[Symptoms] New machine and some hiccups

[PeterP60]

Hi again! Here are the results from the last two nights (still at a pressure of 9), as well as the full results from my sleep study. I hope this helps. Thanks as always for the guidance!

[Gideon]

Thanks for the sleep study.  All I am seeing is normal daily variation.

That tells me that IMHO you should be on 6 cmw.  I would like you to try 6 for a few days.  If you have change it because it is uncomfortable, try 7 or 8, but I would like you to try 6 

honestly, I'm not sure that will work either, but we need to try.

[PeterP60]

Hi again,

Here are my results from 6 nights, with a fixed 6 as you recommended. AHI stayed pretty consistent for the first night, then dropped significantly for two nights straight, then spiked back up, oddly. Sleeps themselves have been...alright, though a bit tired during the day for some of these days. Any thoughts? Thanks!

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Sorry, apparently you can only upload 5 files at once maximum. Here's the data from the final night. Thanks!

[Gideon]

Do you mind trying fixed 5 cmw
This is below what I like pressure to be If it feels uncomfortable, bring pressure back up to comfort.

That said what I see is your apnea is consistently inconsistent, especially the central element and to a certain extent your hypopneas, Flow Limits, and RERAs also.
The best machine for you will be the ResMed AirCurve 10 ASV. 2 Keywords, ResMed and ASV. The ASV has the ability to adjust for both Central/Mixed apneas and obstructive events at the same time. The trouble will be convincing your doctor. We have done everything we can do with either a CPAP, APAP, or BiLevel to manage your apnea and failed. Your centrals are frequently going over 5. A lot will depend on your symptoms, your complaints about your sleep and your wake state tiredness.

[PeterP60]

Hi again,

Thanks for all of the help thus far. 5 didn't really work for me - the sleep was fine, but I didn't feel at all rested the next day. 

The advice about the other machine is helpful. I'll talk to my doctor about it. Unfortunately, I'm not covered for another machine for 2 more years (I think my plan includes a new machine every 2 years, and a new mask every 6 months). I'm going to start by tackling my mouth-opening problem first - I believe this is negatively affecting both my AHI and overall sleep / restfulness. Then I'll see about other machines and solutions for further reducing my AHI. 

Best,
Peter

[SarcasticDave94]

Most insurances allow for machine changes sooner if your symptoms have changed and are now not treated via your current level of xPAP. Your nightly results, complaint of issues told to your doctor about this that becomes documented into your chart, and then the doctor would agree to create a medical necessity report for an ASV.

As bonjour mentioned, when you pursue this, you want ResMed ASV. So when it's time to find a DME to dispense, either the script will need to say ResMed ASV and dispense as written, or you will need to work with a DME that will dispense the ResMed.