The quick version:
- I was diagnosed about 9 years ago with severe apnea.
- Most of my events are hypopneas. In the original diagnostic PSG, hypopneas outnumbered obstructive apneas more than 6 to 1.
- I have treatment-emergent central apneas, and higher pressures always generate more centrals and a higher overall AHI. I also subjectively sleep much worse and feel much worse the next day when this happens (i.e., at higher pressures). As such, I was put on ASV therapy.
- I have always felt at least a little worse on xPAP than without it. I tried a couple different oral appliances and even surgery several years ago, but (as expected) those did not treat the SDB side sufficiently.
- I have no (known) heart or cardiovascular conditions (aside from hypertension), and my breathing is not of the Cheyne-Stokes variety.
- Based on lots of historical data, my AHI numbers are the best and I subjectively feel better (albeit not great) when the ASV min settings are kept low (min EPAP=4, min PS=2, backup rate=8 bpm). Auto bpm seems a little disruptive for whatever reason, and even at the min bpm, PTB is still >=98%.
- I've been most comfortable using a nasal pillow mask (the AirFit P10). I've tried several different full face masks and found all of them very disruptive. That said, things go haywire when air escapes through my mouth (the leak numbers go up, the pressure skyrockets unnecessarily, and my numbers and sleep quality get worse). A chinstrap and/or taping are required.
- As long as the leaks/mouth breathing situation doesn't happen, my AHI is <5 most nights, and my residual events are almost entirely hypopneas.
- Even when things are going well, 2-5% of the night in periodic breathing is pretty common. The PB number shoots up with leaks/mouth breathing, higher EPAP, and/or higher min PS.
Unfortunately I don't think I can try both machines, so I need to choose which way to go.
I'd welcome any advice or thoughts. Thank you!!!