Guidance requested from site newbie

[hwka]

Brief history.. I was formally diagnosed with Severe Sleep Apnoea in Nov 2012.
I followed all the initial recommendations and have since trialled every mask variant and have now settled on a Philips Nuance with gel pillows. Unfortunately I am a mouth breather by habit which would suggest a full face mask or a nose and mouth coverage of some kind - but I have found them intolerable. I return impossible figures (currently using Sleepyhead software which unfortunately does not feature on this forum) The actual report was prefaced by :"You had an AHI of 62.45, which is considered horrible, please consult your doctor
You only had the mask on for 3 hours, 5 minutes and 24 seconds."
Here is my take on this: The science on Sleep Apnea is well-established and to me beyond question. The measurement however of Sleep Apnea is seriously problematic outside a laboratory. Sleep Apnea software relies on a single source - airflow - and interprets the interruption of that airflow and categorises the "incidents" according to its algorithms. So in my situation for example I had a relatively pleasant and restful sleep and awoke with no evidence of being over-tired. I had pulled the mask off half-way through the night which unfortunately is typical but went rather peacefully back to sleep for another 4 hours. I expected a report of no more than 5-10 AHI - if that. I was staggered to see 62.45 ! This included 29% PB, 2%CA, 20%+Obstructive and 40% Hypopnea. Thankful I did not have a bad night.
I purchased a pulse oximeter - Contec CMS 50F - but the latest iMac drivers still crash the Sleepyhead software ( it was designed for Windows originally). If I can show stable SPo2 it proves the reports are useless and probably caused by mouth breathing.
Next consideration is a Windows partition on my iMac but that is not cheap and would be solely for the oximeter.
Unfortunately all the above is representative of my experiences over the past 5 years and resulted in my binning the equipment in the closet for the past 12 months - for the second time. I want this to work , but am pretty much out of ideas.
Comments appreciated.

[grayghost4]

OP wrote Quote: (currently using Sleepyhead software which unfortunately does not feature on this forum)

Please do post screens from Sleepyhead, and there are many here to help you.

https://sleep.tnet.com/resources/sleepy ... screenshot

https://sleep.tnet.com/reference/tips/imgur

[hwka]

Thank you for that advice re IMGUR.
I have never posted an image before - so will see if I can follow instructions.
I have 3 images 03,04,05 Dec 2017 - for some reason they do not seem to be the same definition.
I may have stumbled upon a solution - as perhaps indicated on the 05Dec17 screenshot.
My prescription was 6cm H2O.
For the 05th I arbitrarily choose 7 cm H20 - I had read the advice on making no more than 0.5 changes, but the sleep planned was of very short duration and I was a bit desperate to get some results.
Of course one swallow does not a summer make, but it looks like my prescription may - may - have been way out.
https://imgur.com/a/2um8R

[LSAT]

Post removed by author

[Pugsy]

You are going to need more pressure and probably a fairly substantial increase from where you are at.

Have you ever used the auto trial mode that should be available with your model 460 machine?
That's what I would suggest trying. Start with minimum of 8 and max of 20 and see where the machine wants to to.

I don't know how much more pressure you need but 0.5 cm increases is going to take a while most likely to find out. At least 10 cm most likely if not more.

Did you ever get the clinical/provider manual for your machine?
If not go here and request it because it explains that auto trial mode I was talking about.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

[hwka]

Much appreciated advice.
I have applied for the manual and will enable auto-trial (which I had no idea it even existed - nor was it mentioned by my provider)
Making progress though - last session using 7cmH20 registered 6.41 AHI.
AND ....I finally got the CMS 50F recognised by my desktop Mac...apart from the initial few minutes O2 levels were very stable.
I am now confident that problem readings are primarily caused by mask leak and incorrect pressure settings.
Not a done deal yet - but have made more progress in the last 48 hours than in the last 5 years.

[hwka]

I received the Provider Guide .pdf file for my particular Philips Respironics model which taken direct from the unit itself is a
461P INTL Philips Respironics System One REMstar Pro C Flex+
I previously found how to access the Provider only menus from reading CPAP forums and was not aware there was an Auto pressure setup.
This was confirmed as I just received the Clinicians/Provider manual and there is definitely no mention of it.
Direct link: https://i.imgur.com/2dOGS1Z.jpg
Notice the tag - top left of the image - "Australian Sponsor Details" which may provide a clue.
Best I stop right there.
.......
I upped the pressure to 8cmH20 as a trial last night and recorded AHI of 9 but the results are unreliable as I have a persistent dry cough and the mask is all over the place as a result.

[Pugsy]

In the US there is an auto trial mode option available on the model 460 machines but maybe your 461 since it was made for outside the US doesn't offer it.
Either that or you got one that didn't offer it. Seems like some did and some didn't and for some people the trial days were used up.

That's okay though. Using auto mode makes it a bit quicker to find optimal pressures but you can still get there using fixed pressures. Just takes a few more nights to get there.

[hwka]

For Pugsy:
Just to clarify..the Provider Manual for the 460 model makes no reference specifically to an auto trial or even to CPAP-Check
However the USER manual has as available therapy modes CPAP/CPAP-Check but these settings are locked and do not appear in the SETUP menu unless the Control Wheel and Ramp button is held down for 5 seconds and then CPAP-Check can be selected from 4-20 CmH2O. How to access and change these settings is not passed on to the consumer which is understandable.

Directly from the USER manual.....
CPAP: The mode delivers Continuous Positive Airway Pressure. CPAP maintains a constant level of pressure throughout the breathing cycle.
CPAP-Check: The mode delivers CPAP therapy while automatically adjusting the pressure level to meet your needs.
However it is limited to how much the pressure can be adjusted overall.

I tried CPAP-Check and it can be set to 4-20cm H2O but no amount of effort to simulate a need will induce it to change during therapy.
I imagine it will not change willy-nilly but only after the need has been verified over a period of time.
How long that period of time, or how the need for a different pressure is determined is not mentioned.

I have now set CPAP-Check to 6cmH2O and will see what develops.

[Pugsy]

I tossed the user manual in the trash...for every machine I have ever used and got the provider/clinical manual.

Let's see what cpap-check mode will do for you with the starting pressure of 6 cm.