Non-CPAP treatment for obstructive hypopneas

My at-home sleep study showed some central apneas (some were likely transitional sleep-onset because I kept struggling to drift back to sleep after trying to claw the nasal cannula off my face). For obstructive events, it showed one apnea and all the rest were hypopneas. Both OSA and CSA were in the mild categories.

I recently got a pulse-ox recorder to monitor my own SpO2, and it frequently vibrates to alert me of low oxygen levels as I’m reading just before trying to fall asleep, which is another thing that makes me think some of the central events in my sleep study may have been transitional apneas. I usually have 1-2 segments of time in the night when my SpO2 bounces between 86-93 for a few minutes before returning to baseline.

I can’t do the any of the PAP-type machines that require masks. I can’t even put the mask on my face and the straps over my head without a panic attack. It didn’t matter which style I tried, it was the same result. Even just the nasal cannula during the study had me at the edge of panic all night. It took about 15 months before I could wear any kind of mask during Covid for more than 20 minutes in a row without a panic attack, despite following all of the advice to practice at home building up starting with just a few seconds at a time. By the time mask mandates ended, I still couldn’t go more than an hour before the rising anxiety reached a breaking point. The panic from anything touching my the front of my face originated from ptsd about 13 years ago; I had a sleep study soon after that showed no OSA or CSA, so I don’t think that panic is a result of the sleep apnea.

I just got a Bongo Rx to try since things poked in my nose don’t make me panic as long as there’s nothing pressing against the front of my face. I’ve slept with a wedge pillow for months. I wanted to do the sleep study with the wedge pillow to see what is actually happening during a night of sleep, but they told me that would be testing a treatment, not a baseline study. I also know that my SpO2 suffers when my allergies are worse. Other than treating allergies, using the wedge pillow, and trying the Bongo Rx, is there anything else I should be doing for the obstructive hypopneas? I currently live at high altitude and hope to move to lower altitude next year; the doc said that may help the CSA part. I know if I was using a CPAP, they could look at the data from that, or if I used a MAD, they would re-do a sleep study to see how effective it was, but since the Bongo has a complete seal with the nose, I don’t know how a re-study would work without the nasal cannula sensor.

I don’t have any daytime symptoms, so it’s hard for me to tell subjectively if anything is helping. With the wedge pillow, my husband says I’ve stopped snoring, but that’s the only feedback I have.

One thing to consider is that in the UK the National Health Service will not cover a CPAP unless AHI is over 15. It is not considered serious enough to treat when under that.

Is the prevailing thought here (not just with the NHS) that mild OSA doesn’t require much in the way of treatment? I’m happy to just do the things I’m currently doing, I just wasn’t sure if I ought to be doing more. The provider I saw was trying hard to push me to get a CPAP/BIPAP/ASV, but when I couldn’t even tolerate putting a mask on my face without being connected to the machine, they pretty much just gave me a printout of other options and recommended I pick one and contact them when I wanted to be retested. There were a lot of things about my experience that felt sketchy, but it’s supposed to be a reputable clinic in my area. It felt like a high pressure sales pitch and they looked deflated when I had to turn it down.

I’m in the US, and my insurance would cover CPAP if I could/would consistently use it. They won’t cover most of the non-CPAP treatment options. I paid for the Bongo Rx out of pocket, but it wasn’t too expensive. I wanted to try the ExciteOSA because it’s approved for mild OSA and their website said the VA would cover it for veterans, but the VA told me they don’t. It’s very expensive out of pocket with recurring costs, so it’s not something I can try at the moment.