Thanks to all that have commented over the last week. I've tried several suggestions and have varying degrees of success at reducing the leaks I am experiencing.
In the last few days, I have managed to keep my leaks at a point where I am mostly waking up with a
and an AHI of 0.3 to 0.5 (down from 161 at my sleep study).
As with my original post, I still feel great when I wake up, even without achieving my morning smiley face.
I am wondering about the line of thought that has been mentioned in the last few replies about the 24L/min leak rate being the standard of deciding what is a reasonable leak and an unreasonable one. Specifically, if the pressure is set in the higher ranges (like my 19 cmH2O), doesn't that mean that more air volume per minute is flowing to the mask to maintain that pressure? If so, wouldn't it make sense that even a very brief leak could result in a spike over 24L/min? In other words, if several liters escape in a short amount of time, say 10 seconds, that could push the leak rate for that minute much higher than the remaining 50 seconds of that minute would otherwise register. If 5/6 of the minute has little or no leak, that doesn't seem so bad, but it would still record a spike above an acceptable level of leak for the entire minute.
If this is true, someone with a lower pressure might need to leak for a good portion of a minute to lose 24 L of air, whereas I might lose that in only a few seconds as the pressurized air escapes from the mask into the lower pressure of the room air.
If this logic is accurate, I'm not sure if it makes sense to consider a leak over 24L/min as being that bad. Leaks are bad in general, but it seems like the leak rate target should slide based on pressure settings.
I never was that good at chemistry, so if my thoughts on the relation between pressure and volume are confused, then my whole theory could be nonsense. My recollection is that, all other things being equal-the temperature and composition of the air, then the relationship between pressure and volume is directly proportional (P1V1=P2V2 sort of thing). If anyone would like to correct me, please do so.