Sierra

I can't say I have had issues with dizzyness that I could associate with sleep apnea or use of a CPAP. I have associated being dizzy with low blood sugar and/or low blood pressure though. As far as apnea goes, the only report I have seen associated high pressure used with a CPAP to dizziness. This would seem to not be your situation though. Also keep in mind this was one single case, and not a report of the issue being common.

Otic Barotrauma Resulting from Continuous Positive Airway Pressure

I'm sure you will get used to the pressure over time. I used to think 6 cm was a high pressure when going to sleep. Then I discovered that it was actually low. When you first go to bed and are breathing more deeply it can kind of restrict the air flow. Over time I adjusted the Ramp Start pressure which is used when going to sleep. I kept increasing it until I could feel no flow restriction when breathing deeply. At the right pressure it feels like there is no mask on your face, and nothing restricting flow. Now I am at 9 cm for my ramp start and find it quite comfortable.

Because I used a fixed pressure after the ramp is over set at 11 cm, that is what is there if I wake up during the night. It would be nice if it would sense I was awake and start the ramp over, but it does not. It only does that if I shut the machine off for a few seconds. I had a Trial F&P machine and it had a "SenseAwake" of something like that, that did sense you were awake and ramped the pressure back down. However that was about the only good feature of that machine. But again over time, I now find a fixed pressure of 11 cm quite comfortable. The only irritation I get from my mask are the straps.

Short story, you will likely adapt to the pressure...

On the snoring, my observation is that the pressure needed to stop the obstructive apnea generally is enough to also stop snoring. My wife has some issues with snoring and flow limitations showing up on SleepyHead that are not quite totally controlled by the pressure she uses (ResMed S9). They can be controlled with more pressure, but she does not want to use any more pressure, as it wakes her up. So, I limit the pressure so her AHI scores are very good (averages under 1.0), but it is not quite enough to stop the flow limitation. See the example of her daily report below. Not sure if the DreamStation responds to snoring. Suspect it does to flow limitations though. In short I would not worry about it until you have gotten the pressure up a little higher and your score is better. It will probably go away. Mouth taping generally only stops excessive leakage from air loss through your mouth. It probably wouldn't do much for snoring. Neither would a full face mask. From the reports you have posted I have not seen a high leakage. DreamStation provides two leak rates. The top one included the intentional flow out the mask vent. The bottom one is more representative of the unintentional leak. That is the one to be concerned about.

You may want to try the SmartRamp feature. It is described on pages 4-22 and 4-23 in the manual at the link below. If I understand it correctly it will control the pressure automatically between the ramp start pressure selected and the Auto Minimum pressure, until the ramp time expires. Again if I understand it correctly, unless it encounters a OA or H event it will keep the pressure at your ramp start pressure. For a 8 cm min pressure you could try the SmartRamp with the Start pressure set at 7 cm. And when you try the 8.5 or 9 minimum Auto pressure perhaps leave the Ramp Start at 7 cm if you find that comfortable.

This works a bit differently than the ResMed and the manual applies to all models of the DreamStation so that makes it a bit difficult to understand. The ResMed just hold the pressure at the Ramp Start until it detects you are asleep. It appears the DreamStation will kind of hold it, but will stay in effect until the ramp time expires.

DreamStation Technical Manual

Sounds like you have a solution on the way. Another source of CPAP machines, new and used, if you are in the US is SecondWind CPAP.

One of the issues with the UK data is that they have only been reporting deaths due to COVID if they occur in a hospital. Seniors long term care home deaths, or deaths at home are not counted. France was doing that as well. You can see the jump in the trajectory of their deaths when they corrected that.

https://ourworldindata.org/grapher/covid-deaths-days-since-per-million?country=CAN+FRA+NZL+KOR+USA+AUS+BEL+GBR

I don't believe the UK has made a correction, but they are talking about it. It will probably bump the UK up to the second worst in the world after Belgium

Yes, if you are having issues with the pressure, then it would be good to try going up in lower steps. Perhaps try 8 cm with no Flex first, and when you are used to that, try a small step toward 9 cm. In the scheme of things 8-9 cm is not a very high pressure. When you need 20-25 cm then it can be much more of an issue. Most BiPAP machines go up to 25 cm.

Have you tried a ramp for going to sleep? I am less familiar with the DreamStation machines, but I think they have an auto ramp feature like ResMed. It holds the pressure at a set level until it senses you are asleep. If it does, you may want to try a ramp hold at 7 cm. That may be easier to get to sleep with.

Without getting into the real detail the DreamStation CFlex and FLex systems really do not reduce pressure that much on exhale. They more smooth the transition between inhale and exhale. The ResMed makes more of a real change in pressure. The setting more closely match the actual pressure drop.

I watched the video. The problem I have is I don't know how you measure UARS. I believe it is thought to be a narrowing of the airway but not a blockage. If that is the case it may cause hypopnea, or flow limitation. A ResMed machine gives you a continuous readout of flow limitation, but I believe the DreamStation only flags FL events. If so, with the DreamStation you could look to see if hypopnea events and FL events are reduced with more Flex or not. The other consideration is that if UARS is actually a narrowing of the airway, reducing the pressure may make it worse, not better. So, I really did not see the point that the author of that video was trying to make.

A BiPAP uses much more of a pressure difference between inhale and exhale. It is more of a breathing assistance device to increase the air flow, than it is an airway splint or opening device. With a BiPAP you can have 10 cm or more of pressure support, compared to the less than 1 cm your graphs are showing for the Flex effect.

About the only way to see is to try it. Hope that helps some.

Your graphs are pretty typical DreamStation results. The spikes in the pressure curve are what some call the "hunt and peck" signature of DreamStation. It is kind of like a chicken aimlessly wandering around the yard pecking away to see if there is something good to eat or if it is a stone. I believe the purpose is to raise the pressure to see if your breathing improves. If it doesn't then it drops the pressure back down again. The up side is that it on average keeps your pressure lower. The down side is that it causes the pressure to vary during the night, which may disturb the sleep of some. The other down side is that when the pressure is at the lower value you can have events. See this snip of your April 22 night. I highlighted three events, one hypopnea and two obstructive, that occurred when the pressure was at the 8 cm minimum. These are the kind of events you may potentially avoid if you increase the minimum to say 9 cm. You also appear to be using some Flex (green pressure trace), and you would gain a little bit by turning that off. On exhale it is reducing your pressure below 8 cm.

As far as reducing your maximum, it looks to me that it is not doing any harm (or much good) where it is now. One advantage of reducing it to 10 cm with the minimum set at 9 cm is that it would limit some of the hunt and peck spiking of pressure. There may be a comfort gain in that. Also on the 23rd, I see that pressure went up, and it looks like you may have woken up and shut the machine off? Perhaps the extra pressure disturbed you? The machine however was properly responding to both obstructive and hypopnea events. If the machine had been constrained to 10 cm max it is hard to say if that would have made those events worse or not. I would estimate it would not. And if Flex had been turned off, the events may have even been reduced.

The zoomed in trace on the 22nd, looks to me like a normal waking up and falling back to sleep event. I would say nothing to be concerned about.

My thoughts would be to turn Flex off and increase the minimum to 9 cm, then see how that works. A second step if all is good, would be to try reducing the max to 10 cm to see if that helps with controlling the pressure spikes.

I believe I have seen similar enclosures in other photos. Seems to me that a basic CPAP along with oxygen supplementation may be a viable option to treat less severe cases of COVID. Setting the EPR to max would help some too. All under a doctor's care of course...