I wouldn't go that hot, or you'll be in the market for a new mask pretty quickly.
With home studies, a big factor is exactly what kind of equipment they used. Some home study sets only have 3 sensors in them, which leads to much less reliable data. Others have almost as much as a full in-lab study, so they are much more reliable.
One individual will experience some variation in their breathing from one night to the next, but all the data strongly suggests that it's pretty minor. Also remember the scientific rule of thumb - if you see a thing then it is there, but if you don't see it doesn't mean that it's not there, it just means you didn't see it. So, if you have a good quality sleep study with proper equipment and they record you having obstructive events, then there is little doubt that you do have OSA because there is an actual recording of it happening. If a study doesn't find anything, then it's always possible there is a problem and it just wasn't detected for some reason.
In my experience, home studies are more likely to over estimate AHI than under estimate it. It is certainly not the case that all of them use time in bed as opposed to total seep time. That is very much dependant on the specific system. Although most of my work is in a lab, I also use a home study setup regularly and it certainly uses total sleep time, as we record 4 channel of EEG to measure sleep stage, so we know when you are sleeping and we know when you're awake (we know if you've been bad or good so be good for goodness sake...).
Perhaps try to get a look at the original data, or have a second study and see how it compares.
I work mainly with face to face discussion, but I use written information for patients who need it and pictures as well when writing is not suitable. Indeed, anything I can reasonably do to help a patient understand whatever they need to understand, I will do.
I must admit that the icon-based menu on the Icon CPAP annoys me to no end. Also the humidifier chamber is hard to clean and the lid can be fiddly, but otherwise it's a fine machine. Did you know that it can work as a clock and play your favourite music as an alarm?
We certainly only use sleep time on our home studies, not time in bed. I imagine it depends on which sensors are used in recording the data.
Actually, it is far more likely for a home study to overestimate AHI, and often by a very large amount. They can also underestimate but this is far less common. As a lab based study usually has a lot more sensors, this allows detection of other causes for an arousal besides respiratory, which will reduce the AHI. Because a home study has fewer sensors, almost every arousal detected will be classed as an apnoea or hypopnoea because it is not looking for the other this which could be responsible for that arousal. Sorry if that doesn't make sense. I've just finished a 13 hour shift.
Patient education is a major part of my role. In general the better educated the patient, the better the outcomes. However, I know that this view is not shared throughout the industry. It is also worth remembering that some people are unable to understand much due to language or intellectual hurdles, and other people really want to know as little as necessary, so I try to tailor what I do to suit the needs of each individual patient.
The pressure your ramp starts at is all about comfort, so if it is comfortable then it is right. It's that simple.
Ha. I'm not sure if I could. I can be to honest for my own good sometimes. I work at a facility that provides studies and treatment to patients free of charge, so I have no vested interest in whether someone is treated or not, or in what form of treatment they use. My job is just to help, which is nice.
Are you starting at a pressure of 11? CPAP is more likely to induce central events, especially at onset, at higher pressures. Perhaps you could set a ramp and start at 4 cmH2O. Once you have settled into sleep the problem will most likely go away.