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Newbie - need advice on settings and machine

I'm hoping someone can steer me in the right direction here. I was recently diagnosed with severe OSA and got an ResMed AirSense 10 AutoSet on September 27. I've been using it consistently since then. At first, I was getting horrible AHI numbers, in the teens or even 20s. (My sleep test AHI was 32.)

After several mask changes, and having my DME rep change my settings a couple times, I seem to have *somewhat* adapted and according to SleepyHead, my AHI over the last 53 days has ranged from 2.11 to 8.81 (average was 5.06). My pressure range is 4-16, and I have EPR set to 3. The max pressure each night is almost always is less than 13, usually somewhere in the 10-12 range.

I'm feeling better than I was about a month ago, but honestly I don't really feel any better than before I got my machine. I rarely sleep through the night without waking at least once. It's quite possible there are non-apnea related things going on with me - I tend to be a very anxious person and I'm a light sleeper. However, I'd like to see if there are any changes to my settings I can try to see if some of my insomnia is apnea-related.

I should also mention that my DME rep noticed shortly after I got my machine that I was having a lot of central apneas, so he recommended a BiPAP titration study. (My original study was a home study, and my original diagnosis was just obstructive, not complex/central.) I went to the lab in early November and honestly had the worst night of sleep I've had in a very long time. The inhalation time was set to about 2.5 to 3 seconds, and when I'm trying to fall asleep, I tend to take long deep breaths to calm myself. Basically the machine kept cutting off my inhalations and I started to panic. Somehow I eventually fell asleep for a few hours, and my AHI during that time was 6.1. They concluded that I needed a BiPAP setting of 8/4 and I should get an ST machine.

I haven't been contacted by my DME about getting this machine yet, which is good because I'm really hesitant to go through with it, mainly because with my current machine I usually get better numbers, fall asleep more easily, and feel better in the morning (but still not great). And my centrals, while not zero, seem to be decreasing in general.

So, to sum up, I have three questions:

(1) If you were me, would you get the ST machine, or hold off on that?

(2) Are there any settings changes that you'd recommend on my current machine that might help improve my sleep quality? I think I'm finally brave enough to change the settings myself with the DME's "approval."

(3) Any thoughts on whether the "for her" algorithm might work better for me? (Not that I have access to it on my current machine, but I've been wondering about it.)

I'd be happy to post data. Just let me know what would be helpful. I've already gotten a lot of help just reading though others' questions and posts.

Thank you!
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Hi tmc712!

The apnea type, time of occurrence, and duration mean a lot. Normally our breathing is erratic when we are awake or in a transition state and become more rhythmic during sleep. Without seeing your graphs it would be next to impossible to answer your questions.
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If you were having complex sleep apnea (centrals) that was induced by CPAP pressure, and do not have restrictive or obstructive chronic lung disease (COPD, Asthema, hypoventilation), then the ST is not your best choice. We have had numerous people come to this forum that developed mixed or complex apnea after being started on CPAP. In many cases they were diagnosed with obstructive sleep apnea (OSA), but developed central sleep apnea (CSA) after starting CPAP. Of those who attempted bilevel ST, the failure rate has been very high, with a great deal of discomfort, difficulty sleeping and poor results. However, we have seen those with bilevel ASV (adaptive servo ventilators) do very well. Between the two main providers of ASV, the highest degree of success and reported comfort has been with the Resmed Aircurve 10 ASV rather than the Philips Respironics Auto SV Advanced. These are my anecdotal observation from observing an working with several dozen individuals dealing with mixed apnea on this forum over the years.

Mixed sleep apnea is a combination of both obstructive and central sleep apnea symptoms. Some patients being treated for obstructive sleep apnea with the use of CPAP machines develop symptoms of central sleep apnea upon PAP therapy. This phenomenon had long been noticed in sleep labs, but had not been previously researched. In 2006 researchers from the Mayo Clinic conducted a study of 223 sleep apnea patients and found that 15% of sleep apnea patients who were believed to have OSA in fact had mixed sleep apnea.

During CPAP treatment for the patients believed to have OSA, the patient's airways were successfully splinted open and free from obstructions, but the patients continued to have difficulty breathing while asleep. Their symptoms of OSA shifted to symptoms of CSA while CPAP therapy was being administered.


Optimal treatment options for mixed sleep apnea still need to be refined. Currently one of the best treatments is still CPAP devices, but set at the lowest possible pressure setting that successfully keep the airways free from obstructions, but don't allow CSA symptoms to develop.

In some cases where CPAP fails, BiPAP machines and adaptive servo ventilation devices are then tried which can better control ventilation (source). Bilevel positive airway pressure devices are able to deliver pressurized air that can resolve the obstructive component as well as stabilize ventilation during central apneas by forcing breaths (timed breath) during episodes of central apneas.

Adaptive servo ventilators have shown successful use as the machines are capable of performing a breath-to-breath analysis and altering its settings accordingly.

While both BiPAP and ASV machines have shown improvement in therapy over CPAP machines for mixed sleep apnea there is still no best treatment for Mixed sleep apnea. ASV has generally shown the best results, with some people eventually adapting to CPAP or bilevel at low pressures. Spontaneous Timed machines have never produced a good result in my observation, except in cases where serious complicating health conditions are present.
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As far as I know, I don't have any kind of lung disease. I kind of suspected that an ASV machine would be better, based on reading other posts, so thank you confirming that.

Any ideas on settings I can change on my current machine to see if I can improve things before spending the money on an ASV (assuming I'll even be allowed to get one)?

I will gladly post data or graphs, but I don't know what is helpful. Please let me know.

Thank you!
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It would be a great help advising you on settings to see the pattern of your events, pressure and other data. If you could download SleepyHead and install it on a computer that can read your SD card from the Autoset, it would be ideal.

The links in my signature describe how to organize Sleepyhead data and how to post images on the forum. It's a bit of learning, but trying to advise you on settings without seeing the data is a shot in the dark. In general, we would be looking for what pressure level seems to result in a higher incidence of CA and avoid that, while keeping pressure above the threshold where you may have obstructive events.
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I was looking at your settings, and I think there is something you can try to see if it makes a difference. Turn off EPR. In a few people, the different inhale/exhale pressure can cause CA. Turning this off for a few nights can let you know if it makes a difference.
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Thank you - I will try turning off EPR. Actually, I will probably slowly decrease it over a few days to avoid freaking myself out, just in case.

I have screen shots, but the forum won't let me post them. It looks like I don't have the minimum number of posts yet. I will post them as soon as I can, unless there is some trick I'm not aware of.
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Try posting screen shots on photobucket or imgur and then post their links.
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I'm using imgur and the forum won't let me post links. This is my 4th post, so I'll try again after posting this. (Looks like I need at least 4 posts to be able to post links or images.)
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Since you just passed 4 posts, your next attempt at linking to images or attachments will work. You're official now.
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