You could be my CPAP sister. Don't give up, but also don't sit there and expect them to "fix" it. My Doctor finally gave up on me and said I could change any and all settings I wanted
I was happy with this because I had reached a dead end with him, quite early on.
OA's, hypopneas, and flow limits leave you room for improvement. The machine "should" be able to reduce these.
step one-get your events undercontrol. Your plot is interesting and similar to mine (used to be at least). I use Resmed and was trying to figure out how your machine could reduce your pressure right after having several OA's in a row and then I remembered that the Resmed is more "aggressive" with pressure and hesitates to reduce it, the PR, at least how I understand it from this forum, is more aggressive in trying to reduce the pressure whenever it can. Many people like the PR system trying to keep the pressure low, you personally many not react well to this method of treatment. Look at your data and see if the OA's tend to start right back up again right after the PR drops your pressure back down. Your pressure minimum is set to 7 and for this machine and you, this may be too low causing you to go into and out of OA cycles. This is what I was doing, but not into full OA, but dropping to zero-recovering-ramping down to zero again and repeating, over and over for hours at a time-Quite disturbing to sleep.
If you increase your min pressure it should move this increase/decrease pressure pattern up to a higher pressure range, perhaps above where your apneas occur.
I suggest you help your Doctor see what is going on. I also had trouble getting my Doctor to look at sleepyhead plots-for several reasons. He was not familiar with the plots and he was more interested in averages then one night details. I stopped showing him plots and gave him summary information that I compiled. What percentage of nights were high AHI and disruptive and what kind of apneas during the disruptive nights. Voice your concern that being so varied the chances of getting a sleep study that aligns with the disruptive sleeping is slim, what can we do about that?
My Doctor eventually right out asked me what machine I wanted, scheduled a sleep study and with only 30 minutes of sleep that night, got a report that magically said I needed the machine I wanted. The sleep center was in his office and I am sure the talked to the sleep tech to get this. Insurance goes by the sleep center report not the raw data that led to the report. If your disruptive nights are mixed CA and OA, go for an ASV machine. If not you might want to go for a BiLevel machine, they have many more settings to try than your current machine.
If you don't want to change your therapy setting on your own, tell him what you are thinking and why and ask if he will give it a try?
For me I found I also had COPD on top of SA and once we stopped talking about numbers and started talking about how I was feeling-I said "as soon as I lay down I feel my breathing restricted" he referred me to a pulmonologist and I got Dx'd for COPD. THis got the COPD out of the way and back focusing on the remaining changes I needed for the SA treatment. WIth the help of some on this forum I slowly increased my minimum settings and stopped cycling in and out of apneas all night.
I also found out that I am a abnormally slow breather and had to change settings for that (BiLevel). All of this because of this forum and by dragging by Doctor along with me.
I suggest you fight for the best treatment you can get, you may reach a time when it is the best it can be-but I do not think you are there yet.