(01-09-2016 02:17 PM)Dennis Finnan Wrote: The Doctor said i should just stop using it. My wife says when I do I gasp all night long and snore terribly. I have no mask leaks, and I've set my auto cpap to 8-18cm, and it still averages 17-20 AHI. Occasionally I will have a good night of 6-9 AHI.
I think your doctors should have focused on referring you to someone with greater expertise, not advising you to ignore the problem just because they do not understand what else to recommend.
Firstly, Obstructve Sleep Apnea is usually strongly positional, and flat on our back (supine) is usually the worst position, strongly increasing our pressure needs, leading to Large Leak if mask is adjusted slightly too loose than needed to maintain proper mask seal at high pressures. (However, it is important that the mask not be tighter than whatever is needed for the upper pressure limit.)
Many of us have found that we need to take precautions to assure we will not roll over onto our back (and remain in that position) while asleep. Some of us wear a snug teeshirt with a couple tennis balls in pockets or socks sewn along the spine between the shoulder blades and higher. Others wear a light knapsack with something in it light but bulky like some tubes of tennis balls, to assure they don't roll onto their back while asleep. Others use super long "body pillows" under the sheet to help control sleep position. Others find they they cannot sleep on their side and must sleep on their back and find it helps to sleep in a comfortable reclining chair so the spine and neck are aligned but elevated.
Available by prescription is a new positional sensor device called Night Shift Sleep Positioner http://www.advancedbrainmonitoring.com/sleep-medicine
which is a vibro-tactile device worn on the back of the neck, which silently vibrates progressively more strongly to alert us when we are in the supine position, to gently arouse us enough for us to change position and easily fall asleep again. This can be used along with a CPAP machine, or, if our OSA is mild enough, might be sufficient on its own to train us to avoid the supine position and achieve restful sleep.
Secondly, it looks like your upper pressure limit (14) is too low to stop the obstructive apneas, which are the dominant problem. But if you can totally prevent sleeping in supine position, perhaps you won't need to raise the upper limit higher than 14.
Thirdly, your central apneas look to me like they are mostly occurring at high pressures. This is good to keep an eye on, because in your case raising the upper pressure limit too much may strongly increase the number of central apneas. I suggest a goal of reducing the overall AHI (which includes obstructive apneas, central apneas and hypopneas). If controlling your sleep position does not solve the high AHI problem, I think raising the upper pressure limit would be appropriate if obstructive apneas continue to be the dominant form of apnea.
I think central apneas if short are less harmful than obstructive apneas, because as soon as we try to breathe a central apnea ends, in contrast to obstructive apneas which generally require strong effort and result in strong stress on the heart and strong sleep disturbance, leading to daytime sleepiness and long term damage.
If central apneas are usually outnumbering obstructive apneas and if we are usually having more than more than 5 central apneas per hour, I think an Adaptive Servo Ventilator (ASV) type of bilevel CPAP machine would be needed. ASV bilevel machines are more expensive than standard bilevel machines but are able to prevent both obstructive and central apneas.