Sierra

I am a bit confused by what you are saying. Are you saying that you are manually setting the humidity level and the tube temperature? If so my suggestion is to set the Climate Control to Auto. Then there will be no humidity level to select. The machine adjusts humidity level for you. You still get to set the tube temperature, and I would suggest 81 F. At least that is the way my AirSense 10 is setup and it seems to work fine with no rainout.

There seems to be some recognition that both central and obsructive hypopnea events do occur although they may be difficult to classify. See this page from a sleep report posted by another contributor here. The columns for Central Hypopnea and Obstructive Hypopnea were not filled in, and they were all recorded under Unclassified Hypopnea.

Also see this article.

Scoring Obstructive Hypopnea vs. Central Hypopnea

Not sure where you are at with your machine purchase, but I see that Sleep Yeti has a Black Friday sale (Nov 23-26) of 15% off the complete order. That would make the AirSense 10 AutoSet with a ClimateLine hose about $782. They are in Calgary so Canada Post shipping from there would be less likely to be affected by the strike.

Welcome to the forum. I would not suspect the humidifier is the problem. It should help, not hurt. On nasal pillow size, I have found that the largest pillow size that effectively seals leaks is the best. If you go smaller, it tends to go into your nostrils and irritate the lining of your nose more, but it does tend to seal better. So it is a trade off, but I try to go as large as I can. I have also found that using an over the counter 1% corticosteroid cream to be helpful to reduce the irritation. I just put it on the exterior surface of the nostril area. It should not be a long term use item, and should be discontinued when the normal adaptation period to the mask is over.

Hope that helps some,

If you look at the User Guide specifications for each mask the P10 is rated at a noise level of 21 dB which is very quiet -- probably quieter than the AirSense machine. The N20 is rated at 24 dB which is still pretty quite but should be based on specifications noticeably higher than the P10. The human ear needs about 3 dB differential to clearly tell if a noise is louder. My experience with my P10 is that I can hear my machine just barely at night, and can't hear my P10 mask, when it is not leaking. My wife now uses the F&P Brevida, and while it is a bit noisier in my subjective opinion, really don't hear it unless the mask is leaking.

So, that begs the question. Could your mask be leaking and the noise is the leaking mask? Or, could you be opening your mouth letting air escape from your mouth? That can be just as loud or louder. For that reason I have been taping my mouth closed for some time now, which eliminates the mouth leaks. My wife denied for a long time that she knows how to keep her mouth closed when sleeping. But, that was not what I was hearing. With SleepyHead and my account the noise she was making, I finally convinced her to try mouth taping. Now, no noise, and SleepyHead shows an amazing improvement in mask leakage -- which was really mouth leakage. If you want to post a SleepyHead Daily Report for a typical night with each mask, I can give you my opinion on whether you may have a leakage problem or not.

And on the mask size, I don't believe there is any difference in the frame of the For Her version, but with a FitPack it does come with the three smallest size cushions including the XS. The head straps may be smaller on the For Her though, and that is probably a good thing, as the headgear on the P10 is weak. If I order replacement headgear for my I will probably get the For Her version. What I have found with a nasal pillow mask is that the biggest size that you can use is the best. It tends to be more comfortable. If too small it can go too far into your nose. My wife has also found when the cushion is too small the mask can restrict flow or even block right off. Did they give you the other sizes to actually try? If so I would try them as that is really the best way to see what works best.

Hope that helps, but keep in mind mask fit and tolerance is critical CPAP issue. I would not get hung up with one model over another -- just pick the one that is comfortable and works for you. If it works, it works! I do think there is a health benefit in using a Nasal or Nasal pillow mask over a full face mask, even if it requires taping your mouth. See this video for some more detail on that aspect.

How to Mouth Tape for a Better Sleep

Another update. I did 27 days on the 12.2 min to 13 max pressure setting. The AHI initial AHI average of 2.0 did not hold and I got a final median AHI of 2.64, so not quite as good as a simple CPAP fixed pressure of 12.2.

Since then I have tried going the other way with a fixed pressure again, but lower instead of higher - 11cm or 1.2 cm lower. After only 4 days I have an average of 2.53. Next I plan to go lower still and see if there is a break point where lower pressure starts to cause more obstructive events, and fewer central. Will try 10 cm next to see what that does. I am trying to validate the theory that higher pressure may not only produce more central events, but if you suffer from mixed apnea like I do, then it may cause more obstructive events too. Time will tell, but I am starting to come to the conclusion that fixed CPAP may very well be a better solution than Auto CPAP, especially with a mix of obstructive and central events...

Here are some links I found for another poster who may be suffering from UARS, if you have not already seen them. If you go the CPAP route the preference seems to be to use a nasal or nasal pillow mask to treat UARS.

Short summary

Deeper dive

Deep Technical Dive

From what you have described of your symptoms I suspect you may be suffering from UARS or Upper Airway Resistance Syndrome. This is not a medical opinion, but just a matching of your symptoms with those of UARS. It does not account for the "jerk" issues you seem to have, but it does pretty much describe many of the other factors in your case; younger, not overweight, unrested and unable to sleep, low AHI under the apnea diagnosis level of 5 (just), frequent hypopnea and RERA events, and no full apnea events.

Here are some articles to read. My conclusion skim reading them is that the condition exists, not all doctors know about it or consider it controversial, and the fact it is not recognized by Medicare, and most insurance companies, it most often goes untreated. CPAP treatment using a nasal or nasal pillow mask seems to be effective in treating it, but compliance is an issue, in many cases because insurance companies or Medicare refuse to cover the costs. Dental devices and surgery are also options, but I recall you have been down that road already.

So here are some links in order of depth they go into the issue:

Short summary

Deeper dive

Deep Technical Dive

My thoughts would be to try and find a sleep lab that is well aware of the UARS issue, and is willing and able to test and diagnose it, as well as OSA and CSA. And you would want a clinic that is willing to write a prescription for it -- such as a CPAP and nasal mask. But, you probably need to be prepared to cover the cost of the CPAP equipment yourself, unless you get a positive sleep apnea diagnosis based on AHI alone.

I have never seen any issues raised with the use of melatonin, other that it is questionable whether or not it helps sleep at all. Ambien may be of help and apparently some doctors prescribe it for a sleep test. The consensus seems to be that it does not adversely impact central apnea, but some disagree in that view. You may want to ask your doctor about it.

Keep in mind that AHI and RDI are events per hour, so if you sleep three times as long, and three times the number of events occur, the index numbers remain the same.

You may want to do a little research on Upper Airway Resistance Syndrome or UARS. It is essentially a RERA condition. Here is one link to an Overview, Symptoms, and Treatment, but there may be many other better ones.

I tried the steroid nasal spray as well -- Nasacort I think. But, I found it did not help me much if anything at all.