Rough AHIs after a few months of determined usage

[applecat]

Hello, looking for some advice. 

My AHI the past several months of usage has been rough, never dropping below 3, often averaging around 8. I've only reliably been using my CPAP for the last four to five months, although I've been prescribed much longer - but I'm able to wear it throughout the night and no longer have difficulties sleeping with it. It is difficult for me to breathe through my nose when laying down without explicit effort, so I have been using a full face mask. 

I'm really determined to make this work for me and could use all the help possible in analyzing my data. I understand I've been stupid by not using my CPAP for so long, and I won't bore you with the typical difficulties of acclimating to the machine, or the lack of support from the sleep docs. 

I've been struggling with mask leakages as well, and any help there would be appreciated.

Please see the attached data, including sleep study report; and selected OSCAR data (including last night, although I had a cold). My machine didn't have an SD card until earlier this month, when I learned about this board, the CPAP subreddit, OSCAR, etc. I've linked my sleephq for the month below, although I don't have enough posts to direct link.

https:// [remove this space] sleephq.com/public/b997425a-f98b-4bde-953a-7246610c9ce6

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More attachments.

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Aaaaand a few more attachments, including the original sleep study.

[OpalRose]

The leaking is your biggest issue.  What mask are you using?  It clearly doesn't fit properly.  Read through this link.  
You might find some hints to help you get a better fit.  

Mask Primer

Also this:  https://www.apneaboard.com/wiki/index.ph..._Jeffy1958

Using EPR could also help with breathing out against the pressure.  I suggest you raise your minimum pressure to at least
10cm as your reading is over 11cm for 95% of the night or less.  

Set minimum pressure at 10.  Leave max where it is and set EPR at 2.

But work on the mask leaking.  Hopefully, you can get your mask to work or you may need to try a different mask.
No pressure changes will make much of a difference as long as the leaking continues at such a high rate.

[applecat]

Thanks Opal! Since your response, I've read through the mask docs and have been adjusting it each night - never realized how much of a difference it makes. Back to dreaming again! 

Still working on getting the fit juuuuust right but I've attached the last two days.

[OpalRose]

Looks better, but still a lot of mask leaks. Keep working at it. You may be moving around at night and your mask moves with you. If you sleep on your side, be sure to move your head to the end of your pillow, so that your mask doesn't get pushed around.

Would like to get flow limitation down more. Would you be willing to try EPR set at 3. You may need a bit higher pressure too but let's try one thing at a time.

[applecat]

Sorry for the late response - it's been a constant leak battle trying things like chin straps, mouth tape, chin collars, and new masks.

The chin collar seems to work well (see attachment from mar 15), but is very uncomfortable. Still experimenting with other options. 

Here are some EPR 3 nights:

[applecat]

Looks like I'm using my collar for the rest of time! Last night's readings (had to get up for a bit to drop the wife off at work):

[applecat]

Leaks were fine but my AHI wasn't great last night.

[jdougc]

Are you still using the soft cervical collar , can your chin still tuck down? Maybe it is too small?
Are you still using EPR 3 full time? Your flow limits are high.
We are not seeing your machine settings.
On the 18th your pressure increases were mostly due to your Flow limits
On the 19th you had the flow limits plus clusters of events, usually positional apnea.