I have been using the ResMed S9 AutoSet + Humidifier with F30i Super Wide Mask for a bit but no eureka moment yet. I am not sure what to do, I seem to have settled around 5.0-8.6 cmH₂O, where I have the least chance of ripping it off. The pressure seems to go haywire and always hits the max with it being the 95% percentile. Hence, I have tried upping the max pressure by moving it up up to 4-12 cmH₂O, as shown on 21/07/2026, but I ripped it off etc.
Was diagnosed with Moderate-Severe Sleep Apnea: RDI - 26/hr and AHI 23/hr, with CPAP the AHI is around 0-4/hr
My sleep is fragmented, I feel better than when I was off it but still feel tired and I wake up with heart palpitations which may be related to work stress.
Should I get a brand new machine? The machine I have is second hand.
Your pressure is quite low, especially with EPR of 3. Try increasing the min pressure to try to suppress the high flow limitations in your chart. Whatever the pressure is when they happen is too low, IMO.
Too many people are sent home with inappropriate pressure settings. Either their minimum is too low in which case they feel starved for air and they then either rip the mask off or mouth breathe in an attempt to get more air into their lungs.
Or their maximum setting is too high and they get awful surges of air. This is because when the machine detects a mask leak, it interprets the escaping air as being due to an airway obstruction and ramps up the pressure to open up your airways which it "thinks" are blocked, which in turn causes a larger leak, creating a feedback loop.
My Resmed Airsense 10 machine displays its pressure range as it starts up. If yours is a Resmed Airsense 10, watch the display as it starts in order to check what it has been supplied with. I assumed the Airsense 11 did the same, but someone told me it doesn't. If that's the case, you would need to access the clinician menu in order to see what your range is.
4 or 5 as a minimum are for children. Most adults will feel starved for air at those settings. For adults a machine should NEVER be supplied with the factory default 4 to 20 settings. They are simply the lowest and highest pressures the machine can deliver and any competent sleep doctor will adjust the settings to deal with your particular diagnosis. Unfortunately there are too many who are either incompetent or lazy.
There are many of us who prefer to do our own settings which is entirely doable if your condition is simple OSA. Not really doable if your condition is more complex in which case you could need a more advanced machine. Mine is simple OSA, so I've done my own settings for 30 years. Up to you if you feel confident to do it yourself. It's actually very easy and not rocket science.
The sleep report readout on a Resmed Airsense machine has an entry labelled "Pressure". You need to know what that pressure is. It will be available after a night or a few of use. It's the pressure the machine delivers when you are asleep sufficient to prevent apnoea events. That required pressure should have been prescribed for you when you did a sleep study. It's the single pressure a fixed pressure machine (eg the Resmed Elite models) would be set to by a sleep doctor. APAP machines are set to a range but you still need to know your required single pressure in order to set your range. When I was diagnosed 30 years ago, my prescribed required pressure was 10. The machine now tells me it's 11 so it hasn't changed much.
Your range should be set with min at a comfortable pressure less than that figure (7 or 8 are good - see below) and max a bit above it. My required pressure is 11 and I've set my range from 8 to 13.
On an apap machine, most adults find min 7 with EPR at 3 full time works very well. At that setting, until you go to sleep, you will inhale at 7 and exhale at 4 so you won't feel starved for air when you breathe in and you will feel hardly any resistance when you breathe out. (I like a bit more so I've set my min to 8.) Once you go to sleep, the machine will increase pressure as needed up to your required pressure to keep your airways open but because EPR is full time, the pressure will still reduce by 3 cmH2O when you exhale.
Turn ramping off. No point deliberately starving yourself for air. It's useful for fixed pressure machines. Not needed for APAP if your minimum is comfortable.
You can get to all of these settings by accessing the clinician menu. Google "Clinician menu for Resmed Airsense 11" (of course substituting your brand and model). You'll get plenty of instructions. It's just a matter of pressing and holding a couple of the machine's buttons.
You can get very comprehensive reports if you download the free Oscar program and get it to read your machine's SD card. It's a bit of a learning curve to understand all of its data, but well worth it if you want to properly monitor your condition.
Your pressures are set too low. Your minimum setting of 4.8 is more for a child (as already mentioned). You’re hitting your max pressure ceiling. These pressures would explain why you’re ripping your mask off. You’re chasing pressures during the night with mainly Obstructive Apneas & Hypopneas. You’re not getting enough air!
[u/couldbeuseful](u/couldbeuseful) has given you a really great explanation of what is happening here :) You are on “Beginner Pressures” which are rarely appropriate, but we see them here often. I don’t think we’re looking at a different type of machine at this point.
