CPAP waking me up, could use some advice

[MoonMask]

Hi everyone! I'm really in need of some advice. A few weeks ago I was diagnosed with mild OSA via a WatchPAT One home test (see attached image for results). I ordered an AirSense 11, and have been desperate to see any sort of improvement as I believe I have been struggling with sleep apnea for years now, and I'm at the point where I am genuinely worried about losing my job. My issue is that every single night without fail, I wake up after 30-60 minutes in a panic, feeling as if I can't breathe. Every time I try to power through it, I always end up ripping my mask off. I could really use some advice for any way I could possibly avoid this; some people say it takes time to get used to it, but at the very least I want to make sure there's nothing I can be doing in the meantime.

I keep putting off posting this, so I'm just going to info dump below, apologies for the lack of organization. If there's any clarification or additional OSCAR screenshots I can provide, please let me know!

Background info:

• Based on sleep study results, there's a pretty significant correlation with REM sleep, which seems somewhat common
  
• I had been reading threads about the QuietAir elbow for the AirTouch F20, and how it may lead to hypercapnia/rebreathing. I ordered the old-style elbow, and began using it on May 31st. The awakening patterns remained the same, although I do feel much more comfortable with it (maybe this is psychological, but it definitely feels easier to exhale)
  
• I originally had a whole titration plan which I was planning to stick to, but that fell apart pretty quickly once I realized I couldn't sleep through the night. Right now I'm basically just trying every combo of settings to get a full night of sleep, and then I figure I can work backwards to find some more ideal settings
  
• I can't breathe through my nose when I sleep. I know I should probably see an ENT about this, but I'm pretty adverse to surgery due to anxiety. I don't appear to have any major issues with leaks (albeit based on an incredibly low amount of data), and I'm okay with a FFM for the moment, so I'd like to avoid this route for the time being unless anyone believes there's a strong connection here
  
• Prior to CPAP therapy, I never woke up while sleeping, at least consciously (though obviously I was having arousals, I just never noticed). I'm usually an incredibly deep sleeper, will sleep through just about anything, with my natural sleep time being 10-12 hours. I must take a prescription stimulant to wake up, followed by 1 hour of alarms every 5 minutes, and I never have trouble falling back asleep. Interestingly, as a general rule I do not ever fall asleep or take naps (intentionally or unintentionally) once I'm out of bed for the rest of the day. Additionally, while I've struggled with very strong and consistent fatigue for years now, the daytime "sleepiness" feeling people describe did not start setting in until quite recently when my symptoms started worsening exponentially.
  
• It's a little difficult for me to fall asleep with the mask on, but not nearly as bad as I thought it would be. I wouldn't really consider falling asleep to be a "problem" right now, and I expect this will further improve with time.
  
• Probably unrelated, but I suspect I may have Delayed Sleep Phase Disorder (I also have severe ADHD, for which there's supposedly a correlation). For the past decade or so I've always reverted to a natural sleep schedule of about 3 AM - 2 PM when I'm "allowed" to, no matter how much or how long I manage to deviate from it.
  
• Ignore the absolute timestamps OSCAR shows, there's something funky going on there and they aren't accurate
  

Below I'm including a log of every single night so far, and my (very inexperienced) observations. Take with a gigantic grain of salt, but since I can only include 3 images this may help narrow down specific instances I can provide OSCAR data for if requested (for now I'll just include the full chart for a couple random nights). Note that sleep time estimate is based on when Minute vent/ tidal volume / resp rate seem to "mellow out", which from my understanding appears to be when I begin actually sleeping.

May 23

• Min: 4, Max: 20, EPR: off
  
• Sleep time: 45 minutes.
  
• Arousal happened at 10 cmH2O, preceded by class 7 flow rate shape, no significant pressure changes at time of arousal
  
• Consistent mild flow limits throughout night, <0.1
  

May 24

• Min: 6, Max: 20, EPR 2
  
• Sleep time: 35 minutes.
  
