[Diagnosis] Should I change my treatment?

[jmordoj]

Hi, I have been reading this forum for over a year, and lately I have been thinking maybe there is something wrong with my treatment, 

I started with a study in October of 2018 with over 30 AHI, and wen I got my ResMed S10 AutoSet my numbers went down very quick to the low 10's

But now, almost a year and a half after that, It seems I can get to the numbers people in this forum share (like 5's or less AHI)

Should I change my treatment, maybe get a ASV?

(I'm much less tired now but I still feel sleepy every day..

Jack
(I'm in Chile, South America so my sleep study is in Spanish, maybe I can post the relevant stuff)

[Sleeprider]

You have obstructive apnea that appear to be somewhat positional (chin-tuck), but the majority of events by far are central apnea. A CPAP, even one as good as the autoset is not capable of causing you to take a breath when you don't make the spontaneous effort. You are currently using pressure from 6.0 to 13.0, and generally do not exceed 9-10 cm. Just for starters, I'd like you to consider the factors that cause your obstructive apnea to cluster, like a high pillow, and try to deal with that. A soft cervical collar might be worthwhile as a trial. The CA events we really can't reduce with CPAP. You an try turning EPR off, and we can see what kind of reduction in events (and comfort) result. Fixed pressure often reduces CA events, and a fixed pressure of 8.0 might be worth trying to see if that can reduce events. I think that is a good starting point before suggesting you move to ASV.

[jmordoj]

Thank you very much for your advice, I think the EPR setting I wold ask my Doctor if he allows me ti do it.
So if my pillow could be a factor should I get a very flat o no pillow at all?

[Sleeprider]

Since the EPR setting is considered a comfort feature, it's rare that a doctor would even consider it. Just do it, and I'm sure you can determine if it is better or not. Easier to just do the deed and decide whether to keep the change, than to ask permission.