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Crikey, I had no idea that my lingo would leave youse blokes so bamboozled. Well, strike a light, I guess I'll just go and throw another shrimp on the barbie. Or something.
CPAP definitely is a valid option for OSA of any severity. If weight loss cures it in you case then that is ideal, but it doesn't work for everyone and many people find weight loss very hard. Really, it doesn't matter what treatment you use as long as it works, but don't discount CPAP just because your sleep apnoea was labelled (somewhat questionably) as mild.
Also, don't be put off by the negative talk about CPAP. It is by far and away the most effective treatment for OSA. This is why it is used by millions (if not tens of millions) of people around the world. Even if it is only unsuccessful for 1% of these people, that still equates to tens to hundreds of thousands of people venting their frustration about CPAP, while the 99% who are successfully treated are far less likely to make a fuss about it. The volume of negative talk about CPAP is simply a side effect of it being so a successful a treatment and so widely used.
OSA does cause reduced libido. The research is pretty clear on that. So you are correct.
Actually, there is a documented effect where swapping from a nasal mask to an full face can cause an increase in AHI for SOME people. This is referred to in sleep tech slang as the "reverse MAS effect" as it is believed that what is happening is the opposite effect of using a dental mouth splint. The full face mask presses on the lower jaw which in turn puts more pressure on the air way making it collapse more and emphasising the obstruction. This can usually be countered with a higher pressure. I have seen it myself several times. With this in mind, it is not that surprising that swapping from a full face mask to a nasal has lead to a decrease in AHI. Lucky you!
Well, calling it better or worse is a bit simplistic. Neither the fragmented sleep architecture and sleep stage deficits caused by OSA nor the sleep stage rebounding which often occurs in titration studies are a natural, health sleep pattern. Both of them will have deleterious effects if they remain unchanged over the long term. The difference is that one is the result of disruption by OSA and will only get worse if untreated and the other is that start of the path to health sleep. Neither is necessarily better or worse, rather both are abnormal. Think of it like food. Both eating too much and too little are bad for you in different ways (as is eating the wrong things). What you need is a healthy diet with the correct balance of various different nutrients. Anything else will cause a problem.
Also, when looking at the sleep staging on a titration study one must take into account the fact that sleep lab is not a normal sleep environment. The patient is covered in sensors, in a strange bed, being monitored by some weirdo on the other end of a camera (i.e. me), stressed by having a medical procedure (albeit a minor one), trying CPAP for the first time and so on and so forth. All of these things will lead to disrupted sleep. Then there are external factors in a patient's home environment which may disrupt their sleep, but which are not present at the sleep lab. All of these factors, and more I can't be bothered trying to think of, all mean that the chances of someone having normal sleep architecture in any sleep study, and especially a titration study, are incredibly small. This is why simply looking at sleep staging in a titration study, while being able to reveal certain information to a trained eye, is a poor guide as to the success or otherwise of the study. It is a part of the picture, but only a small part and it requires some skill and knowledge to properly interpret.
I know that explanation is getting a little technical, but I hope that it clarifies things to some degree.
Some variation in AHI is normal, and the level of variation you describe is not unusual, so don't get too concerned. 23 L/min is a medium-ish sort of leak (sorry, but it's hard to be more specific). At the moment, the best hing you can do it to monitor your AHI and leak readings to get an idea of how they vary. You may find your AHI drifts up and down a bit. You may find your leak varies too. It's hard to say without spending a bit of time working out what is normal for you. You may just be seeing a bit of blip.
Remember, the damage sleep apnoea does occurs over the long term. A few nights make little difference. Also, you have survived so far without CPAP so it's OK to take a little time to iron out the kinks. Before there is a stream of angry posts, I am not in any way suggesting that you abandon treatment or that it's not important. Only that it is a long term proposition and if it's not all perfect from the first night, that's OK. Take the time you need to get it right.
Both the main problems you have mentioned are common symptoms of OSA. The simple answer is to give treatment a go. I would not recommend ignoring it as it is only going to get worse with age. It's not a question of IF it causes a problem but WHEN. It would be wise to deal with it now, before it has damaged your body (hopefully), rather than waiting until after you have a heart attack. Have a go. You can only benefit if it works.
Just a point of clarification: sleep architecture does not just spring back to normal as soon as OSA is resolved. The reverse is true. It usually takes some time for the brain to re-establish normal sleep patterns after OSA has been successfully treated. Because of this, abnormal sleep staging in a titration study is not an indication that the study was unsuccessful. In fact it is quite rare for a patient to have completely normal sleep staging in a titration study, based on the thousands I have done over the years and the literature on the subject. Instead, sleep staging normalises over time.
None of that part makes sense. It's gotta be a stuff up somehow. Probably the doctor just ignored that part because it is clearly wrong.
I am guessing that you have BiPAP for 2 reasons, Wiredgeorge. 1) If you need a pressure above 20 then you need a BiPAP because CPAPs only go up to 20. On a side note, a BiPAP can be set to work like a CPAP, so if we need CPAP of 20 - 25 we use a BiPAP set as a CPAP. 2) Comfort. It is usually assumed that a little variation in pressure makes for better comfort. In my experience this is not the case for the majority, but it can help in some cases. It works just like EPR really. It is worth noting that at settings of 25/21 you are getting the equivalent of a CPAP of 21, not 25.
As I mentioned above, few people fully appreciate the intricacies of BiPAP. That goes for doctors as well as technicians, so it's possible the people that set you up didn't know that much about it. I am privileged to work somewhere that has given me the chance to do hundreds of BiPAP studies, and develop some very specialised skills and knowledge.
