure is less than 7 cm the automatic shutoff will not work. This would seem to suggest for some time you may be getting less than 7 cm pressure. Do you know if it should be higher than that, or if it has been changed?
2. Do you use SleepyHead to monitor what the machine is doing? If so you could look back through the history which should all be on the SD card to see if the machine was slowly failing, or if it was an intermittent thing.
3. A few weeks ago we went camping and tried out our new 12 volt to 24 volt power adapters. Mine which is on an A10 worked fine for all nights. On my wife's S9 machine it initially worked, but then one night it started to act up. In her case it would shut down and then start up again in ramp mode. When I looked at what happened in SleepyHead the next day, I think it shut off and restarted about 15 times. I am amazed that she got any sleep at all. She was going fairly long periods with the machine not running at all. At about 5:00 in the morning she changed to the normal AC adapter as we did have AC on that night. It then worked fine. After some troubleshooting I figured out that the plug on the adapter where it goes into the S9 must have had a broken wire or solder joint to the connection inside the molded plug. If you wiggled it just the right way the power would go off and on at will. I did a screen shot of the SleepyHead chart and sent it to the vendor that I bought the adapter in the spring. They immediately sent me a new one. The warranty on the adapter and the machine is 2 years. That said it sounds like your machine is not shutting right off, or if it is, then it may be immediately restarting without you knowing. I would try wigging the plugs and wires to see if you can make it shut off and on.

In any case I would look at the data on SleepyHead before giving up on it. It might just be the adapter.

It does take some time to get comfortable with your mask, and relax so you can get a good sleep. I have been at it for 5 months now, and am just starting to feel comfortable with one mask. I gave up on four other masks I tried. So time helps.

If you want to dig deeper it would be really helpful to download SleepyHead so you can see in detail what is happening during the night. You will find out how much your pressure is going up and down, and when exactly you are having your apnea events, and be able to compare that to when you wake up. The Dreamstation machine in particular likes to ratchet up pressure quickly and back down quickly. That can be annoying to some people, and may wake them up. And while pressure is down, you can have apnea events which are not helpful either.

An AHI of 5 is OK and considered the minimum treatment goal. It would be helpful to know what the breakdown of your AHI is. If it is mainly central apnea events, then reducing AHI is difficult as CPAP pressure doesn't stop central apnea and an AHI of 5 may be the best you can do. If it is mainly obstructive apnea and hypopnea then a well adjusted CPAP should bring events down closer to 1.0.

In short, you kind of have to dive into the detail to find out what may be causing you to wake up. You might find some of the tips at this website helpful in getting a good sleep.

I believe you have the AirSense 10 machine. If so here is a link to a pdf of the Clinical Guide for this machine. It is much more comprehensive than the user guide they give you with the machine. I would suggest downloading it and saving it as a pdf as these documents come and go on the internet. Pages 4-11 alone are a worthwhile read to just understand how the machine works. Best to grab it while you can. If you have the Dreamstation I can give you a link to the detailed manual to it as well. Just ask.

AirSense 10 Clinical Guide

Not sure what to suggest. The new Dreamwear Full Face mask was just released earlier this year and might be a possibility. It minimizes the hose protrusion in front of the face, and the mask itself is fairly small. To sleep on your stomach I think it is pretty much essential to sleep on the edge of a pillow with the mask extending out past the pillow.

Going to sleep OK, but waking up feeling claustrophobic an hour or so later might suggest the air pressure is not set high enough.

I think that getting the CPAP working would be the biggest step you could make. What are the reasons for the failure of each type of mask? Full face? Nasal? Nasal Pillow?

I am on mask number 5 and so far the ResMed AirFit P10 Nasal Pillow has been the most comfortable. I have addressed the common mouth air opening and air loss problem with a Breathewear Halo chin strap and I tape my mouth shut. Sounds awful, but I find it much more comfortable than a full face mask.

If you could update on what masks have been tried and why they failed, you may get some suggestions on what to try. If you are in the US I believe CPAP.com has a mask return policy if it doesn't work.

My wife and I manage to stay in the same bed, but not without some issues from time to time. We are considering going to a king sized bed to give more room. We both use a CPAP so snoring has been eliminated for both of us. Is your hubby using a CPAP? If set up properly it should eliminate snoring.

You may find some of the tips on addressing insomnia useful at the link below.

SleepWell CBTi

Joe,

I noticed from your bio that you are from Canada. Are you in a situation where you have bought your own machine and do not have a care provider to monitor/adjust your machine? I am in that situation and essentially look after myself when it comes to CPAP. I noticed from one of your earlier posts that you use SleepyHead. With that software it is not all that hard to see how well your machine is set up and is performing for you. If you need any help just ask. For what it is worth, I believe that taking control on one's own machine and monitoring your own results is far superior to blindly waiting and following advice from the "health care system" which does not have nearly as much interest in my health as I do.

Except that if anything the leaks make your AHI better, not worse.