Sierra

I forgot to mention a couple of other things I do to try and keep in the mask in place when I sleep. I was using a memory foam orthopedic pillow, but found it was too firm and when I side sleep it would dislodge the mask due to the pillow pushing back. I switched to a softer down alternative pillow ($18 a pair at Costco). And I found an old satin pillow case to make it easier for my head to slide around without dislodging the mask and straps. My next purchase is going to be a Rest & Renew Satin Pillow Protector from Bed Bath and Beyond ($10 in Canada, $8 in US). They are sold to help keep your hairdo in place when you sleep. I just want to keep my CPAP mask in place! Hope that helps some...

Yes, I believe you are correct. It sounds like your BiPAP is set to an EPAP of 11 cm, with 3 cm of Pressure Support. That is essentially the same as a ResMed APAP set to 14 cm of pressure with 3 cm of EPR.

I would think through the pros and cons of a travel CPAP though. We have a Z-1 that goes unused. The new AirSense full APAP 10 has a nice travel bag that is fairly compact, and it has two velcro straps on it that will secure it to a roller travel suitcase that has a two pipe extension handle. And, a CPAP is a medical device, so it does not count as an additional item or weight to your standard travel allowance.

I found this statement in the user manual for the machine:

"Available Therapies The BiPAP Auto Bi-Flex device delivers the following therapies: • Bi-level – Provides one level of output pressure during EPAP (Expiratory Positive Airway Pressure) and a second higher level during IPAP (Inspiratory Positive Airway Pressure). • Bi-level with Bi-Flex – Bi-level therapy with pressure relief upon exhalation to improve patient comfort based on patient needs. • Auto Bi-level – Delivers spontaneous Bi-level therapy while automatically adjusting EPAP and IPAP levels to meet the patient’s needs. • Auto Bi-level with Bi-Flex – Auto Bi-level therapy with pressure relief upon exhalation to improve patient comfort based on patient needs. The following therapy modes may also be available: • CPAP – Delivers Continuous Positive Airway Pressure; CPAP maintains a constant level of pressure throughout the breathing cycle. • CPAP with C-Flex – Delivers CPAP therapy with pressure relief upon exhalation to improve patient comfort based on patient needs."

It sounds like there may or may not be an option for CPAP. A true CPAP runs at a single fixed pressure. Are you sure that is what you want. The other option is an Auto CPAP or APAP. With that the pressure is adjusted to suit your pressure needs from minute to minute. In Auto Bi-Level mode it should operate similar to a APAP.

The link below is to the Provider Manual. If you go into the provider menu you should be able to see what modes your machine supports.

BiPAP Auto Bi-Flex PROVIDER GUIDE

I think the Brita filters are just activated carbon and do not remove dissolved minerals. It would be no improvement over tap water. There is another water purification device called Zero Water that does remove dissolved minerals that would be good to use. However, for just a visit or holiday I would not be bothered with the expense of getting one. Some bottled water may be RO water. I have seen it in some south vacation destinations like Mexico.

In Canada I found it at a place called Sleep Yedi for $25 plus shipping:

Sleep Yedi - Halo Chin Strap

I see that it is available in the US at CPAP.COM for $24:

CPAP.com - Halo Chin Strap

If you have a ResMed CPAP there are some interesting comments in the Clinician Manual.

"Note: Under conditions of high leak with EPR enabled, AHI detection may not be optimal." "Apnea-Hypopnea Index—average AHI during the selected period. AHI and AI are calculated for times of low leak only." "Happy Face for Leaks: Good—if the 70th percentile leak is less than 24 L/min."

So it seems that ResMed does not trust the machine to correctly identify apnea events when there is a high leakage rate, which it looks like they set at 24 L/min or higher. And, for that reason it appears they ignore the high leak rate periods of time during the night. It is my observation using SleepyHead that there seems to be very little indication of apnea events based on the flow signal trace during these high leak periods. If that is the case, then it seems like the process of ignoring high leakage periods, would tend to increase the reported AHI, because periods of time where there are very few apnea events are being ignored.

