Sierra

It seems most of your AHI is unidentified. I have seen that before with BiPAP machines using the timed backup. You could assume those apneas are probably central in nature. But, in any case they are not putting you above a total AHI of 5, so still not too bad.

The other number you might want to watch in the Overview page is the total time in apnea bar graph. My thoughts are that at the end of the day this might be the best measure of the severity of the apnea. Apnea is apnea so the type does not matter that much other than when trying to do a diagnosis.

I would suggest you post your Daily report screen. It may have some data on it that gives some clue. If you are using the timed backup on your machine it may be changing centrals to unidentified apneas. The Daily screen should report unidentified apnea.

There are a couple of simple things to check. One is to ensure your inlet air filter is clean. The other is to check and see if your mask type is set properly. See this ResMed Chart for the correct settings.

Your machine should not be wearing out after 4 years. My wife's S9 is 4 years old and is going strong. If you know how to get into the clinical menu you can check the operating hours on the machine.

Everything I see shows zero CA events. If central apnea has been an issue, it certainly is being well treated now. Total AHI is good. The only strange part that I see is that the total AHI is not the total of the reported OA, Hypopnea, and CA.

I did my CPAP machine trial on a F&P SleepStyle. It was not supported by SleepyHead. I think the Icon model was supported though, but not sure. I am not sure OSCAR has progressed much beyond where SleepyHead left off. Perhaps support is coming...

If you use SleepyHead it will report your 95% Pressure. However, since you have your minimum set at 8.4 cm, and maximum at 9.4 cm that is a very tight range, and most likely your 95% pressure will be reported at 9.4 cm. So, what you might want to do is set the minimum at 7.4 and max at 8.4 to see if that gives you some relief without affecting the AHI too much. It is best to download SleepyHead though so you can see what is really happening.

One of my personal theories based on my central apnea is that an obstructive event or possibly an obstructive hypopnea can start a cycle of waxing and waning breathing that can end up as a central apnea. You can explore that by checking the around what happens before a CA. In the graph above I don't see any events close to the CA events, so they may have occurred just due to arousals as you suspect. If my theory is correct, then a CPAP can to some degree reduce CA events by preventing the hypopnea or OA events that may trigger the unstable breathing. I find that dragging the Minute Ventilation graph up on screen lets me see when the waxing and waning of breathing starts relative to the Flow Rate graph.

My thoughts on where you are now, would be to increase minimum pressure to 5 cm and reduce the maximum pressure to 7 cm. This will get your pressure up to 5 cm right away and perhaps avoid some hypopnea or OA, and as a result avoid the CA's. Reducing the max pressure to 7 will keep the machine from chasing hypopnea events and increasing the pressure too much and causing CA's. In the end you may be best switching to a fixed pressure CPAP mode and set the pressure somewhere in the range of 5-6 cm. That may be high enough to stop any obstructive hypopnea and not high enough to create CA events.

As bonjour suggests it is generally the high pressure that cause the air swallowing. And again in general, many that have the issue get over it. So you could limit pressure for a while and accept a little higher AHI, and then increase it over time.

There have been a few posts here about the Inspire device. I would suggest doing a search. In general my recollection is that the reviews are somewhat mixed. Some love them, and some not so much.

The standard treatment goal is to have 5 or less for an AHI in North America. So if your centrals are always pushing you over, then you may need to consider an ASV in my opinion.

In the UK for example they do not consider mild apnea (5-15) serious enough to treat with a CPAP, so it is kind of a grey area.