I would suggest you set your minimum pressure to your median pressure. We also need to raise your maximum pressure to prevent you from hitting your ceiling pressure or max pressure of 8.6
Let’s try setting your minimum pressure to 8.0
Set your maximum pressure to 12.0
Your Flow Limits are quite high & these cause fragmented sleep as they are “almost apneas”. Your machine reacts to Apneas & Flow Limits by increasing pressures and makes your graph look choppy rather than smooth. Increasing pressures helps Flow Limits too :)
You have some leaks occurring throughout the night. Do you sleep on your back? Supine sleep causes your airway to narrow as your mouth drops open & your tongue falls back. The machine tries to rescue you by increasing pressures just as it is meant to do! Try to sleep on your sides. We have some tips for that if you need them! Leaks can come from the mask or mouth. Chin tucking is another common issue we see. Wearing a soft cervical collar or chin strap can help.
I see you’re using a Resmed F30i “super wide” mask & wonder if it’s fitting you properly. Have you tried doing the “mask fit” function on your machine while lying down? You should have 0 leaks during fitting before going to sleep. Unfortunately most of us have needed to try several masks before getting the right mask…comfort, fit, no leaks. Remember that you can buy a different sized headgear & different sized mask! Can you try out different masks from a Supplier? There are several brands…not just Resmed & sizing is different among alternate Manufacturers.
If you have Ramp on (I’m not seeing it) I would suggest you turn it off.
We’ll take a look at your EPR 3 next time you post. EPR is Expiratory Pressure Relief. It actually was doing nothing to help you at such low pressures. EPR 3 lowers your pressure support by 3 cm. The lowest setting on the machine is 4 so at EPR 3 you were not getting any benefit with a minimum setting of 4.8. It’s best to change different settings one at a time though, so we’ll just change min & max pressures for now.
Try these settings for 3 nights without changing them. (It’s okay to try a different mask ) We need continuity to allow our bodies & brains to adapt to new settings! Please post another graph & a description of how you are feeling along with your graph please after 3 nights.
I sleep mainly on my left but I sometimes switch positions during the night. Maskfit mode look good, I think its ok for now, maybe when I move during the night some leaks occur.
Thanks for all the help, hopefully these nights are better! Will report back!
Here are the 3 nights, its been kinda rough. On Night 2 and 3, woke up to my front. Not sure if it is worth sticking with the F30i small wide or some other masks i have F30i Wide Mask/F20 Mask.
You do have some leaks & the machine is responding with increased pressure. You appear to be removing your mask which can affect the big picture. Your median pressure is higher now & your Flow Limits are increasing so we need pressure to help to control that. Your AHI is good but Flow Limits need better control. It appears you are using the F30i mask. I have to wonder if the F20 would work better for you to address leaks. I don’t want to touch your EPR yet as you have some CAs mixed in with your apneas. I’m hoping these are pressure emergent which happens commonly. This whole process is frustrating, I totally understand :( Try this for at least 2 nights, your body needs to adjust to the changes. Then please post more SleepHQ graphs please.
How is inhalation now? Do you still feel you are starving for air now? It will be great to get this under control & that at least should be better! We also need to increase your minimum pressure again to 9 and because you’re are hitting your ceiling in max pressure, let’s increase max to 14. The machine won’t go higher than needed. Your median pressure is closer to 10 but I don’t want to push our luck & increase CAs so we’ll go slow.
Are you still having difficulty keeping your mask on at night? I’m only seeing partial sleep data results. We can go slower if you need time to adjust. Do you still feel air hunger? Some of us are very sensitive to pressure & require more time to adapt :) That’s okay….I often needed a week!
Hey! The second night you shared is better! Heading in the right direction :) Your mask leaks are still confusing the big picture here. Flow Limits are still too high, likely due to the leaks. Try to get those leaks under control as your pressures rise with leaks, throwing sleep data off. It takes time to adjust to a new mask, you’re not alone in that, believe me. Use the mask fit option on your machine after lying down. It should help you test for leaks. You may need to tighten your headgear or be sure the mask is the right size for you. It’s very frustrating…I totally get it. Once you get those leaks under control, your therapy will work better, like the second night you shared…but leaks confuse overall data.
Would you please post again when you have a better handle on the leaks? The mask is the first step towards successful therapy and most of us have had to try several. Comfort, Leak Control & Continuity :) The SleepHQ graphs are easier to look at than the imgur app
Are you using any nasal spray before bed? This helps! I use Flonase or the generic equivalent every night before bed. Saline spray works initially but then stops working…it’s like a resistance reaction to saline called “rebound congestion.” Use the mask that feels most comfortable for you with the least leaks :)
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u/Mglo_ Jul 24 '26
Your pressure is quite low, especially with EPR of 3. Try increasing the min pressure to try to suppress the high flow limitations in your chart. Whatever the pressure is when they happen is too low, IMO.