I have a friend who flies to and from Paro regularly in MSFS. I think he logged around 500 hours or so with flights to and from Paro all the time, and he does it in the PMDG 737.
For him, he always takes manual control and always fly visually even though the approach is RNAV Z. He always “hugs” the terrain as low as possible so he can make the final turn at the right time and altitude for a single digit landing FPM. He’s an expert on both runway approaches.
Last time I fly on the FBW A32NX was also following the same method. Keeping AP to follow the RNAV path is more difficult because you’re doing too many things in the instruments to make sure you’re on the right altitude at the right time. Almost always whenever I try to use the AutoPilot and the MCU switches to follow the flight path always end up overshooting the runway.
So I follow his method instead, as soon as I enter the valley, disengage AP and keep hugging the terrain as low as possible and follow the valley, at the end do a final turn towards the runway and land the aircraft manually.
Suffice to say, I only want to do it once or twice and never do that airport ever again. Hahaha, but he always fly to Paro at least 3x a week.