Sierra

I try to exercise 1 hour a day, primarily cardio, and do weights about every 2 or 3 days. I have not considered that it could have any effect on the severity of my apnea. It strikes me that doing weights is unlikely to make much of a change to the throat area. Excess body fat probably does not help though.

The first thing you should do is ask for a detailed sleep study report which should breakdown the incidences and rate of the obstructive apnea, central apnea, hypopnea, and snoring. That will give you a better idea of what capability you need in a machine. I presume at this point you have been tested and verified that you need a BiPAP rather than an Auto CPAP? The BiPAP will be capable of up to 25 cm of pressure compared to an APAP at 20 cm. Also the BiPAP will provide more than 3 cm difference in pressure between inhale and exhale.

The best report I have seen on sleep apnea machines is at this link:

All APAPs are not Equivalent

There are a couple of limitations to this report though. It is for APAPs not BiPAPs, and it was written in 2015 and many of the model names have changed. I suspect however that the basic capability in most cases has not changed, and there are a lot of similarities between and Auto CPAP and an Auto BiPAP.

Without getting into all of the models, in my opinion the two top machines in the 11 they tested are also probably the two most popular and most available machines. My comments on them:

ResMed S9 Auto - It is designated D8 of the machines tested, and the current model name is ResMed AirSense 10 AutoSet

It does an excellent job of normalizing obstructive apnea. See figure three, left hand column. It also does an excellent job of normalizing hypopnea, the right column. From figure 4 it increased pressure modestly to stop snoring (left column), and from the right column it does NOT increase pressure in response to central or clear airway apnea. That is important. Increasing pressure does not correct clear airway apnea, but many machines increase it anyway. These other machines probably have no way to distinguish between central apnea and obstrutive apnea. The ResMed does.

PR1 Remstar Auto P-Flex, Philips Respironics - It is designated D7 in the report and the current model name is the Respironics DreamStation Auto

It increases pressure to normalize obstructive apnea, but does not fully normalize it like the ResMed does (left column of Figure 3). It increases pressure to respond to hypopnea (right column), but then it cuts pressure back and does not fully normalize the hypopnea. In figure 4 left column it increases pressure rapidly and holds it up in response to snoring. The concern would be that it may increase it too fast and too high causing a comfort issue. While it makes a slight initial increase in pressure in response to a clear airway central apnea, it immediately reduces it and holds low pressure. Response to central apnea is essentially just as good as the ResMed.

So assuming you have obstructive apnea, hypopnea, central apnea, and snoring, I think either the ResMed or the Dreamstation would work, but the ResMed is the better of the two - based on this benchmark test report.

The BiPAP version of the ResMed is the AirCurve 10 VAuto. I suspect it behaves very much like the ResMed S9 tested in this report, but has the extra pressure, pressure support, and features of a BiPAP machine.

Hope that helps some. You may want to try the UK for an on line store. I have seen vendors there that will ship internationally and the prices for the equipment seemed reasonable.

One last caution if your sleep test indicates you have a high portion of central or clear airway apnea events. A BiPAP machine may help a bit to reduce them, but not a lot. A high portion of central apnea events may need a more sophisticated (and much more expensive) ventilator style machine like the ResMed AirCurve ASV. This would be something to discuss with a qualified sleep doctor.

When I was using a full nose and mouth mask I was plagued with mask leaks near the bridge of my nose. The air leaks irritated and dried my eyes out. And it would also wake me up. I have given up for now on the full face mask and gone back to a nasal cushion mask. It still does leak occasionally, but at least the leaks don't go into my eyes.

I don't believe the at home ResMed device uses EEG. I saw no mention of it in the product datasheet. My Phillips Alice NightOne setup certainly did not. My thoughts are that this test probably did include the time not sleeping and while sitting up. Positional data was probably messed up in the sitting position, and since most people don't have apnea while awake, the overall AHI is probably underestimated.

It looks like you may have until the end of 2018 to make a claim. Best to call them now. See this link:

Narval CC

So I am taking this to mean you have no opportunity to do a free trial of the machine? That certainly makes it more difficult.

As for a prescription the way it works in Canada is that your doctor gets the sleep test report. If it indicates apnea and they believe a CPAP is suitable, the doctor just signs it and it becomes a prescription. I would think it is similar in the US, and the doctor involved is obligated to provide you a prescription even if they don't sell you the machine. Kind of like a prescription for a medication.

As for a machine, your issue is essentially hypopnea and not apnea. Not all machines detect and treat hypopnea as well as full obstructive apnea. I think the best auto CPAP on the market is the ResMed AirSense 10 AutoSet. From testing it does treat hypopnea well, and it is good at reporting hypopnea, obstructive apnea, central apnea, snoring, flow limitation, and other variables. It is compatible with SleepyHead so you can take the SD card from the machine and read it with SleepyHead to get your detailed results.

