Hello Dr. Luisi. Apart from what you mention you have have already done, and the great tips by "MakeSleepAPriority!", some things that might help (and some/many of these may already have been tried) include:
Of course, one of the primary aims of the forums here is to develop research questions. The question here being how do the people with a high pre-test probability of sleep apnea do after a negative home sleep study, when followed with just sleep hygiene and weight loss advice versus having an in-lab study and formulating a management plan based on those results. Some studies have looked at this, but more work needs to be done.
OP, home sleep studies may sometimes underestimate the severity of sleep apnea. Sometimes when people have significant symptoms such as daytime sleepiness or excessive fatigue, or additional disorders such as diabetes or uncontrolled high blood pressure, they may be a candidate for an in-lab sleep study despite borderline (or negative) home sleep study results. Again, as truckerdad57 said, someone who is well versed with your medical history and your sleep symptoms can best help formulate the plan for management of your sleep issues.
Hello OP, how long ago were you diagnosed with sleep apnea? Recent years have seen several advances in technology, with the newer machines being more compact, less noisy, and with algorithms to make breathing on CPAP easier. The masks have also evolved, and several shapes, sizes and types (nasal, full face, hybrid, nasal pillows etc.) are now available. Furthermore, several issues such as anxiety, claustrophobia, nose congestion and bloating can make it difficult to use CPAP, but can be treated to improve comfort and ability to use CPAP.
If it has been some time, you may want to consider meeting your sleep provider again to discuss the above, as well as other potential treatments if you still cannot tolerate PAP therapy.
Hello OP, sorry to hear about the issues you are having. Do you know if the bi-level machine was able to alleviate your apneas significantly?
In selected people with CSA with poor response to CPAP or bilevel, a newer device called adaptive servoventilation (ASV) may sometimes be of benefit. Caveat being there is a dearth of studies assessing ASV in people with CSA who do not have heart failure.
You may discuss with your provider with a detailed knowledge of your history and comorbid conditions whether, in their opinion, you would be a good candidate for this therapy.
Hello SleepyKitty, chronic sinus issues indeed could worsen snoring and sleep apnea. However, the improvement in sleep apnea just with the treatment of nose issues is usually not that significant. The treatment, however, may help decrease the CPAP pressure required to treat the sleep apnea, and also make it easier to use the device.