Sierra

If you have a PC delete that rather useless menu bar on the right, minimize the calendar to a single date, and use File, Preferences, Appearance, to uncheck the show pie chart box. Maximize the window size with the Daily Report showing, then push F12. That will create an image file in the SleepyHead directory under ScreenShots. Then just left click and hold on the file in Windows explorer, and drag to the body of a post.

I had the same issue with the chin strap. It helped, but I still got mouth leakage.

Here is what my typical leak rate was like while using a chinstrap only with the AirFit P10. 23% of the time over the leak redline:

And here is what it looks like now with the AirFit P10, same chin strap, but with the 1" tape over my mouth. 0% of the time over the leak redline:

I tried and failed with the Mirage Quattro, but the Quattro FX is a bit different, and I can't comment on it. You may have already looked, but the CPAP.com site seems to collect a lot of reviews of each mask. On many masks they offer a free return policy if they don't work for you. Perhaps worth a read of the reviews there.

Quattro FX for Her

With a higher score on the STOP-BANG and if there are no other medical conditions, you would look like a candidate for the at home study. It is also likely less of a wait to get an at home study. They are less expensive for your insurance company, so they may be more cooperative in doing one. Here is a link to an article on the pros and cons of the lab vs at home tests. The basic difference is that the lab study collects more data, including brain activity so they can determine what stage of sleep you are in. But at the end of the day you are either prescribed a CPAP or not. The real test is actually doing an at home trial with a CPAP to see what it does and how tolerant you are of it. Try to get a free trial so you can find out if it is worth getting one.

At Home vs In Lab Sleep Study

Perhaps I am not reading it correctly but the manual at the link below seems to suggest that the VAuto machine can be put in a "S" mode, and when in the S mode there is an optional Backup Rate which can be set to Off or 10 BPM. See page 14 in the manual at the link below.

VAuto Manual

You can do a self evaluation to determine if you are likely to have sleep apnea. See link below:

STOP-BANG Test

If the test indicates a high probability the next step is to get a sleep study done. This can be done in a lab or at home. The lab method is recommended if there are other complicating conditions such as heart and/or lung disease issues. If the test indicates apnea, ideally you will be given a Auto CPAP for a trial, and if successful then a prescription for one. It is not legal in the US and Canada to buy a new CPAP without a prescription from a doctor.

You can make an assessment of how likely you are to have sleep apnea with the STOP BANG quiz. See link below.

STOP-BANG

In your situation I think I would wait for the at home test. Yes, some people do just buy a machine, but it is actually not legal without a prescription in Canada and the US. That said some buy used machines, but I would not recommend it.

There are chin straps sold to prevent snoring, and also boil and bite mouth appliances sold at a pharmacy. Neither are real good solutions, but they may provide you with some relief until you get the test. Many of us find we need to use the chin strap even with the CPAP machine to keep our mouths closed during sleep. So, it may not be a wasted expense.

Computer stores sell small portable SD card readers that plug directly into a USB port. Usually about $10 or so.

The generic impact of mask leaks is not really clear. I have a ResMed machine which reports mask pressure, not just set pressure. I have not seen quite high leak rates impact mask pressure very much if any. I guess at some point pressure may reduce.

The other thing that mask leaks will do is increase the oxygen level in the mask. Masks have a certain design mask leak rate to maintain oxygen high enough, but a high leak may make that even higher. The impact of this is uncertain.

ResMed, and I'm not sure about Phillips, seem to suppress the reporting of apnea when the leak rate exceeds a certain value. But, on the other hand with SleepyHead I don't see anything that looks like apnea during a high leak period. So again not clear what the impact is. In some people higher oxygen can initiate central apnea, so it would seem leaks might initiate higher CA events. You seem to have the reverse. About the only thing I have noticed is that I seem to have central apnea events right after a high leak stops. Seems possible that the sudden step change in oxygen levels might initiate something. All of this should start be be more obvious once you have data in SleepyHead because you then will be able to see exactly when the central apneas are occurring. This is much more useful than just knowing what the total is for the night.

The normal objective is to try to get total AHI under 5. That can be difficult when central apnea is involved. And if there is a normal approach the general idea is to try to keep the EPAP pressure as low as possible while still controlling the obstructive apnea. I think the initial approach with pressure support (IPAP minus EPAP) would be the same. Keep as low as possible or even zero as a starting point.

If low pressure support does not work, then the next potential step is to increase pressure support to try and assist breathing effort to reduce the onset and severity of a central apnea. That is easier said than done though. I believe part of the trick is to make a fast transition from inhale to exhale pressure. In the DreamStation I believe that is what they call Rise Time (see page 4-23 in the manual). I do not have a BiPAP, but I think the tradeoff here is comfort. A fast transition may be more effective, but less comfortable.

Hope that helps some for now. Post your Daily Report and that will be most helpful. Just left click and drag the image file to the body of a post, if you are using a PC.

Here are the links again:

DreamStation Manual

SleepyHead Download

SleepyHead Basic Manual

To use the SleepyHead software you need a PC or Mac computer. It will not run as an app. You also need a SD card reader. If you could get your data into SleepyHead it would be much more informative.

From what you have posted, it seems to me that the obstructive events have remained about the same with the two mask sizes. However with the larger mask the central events have increased significantly, and the mask fit has gotten much better.

One possibility may be that the mask leaks are masking the reporting of the central apnea events.

If you could get your results into SleepyHead there should be a lot more to see. Are you able to do that?

Do you have access to a sleep doctor or sleep technician? They may be able to help you as well.

I think I mentioned it before, but if you do decide to go with the ResMed, be sure to ask about the "For Her" version of it. It is the same price, and does all the same things as the standard AirSense 10 AutoSet, but it offers an optional extra program that can be tried to see if it gives you better results. It is more suited to someone who may be using pressures in the lower range (<12 cm).