I see that CPAP.com offers a 30 day free return policy. So I guess one could buy the machine, try it, view the results on SleepyHead, and then decide if an APAP is really necessary, and if you can tolerate it.

Here is a link to the machine at CPAP.com. I would suggest the "For Her" version even if you are male. It has an optional extra program that you can try to see if it works better than the standard program. Unlike places in Canada, this outlet does not seem to offer packages. This appears to be just for the machine standard hose, and no mask. Most will want a heated hose for comfort, and that is an extra $40. A basic mask would be the ResMed AirFit P10, and it is $100. It comes with a fit pack which means it includes the small medium and large inserts, and you use the one that fits you the best. But, I would look around. In Canada you can get the machine, heated hose, and mask for about $900 CDN ($660 US). There may be better prices in the US. But perhaps at CPAP.com you are paying extra for the 30 day ability to return and get your money back. In any case here is the link:

ResMed AirSense 10 AutoSet For Her

Based on the data you provided the diagnosis of "Mild Obstructive Sleep Apnea" would seem about right. The home sleep test is considered suitable for straightforward cases of quite probable sleep apnea in the absence of other cardio pulmonary issues. Your case is not so obvious based on the test. The rating system used for AHI is:

None/Minimal: AHI < 5 per hour

Mild: AHI ≥ 5, but < 15 per hour

Moderate: AHI ≥ 15, but < 30 per hour

Severe: AHI ≥ 30 per hour

Your oxygen desaturation is kind of on the borderline to normal too. See this link for a bit more of an explanation.

In my amateur non medical opinion, the cost no object obvious alternative would be to get a full sleep in the lab test done. That probably will be more invasive than the home sleep test, and if you are paying out of your pocket it can be in the thousands of dollars, depending on your insurance and where you are located. And, at the end of the day the results may come back exactly the same but with more detail.

If that is not feasible then there are three options I can think of:

1. If there are no sleep issues to deal with, do nothing. Up to an AHI of 5 is considered normal. You are close to that, and not having any full apneas (zero air flow), only flow restrictions. If it is an option, weight loss may improve the situation.
2. Dental devices can be considered with mild apnea, but they tend to be expensive. You could talk to your dentist about it. There is one dentist that checks in here and may comment. I also believe there are "boil and bite" dental devices you get at a drug store, but that is probably a last resort. No experience with them, but some report they help.
3. Buy or do a trial on a APAP and see what it does for you. If you get a good APAP that is compatible with SleepyHead you will get much better data on your apnea than you got from your sleep test.

Where are you located and have you been given prices for an APAP? It may seem rash, but in Canada at least you can get a good APAP for $900 CDN or so. In the US about the same, or perhaps a little more. Also in Canada when you have had a home sleep test the labs at least in our province, will give you a free trial of an APAP to see if you tolerate it. That would be the very best way to go if that is an option. In fact that is what I did. I did the free trial and then took the equipment back because they wanted a ridiculous price for it ($2400), and bought my own from an on line company for the $900.

Hope that helps some. If you can fill in a little more detail on what your options and costs are for a machine, I can probably make a few more suggestions.

Back in March or so, I had a home sleep study done with the Philips Alice NightOne system. The Phillips system looks very similar to the ResMed setup and I would say records all the same things. The test report looks very similar. Remember that besides nasal flow there is a respiratory effort sensor based on tension in the belt around your chest. That is an indicator of your breathing. And if you have an apnea there should be a reduction in oxygen saturation which is being measured also. So there are three independent measures of breathing flow, effort, and oxygen. I also breathe through my mouth, and now that I have a CPAP I know I open my mouth in my sleep based on leak data.

My sleep test was a horrible experience and I would have sworn that I got close to zero sleep. But, the device monitors data quality and gives a quality signal in the morning that indicated the test was valid. Who can argue with a computer? In any event it came up with an AHI rating of about 34 which puts me just into the severe range. Now that I have a CPAP and frequently analyze my own data using SleepyHead, I can easily see that I do in fact suffer from obstructive apnea, central apnea, hypopnea, and snoring. It takes about 12 cm of pressure to normalize the obstructive apnea and eliminate the snoring. Central apnea is not reduced with pressure, and my hypopnea seems to be mainly an incomplete central apnea cycle, so it is not reduced so much either. I now have no question that the home sleep study report was reasonably accurate for me, but I sure did wonder at the time.

That said your concern about validity and accuracy is a fair one to question them about. Also for sure you should ask for a copy of the sleep study report. It should look like the example shown on page 4 of the product brochure at the link below.

ApneaLink Product Brochure

If you post the critical details from your report (AHI, OA, CA, hypopnea), you can get some feedback on what it means, and what implications it might have on a need for a machine, any things to watch out for.

The Mayo Clinic review of the system is probably as objective as you are going to find. On a quick read, it sounds like it may work in some people, but it is not a sure thing.

Pillar Procedure - Mayo Clinic

An AHI of 6 is on the borderline of not requiring any treatment. What is the breakdown of events that compose the AHI?