Sierra

A few points to consider.

1. The titration test using different pressures is to determine how much pressure you need to stop the obstructive apnea events. It is not about making you sleep.
2. A BiLevel machine is typically only used if the APAP cannot provide enough pressure, i.e. more than 20 cm.
3. The ResMed machine is probably better than the DreamStation and it can be easily set to a fixed pressure.
4. The main reason people feel like their suffocating is when the low pressure and ramp start pressure is set too low. For example the 4-20 cm you tried on the ResMed is too low. I would suggest minimum pressure should not be less than 7 cm.
5. A nasal pillow mask typically works best with a beard. That said my son has a full beard and uses a full face mask while tolerating the leaks.

My thoughts would be to try a nasal pillow mask with the ResMed machine set to 7 cm minimum and 12 maximum to see if that works for you.

Let us know what your findings are. Sounds interesting...

As I have said before, I don't think your issues are related to UARS or apnea, but keep in mind I am not a medical professional. I have a couple of thoughts on the issues you are having. One is doing an extended test to what your heart is doing over a longer period. There is one specific test where you are given an instrument to wear for a couple of days, and then the data from it is read to determine if there are any abnormal heart conditions. Some information:

Holter Monitor

My second thought was on the beta blocker medication you tried. Beta blockers are not all the same. They are mainly used to treat irregular heart rate issues. The Holter test will be helpful in deciding if that is an issue. They are also used to treat anxiety but that is an off label use. You may want to ask your doctor what type of beta blocker may be best suited for you. Some may disturb sleep less than others as well. The other issue with beta blockers is that they can cause a "rebound" effect. If you keep starting them and stopping them, you could make things worse instead of better. It is also best to use a beta blocker that has a long lasting consistent effect.

That is about all I know on the issues you raise.

My recollection is that the Icon data could be read by SleepyHead, but the next generation SleepStyle could not.

It is quite normal to have a disturbed sleep until you get used to sleeping with a CPAP mask on your face. Not normal to have chest pain though. Sounds like it might have been a positional thing.

Unless things have changed the new F&P SleepStyle was not supported by by SleepHead, and not likely OSCAR either. You could try it and see if OSCAR can read the SD card. When I did my sleep trial with a CPAP it was with the F&P SleepStyle machine. It tried to read the data with SleepyHead but it would not work. The other issue with the SleepStyle is that it can't distinguish between obstructive apnea and central apnea. If you never have central apnea it is not a big issue, but if you do have central apnea the machine can increase pressure in response to a central apnea event, which can make it worse. My suggestion if there is any room to negotiate another machine is to go with the ResMed Auto, and as a second choice the DreamStation Auto.

It is a tough battle. The most effective chin strap I found was the BreatheWear Halo. It always kind of bugged me because it seems it was made for someone with lower ears than mine, It seemed to rub on the top of my ear and irritate me. And, I also found it was not good enough to keep my mouth closed, so I had to assist it with tape on the mouth. Finally I found the chinstrap so annoying that I gave up on it, and just went to wider tape on my mouth. That has worked well for a long time. Then a few days ago I pulled the tape off too quickly, and too part of my upper lip skin off at the same time. Ouch!. Now I am also using copious amounts of hydrocortisone cream, and it is recovering slowly. Will not do the rip it off like a band-aid trick again! It does work though. Most nights I get no more than a couple of percent leak rate above the redline score.

On a google search I found some reference in how hypopneas are defined. They are the "H" part of the Apnea Hypopnea Index. It appears there may be A1 hypopneas with 3% oxygen desaturation, as well as B1 hypopneas which have 4% desaturation. I would expect the A1 definition to give a higher number than the B1.

In the UK the National Health Service will not treat mild (5-15 AHI) while they do treat moderate (15-30). In North America mild apnea is more likely to be treated/insured.

If you post your daily report here with a list of questions, I will be happy to try and answer them. One of the things you would want to look for are when the events occur, what type they are, and what the actual pressure was at the time they occurred. That can give you a good idea what the issue is. With a BiPAP the other thing to look at is the pressure support, and whether or not it is too much.

I have never heard of 1A and 1B. Where have you seen it? AHI is simply Apnea Hypopnea Index. It is the total number of obstructive apnea, central apnea, and hypopnea events divided by the number of hours slept. It is basically events per hour.

I see that fairly often with my ResMed A10 APAP. I don't think it is any fault of the machine. My view is that when we don't sleep soundly and keep waking up events which may or may not be real apnea events are recorded. Some call it "sleep wake junk". However, you have to look at the events in detail to decide if they are being falsely flagged or not. Even then it can be hard to tell.

OSCAR is a free opensource software application that uses a PC or Mac and a SD card reader to look at the detailed data on your SD card. It can be very helpful in understanding what is going on, and perhaps even more importantly whether or not there is room for improvement it the machine setup.

Here is an example of a night where I noticed the effect you are having, although perhaps not as extreme. First here is the total night which resulted in an AHI of 1.94 (about average for me). Of that 0.91 is Central apnea, which again for me is about normal.

Oscar (SleepyHead) lets you turn off individual sessions in the night. Since I got up for a bathroom break, this night was broken into two sessions. You just turn the sessions on and off with the red-green switch in the bottom left. Here is what the first half of the right looked like. AHI was .99 which is very good for me.

Now here is the last part of the night. AHI for this period is now 4.0, and CA events at 1.45. Have not looked in detail, but from the Minute Ventilation graph these appear to be real CA events.

So, it is kind of normal what you are seeing, but even your score of 5 for AHI while acceptable, it is on the high side. There may be opportunity for improvement. Kind of as a rule of thumb, more pressure reduces obstructive apnea, but can increase central apnea (CA) at the same time. So it can be a bit of a tradeoff. Ideally you want just enough pressure to control the OA while not increasing the CA. As a starting point I would suggest trying to determine your ratio of CA events to OA events. That can help focus where the problem may be. If you post a Daily Report from OSCAR I can comment on what I think is happening.