• Arousal happened at 7 cmH20 (7 IPAP, 5 EPAP). Inspiry flow shape is a bit odd, but can't make strong determination for which type
  
• Consistent mild flow limits throughout night, <0.1
  

May 25

• Min: 7, Max: 7, EPR off
  
• Sleep time: 50 minutes (with 2 additional arousals in the middle)
  
• First 2 arousals occurred with high flow limit followed by definitive OA (some of the only non-junk flags I've seen so far). I do not remember waking up for those 2 at all. 3rd arousal was seemingly "random" like the rest.
  
• Consistent larger flow limits throughout night, 0.1-0.5.
  

May 26

• Min: 7, Max: 7, EPR off
  
• Sleep time: 60 minutes (with 2 additional arousals in the middle)
  
• Inconsistent flow limits. 1st arousal had none, and was preceded by both class 2 and class 4 shapes. 2nd arousal had a flow limit spike to 0.5, with marked RERA and Hypopnea, and was preceded by class 4 and class 7 shapes. Again, I did not remember the first 2 arousals occurring. The final arousal had no flow limitation, was preceded by a very quick class 4, and the first "aroused breath" was class 2
  

May 27

• Min: 7, Max: 7, EPR: off
  
• Sleep time: 30 minutes
  
• No flow limitations
  
• Arousal preceded by class 2 and class 4 shapes
  

May 28

• Min: 7, Max: 7, EPR off
  
• No flow limitations
  
• Difficult to tell when arousal happened exactly, but I see what appear to be class 2 and class 4 shapes
  

May 31

• This is my first night with the old non-quiet elbow
  
• Min: 7, Max: 7, EPR: 2
  
• No flow limitations
  
• Class 4 pre-arousal, followed by multiple class 2 "semi-aroused breaths"(?) before complete arousal
  

June 1

• Min: 10, Max: 10, EPR: 3
  
• No flow limitations, other than some small ones while falling asleep, and a very small one which appears to possibly be after the arousal
  
• Preceded by class 4 shapes
  

Thank you all in advance!

[MoonMask]

Attaching some screenshots for the arousals over the past few nights in case they may be helpful

[MoonMask]

Bumping this to hopefully get some advice

It's now been about a month since I started using CPAP every day, and I'm still running into the same issue. I've gone as high as 12 cm pressure (with EPR set to 3), and I'm still ripping the mask off in a panic after about 30-45 minutes (many times I don't even remember doing this). Notably, the majority of my flow rate curves seem to be not-so-great regardless of the pressure, yet my flow limitation is *usually* stuck at 0. It seems to only increase when airflow is being restricted overall (i.e. hypopnea), but does not react at all to flatness or curves with multiple peaks. No idea why that is, since the manual seems to imply otherwise, so maybe my untrained eye is just reading incorrectly?

I've also been using the F&P Evora full face mask, which has been much better for me in the sense that I can truly breathe through my nose for the first time in my life (my guess is this is because of the pressure differential between the inside of my nose and the outside air, which is why the traditional full face mask didn't help at all), however I'm still not able to sleep long enough to get some actual usable data.

I'm considering trying a nasal mask + mouth tape, or possibly looking into a bi-level, but I'm really starting to lose hope at this point. Has anyone else experienced this? I know it takes time to get used to, but it seems most people have issues either falling asleep, or waking up at the 4-5 hour mark, while I'm somewhere in between. Any advice at all would be very much appreciated!

[velolab]

I am started the therapy back in February. I have tried the Evora and found it too uncomfortable. I sleep on my back. I am currently having issues related to mouth leaks.
I use the N20 the most.

[Jay51]

I am not that familiar with the Autoset.  One strategy that helped me at least get to sleep and sleep all night was this:  decrease your max pressure (if you can on this machine) enough so you can at least fall asleep and stay asleep.  When you have accomplished that, then slowly start raising it again for maximum therapeutic benefit.  Can adjust EPR 3, 2, 1, or 0 to comfort also - then adjust for therapeutic later.

[Duncan Hammon]

I am using a mask with a silicone seal.  I have found that if it slips down too far on my nose it restricts my breathing.  It works better for me if I keep it pushed up high on the bridge of my nose.
Duncan