sleeptech

That is an AHI of 6.9 (I'm too tired to double check) which is only slightly elevated. Not panic stations but keep an eye on it. If it remains at that level there may be scope for improvement.

If you have central apnoeas, the only way to properly assess that, and certainly to treat it, is with an in-lab study.

You say "during a titration, as a tech raises pressure(s), the saturation usually gets fixed at a lower pressure than what is required to fix sleep disturbance"

In most cases this is incorrect. I am a tech who raises pressure during a titration and usually oxygen saturation is not fully stabilised at a lower pressure than is required to fix sleep disturbances. While this can be true occasionally, it is far more common that the pressure at which oxygen saturation is fully stabilised is the best one to fix sleep disturbance.

You are correct. If you had such a large leak that it was causing a large drop in pressure it would definitely show up in the data.

As I said before, It is not necessarily correct.

I have watched thousands of people using CPAP with nasal masks and mouth leaking. Sometimes it is a problem and sometimes not. Sometimes there is no loss of pressure, sometimes a small loss of pressure and sometimes a large one. I have never, in almost 2 decades, seen anything like a total loss of pressure due to mouth leak. It may be possible but I have never seen it.

While it is not ideal to perform a titration PSG with mouth leak it is certainly possible and in some cases necessary. Some people cannot use a full face mask for various reasons and have no option but to use a nasal mask even though they mouth leak, and in these cases they must be titrated with the mouth leak.

A diagnostic study cannot be performed with a mouth leak because to have a mouth leak one must be using CPAP and if the patient is using CPAP it is not a diagnostic study.

If a patient using CPAP at home had such a large mouth leak that it was causing a major loss of pressure it would show up very clearly on their download data.

These are the simple facts.

That is not necessarily correct. It very much depends on the size of the leak. In many instances the machine will compensate and treatment pressure does not alter a lot. It is very individual. I have never seen a mouth leak so large that there is no pressure.

It is possible for mouth leak to affect the accuracy of the data reported by your machine, but I wouldn't get too worried. Fix the mouth leak and then see if your AHI goes up much. Typical approaches are a chin strap or a full face mask.

Better mask fit may help, but basically that is what autoset CPAPs do. It is turning itself up because it thinks you are obstructing and need the increasing air pressure to keep your airway open. I would guess that your obstruction is worse in your REM sleep and your machine is responding by increasing the pressure. In the past ResMed machines have been rather slow to reduce the pressure after having increased it but this may be linked to the leak you describe. The leak may be interfering with the machines ability to sense your breathing and so it just leaves the pressure up. Hopefully, though, you will become less sensitive to it over time. Stopping the machine and starting it again is what you should be doing when the pressure is too high.

There are 2 types of sleep apnoea, obstructive sleep apnoea (OSA) and central sleep apnoea (CSA). OSA means that your upper airway relaxes too much in sleep causing it to collapse and obstruct the airflow to your lungs. Your brain has to stop sleeping for a moment to tell the muscles to open up your airway again, causing a disruption in your sleep and an increase in your heart rate. CSA means that the muscles around your lungs aren't pushing the air in and out properly. Instead, sometimes they stop working for a few breaths at a time. The effect it very much the same as for OSA.

Both are significant medical issues and both are treatable by PAP (Positive Airway Pressure) therapy of one kind or another.

The short answer to you original question, DadisSnoring, is that if the few events you are currently experiencing on CPAP are due to obstruction then increasing the pressure should indeed get rid of them. However, obstructive sleep apnoea is not the only thing that can cause a raised AHI as reported by a CPAP machine. I strongly support the idea that you consult with you doctor, but it should not be hard to have a try at turning you CPAP up a little to see if this reduces your residual AHI without negatively affecting you comfort. To be clear, I am not a fan of the "set your own pressure however you like and who cares what anyone else thinks" line of thinking that is prevalent on many internet OSA fora, but your above posts suggest that this is not what you had in mind anyway. Best of luck.