Sierra

It may depend on how the AirCurve 10 is set up. If it is in Auto pressure control it will adjust the pressure based on the events you have had. One thing you may want to do is download OSCAR. This is a freeware program that lets you produce graphs including the pressure of what the machine is doing over the night. This would let you decide if it is behaving as it should, or if it is defective. Using OSCAR requires a PC or Mac and a SD card reader. There should be a SD card in your machine which is recording the data in very fine detail over each night.

OSCAR is quite helpful in determining if the machine is set up as well as it could be.

The issue with posting multiple images is that it can trigger the spam filter. After you have made several posts it seems to be OK after that. The spam filter is a little mysterious in how it works...

About all I can say for what I see in these is that higher pressure seems to help sometimes. The majority of OA events are occurring when pressure is maxed out. It is possible that you may need a BiPAP with a 25 cm max pressure.

One other thought is sleeping position. Most people will have a higher apnea frequency when they sleep on their back, compared to sleeping on their side. If you have any awareness of when you are getting these bursts of OA events you could see if the cause might be sleeping on your back. Some people go to the extend of sewing a tennis ball into the back of their PJ's to discourage sleeping in the back position. Another recent poster here has had some success with this trick.

Are you using a CPAP?

I would suggest going to the Statistics tab and set the report to a custom Date Range with the radio button at the bottom, and set it for the time you had the pressure at 13.6 to see what the breakdown of events are for that date range. But the much higher number of CA events would suggest the pressure may be too high. It looks like you tried a couple of nights at 12.0. I would suggest going back to that pressure for at least a week to see if things get better or or not. Check the breakdown of event times over the time as well to see if CA's go down without OA going up. The idea is to try to get them more in balance or at least get the pressure down as low as it can go without OA events dominating. When doing this I found small changes get lost in the noise. It is better to make 1 cm changes minimum until there is a clear break point in the number of OA events going up. Once you get close to an optimum pressure then you can try smaller changes to get to the optimum point.

I am afraid I have never been able to correlate how I feel in the morning to my AHI score. When I get up I have no idea what the score will be until after I check the machine screen to see what it is. I just have faith that a lower score is better if I get a reasonable sleep.

If you can increase the Flex to 2 or even 3 without increasing your OA frequency, it should help with the exhale effort. It may also reduce your hypopnea. But, as I said before, everyone is a bit different and trying it is the best way to find if it works or not. Same with going to a fixed pressure instead of automatic. You have to try it to find out if you gain or lose with it in fixed mode.

About all I can see for a pattern is that you got the lowest AHI with a minimum of 14 cm and Flex at 3. Raising the minimum can often be the best solution to high OA frequency. It can be more effective that raising the maximum. Narrowing the gap between min and max is more and more like a fixed CPAP pressure mode.

I believe at least the ResMed BiPAP still uses pretty the same algorithm as the APAP. The differential between the IPAP and EPAP is fixed but you can set it up to 10 cm, rather than 3 cm.

The aspect I like about the ResMed compared to the DreamStation is that the ResMed increases pressure fairly quickly and then is much slower to reduce it. The DreamStation in Auto tries to reduce pressure right away. So, it can spend the night going up and down quite a few times. But, you can take this away by narrowing the differential between min and max pressures. Or, if you switch to a fixed pressure than it is irrelevant.

I had an issue where nothing was recorded on my machine a few nights ago. I did a full format (FAT 32) of the card and it has been OK since. Not sure if it was that I didn't have the card fully in, or if the reformatting cured an issue.

I am not so sure based on what I have seen of your results that you would benefit from a BiPAP. The only real difference between what you have and a BiPAP is that a BiPAP can go up to 25 cm maximum pressure instead of 20 cm. And the BiPAPs typically can give you up to 10 cm differential between inhale and exhale, while what you have with Flex limits you to 3 cm differential. It is not obvious at this point that you would benefit from either of those features. I have watched a few of the LankyLeft videos and to be frank, I think he is a bit of a wingnut. Be careful with his advice.

Another thing to keep in mind is the use of a cervical collar if you have OA events in fairly rapid succession. Have a look at this thread. The OP has had very good outcomes with the use of a cervical collar in reducing OA event frequency. The idea is that it keeps your airway straighter and not kinked during sleep.

https://myapnea.org/forum/being-recommended-for-bipap-1-year-out-from-craniotomy

Good that you have the Libre 2. I tried one of the Libre 2 sensors and had issues with getting it to run on my iPhone. I've been waiting for an update to the Libre 2 app to bring it in line with what I have on my phone. They seem very slow in updating their apps.

1. Sorry about the Flex off experience. One never knows until you try it. The "theory" is that because it reduces pressure on exhale and if you are prone to obstructive apnea during the exhale portion of your breathing cycle it can increase the frequency of your OA events. Then if you turn Flex off because it maintains pressure during exhale those OA events will be avoided. I used no EPR on my ResMed for a long time believing it helped. Then I tried it back on full time at 2 cm. It amazingly almost eliminated my hypopnea events without any increase to the OA frequency. It remains a try it and see what happens thing. Different people get different results. I also am a type 2 diabetic on insulin and I know what going low is like. Not a pleasant experience at all. For a couple of years now I have used the FreeStyle Libre sensor system. It is expensive as it is not covered by my insurance, but it sure helps me regulate BG levels a lot better and avoid most of the lows. If you have not tried it you may learn a lot by just using it for two weeks (one sensor). It works with most smart phones, but check to be sure it is approved for yours and your current operating system.
2. I have a ResMed F-20 mask but have not been able to tolerate it. I like my P-10 nasal much better. I cannot keep my mouth closed and I use tape on my mouth to keep it closed. If you can learn to do it without tape that is a good thing.
3. I would experiment with Flex to see what works best for you. More Flex may improve hypopnea, while less may improve OA frequency.

After you settle on the best flex you may then want to try a fixed pressure in CPAP mode.