If you ask for a copy of the sleep report it should have the times or ratio of times that you sleep on your side, back, and stomach on it. Sleeping on your back is the easiest for using a CPAP, and side sleeping can be tolerated. Sleeping on your stomach with a mask on can be difficult.

With an AHI of 12 you are in the mild apnea category. A CPAP may still be the best option, but a dental appliance may also work for you. It should be easier to tolerate in all sleeping positions. I see there is a dentist contributing here, so perhaps they will comment. If you go the dental route you should discuss it with your doctor and dentist.

If you go the CPAP route, you are in the category where a fixed pressure CPAP might be prescribed. I would resist that, and insist on an automatic CPAP or APAP. There is little difference in the cost, and the APAP is more flexible. The ResMed AirSense A10 AutoSet is a very good choice. But, the mask could be your biggest issue - finding one that stays on and doesn't leak. Be sure to try different masks to see what works.

The most comfortable mask I have tried is the ResMed AirFit P10 nasal pillow type. However, I find the headgear that keeps the mask on your head very poor, and I have had the same issue as you have. The mask falls off in the night. One solution that I have found is to wear a chin strap like the Breathewear Halo. It not only keeps the mask in place, but it helps to keep your mouth closed. You put the mask on first, and then the chinstrap over it. The other solution I have tried is wearing a nylon and lycra head cap. They sell them for swimming, and other purposes. Just be sure to get one that is not waterproof, and is just fabric, or it would be way too hot. Speedo and others makes them. Again, put the mask on first, and the cap on second. The only downside of the cap is that depending on how tightly it fits, it can leave a mark on your forehead.

Hope that helps some.

The ideal water has no minerals in it. Minerals will build up in your humidifier reservoir over time, because each night you are evaporating the water, and leaving what doesn't evaporate (minerals) to build up in the reservoir. For that reason, distilled, demineralized, or reverse osmosis (RO) water is the best to use. I have heard that it is hard to find in the UK however. Just plain bottled water is usually just tap water in a bottle. Mineral water is probably about the same. If you look on the ingredients list, distilled, or demineralized, or RO water will have zero or close to zero calcium (Ca), or Magnesium (Mg). If you can't find water without minerals, just use ordinary tap water, and rinse out the reservoir daily before you refill it. If you see any build up of minerals use vinegar to remove it, and then rinse thoroughly. When we go on holidays and don't have easy access to demineralized water, we just use tap water. Using vinegar to clean the reservoir every few weeks even when you use demineralized water is a good practice.

It sounds like you have a lot going on. I have had none of the issues you describe, but here are some of the things I have tried with the pillow issue. Prior to using CPAP I have used an orthopedic shaped memory foam pillow. It seems to minimize getting kinks in the neck, as it provides higher neck support than head support, kind of like your wedge pillow. However with a CPAP mask on, I find it is too resistant to pressure and dislodges the mask easily causing mask leaks. For that reason I have switched to a down alternative pillow, which form fits to your head neck, but does not have the same push back resistance on the mask. Costco has them for about $18 a pair.

Some people suffer from positional apnea, or restrictions caused by your head position when sleeping. I do not, but those who do report that wearing a cervical collar during sleep helps by keeping the neck more aligned.

Another issue that CPAP users of nasal masks have issues with is the mouth coming open during sleep. It is often called mouth breathing, but with CPAP pressure on your nose, it is nearly impossible to breathe through your mouth. However, if you do open your mouth and your tongue does not block the airway, you can get a major flow of air out of your mouth which is being supplied from the CPAP. That can cause a dry mouth and irritation. In your case without a CPAP you may be actually breathing through your mouth and causing issues with your tongue. Just guessing. I deal with the air leakage through my mouth by using paper medical tape on my mouth to force all air flow through the nose, and not the mouth.