5 months in, still feeling tired, sleep, brain fog killing my career. help plz

[Tabster]

5 months on APAP, I still feel tired, sleepy, and have brain fog, migraines are still a thing. Today I thought I slept well after I woke up, 3 hours later I passed out in a nap (with pap) that lasted for one hour, I woke up many times during that nap but directly went back to sleep and because of it I was late to work. When I came back from work (part-time shift 4 hours) I was super sleepy again and passed out for another 2-hour nap. help please I'm desperate and don't know what to do.

during the sleep study my MLST was completely negative, AHI was 23 but 41 on the back side, and spO2 low was 92, i am muscular.
since starting pap, all my apneas have converted from OSA to CSA. I tried adjusting the pressure to no avail.

images below, please let me know if you need anything else:

           

[PeaceLoveAndPizza]

Please read the link in my signature, “Formatting OSCAR Charts” and post a chart using that format. It makes it much easier to read.

You are spending almost 25% of your sleep with large leaks. That is enough to disturb anyone’s quality sleep. It is quite possible your mask is slipping due to being the incorrect size, not properly adjusted, or is just the wrong mask. Watch some YouTube videos by LankyLefty27 on proper fitting of your mask and see if that helps.

Once the leaks are resolved, we can get a better sense of what may or may not require tweaking.

[Deborah K.]

I notice that you are using a nasal mask.  Might you be mouth breathing?  If so, using good quality mouth tape will solve the problem.  Cover Roll Stretch tape works well.  I prefer Theraband Kinesiology tape as it conforms better to my facial contours and is more comfortable but it is more expensive.  I don't know what is available in Japan, but I think Kinesiology tape will be sold there. If you buy tape make sure it is 2 inches wide, and cut the piece to about 5-1/2 inches long. That will stop the leaks.

Also, are you saying there were no central apneas in your sleep study? If that's correct your CAs are treatment-emergent and will lessen on their own as time passes.

[Tabster]

thank you, I was taping up before but now my mouth adjusted and pretty much stays closed 80% of the time.

I believe treatment-emergent is a valid point. not sure if it will go down though, might consider switching to asv

[THEVGE]

Although your screen shots are not ideal (see comment PeaceLoveandPizza) I can state your pressure is too low. Do you use ramp starting at 4? I would stop using ramp, increase your pressure a bit and check if your flow limitations go down.

ASV is a risky thing if you have no good purpose for it, why do you think it will help you?

[Tabster]

you are correct in that regard, i will go back to taping tonight, i will also adjust fit, but possibly switch to nasal mask soon because of that issue, also i have a beard that might be an issue

[Tabster]

because many events are not detected by the cpap machine that look like central apnea, like it completely ignores them and does not even flag them even though they look the same as other CA events on the flow rate chart.
also the misses recorded me sleeping once and she said i had central events even without pap.