[CPAP] CPAP works, but at the same time doesn't

[joeblough]

your story is remarkably similar to mine, only real difference being that i've always used APAP and originally had 6-12cm but after review with the doctors my median pressure was 7, so i'm now at 6-9cm. i would wake up and just take the thing off after 2-4h of usage. the doctors told me that i really need to wear the thing all night in order to see any benefit from the treatment, so i just grit my teeth and stopped taking it off (when i did so consciously). i'm up to 6.5-7h of usage now and i do feel slightly better though i usually have a headache and some diziness during the day now, rather than full-on fatigue. i do have nights where i wake up and i'm awake for 1-1.5 hours struggling with the mask, but that is a recent phenomenon which i don't fully understand. it was kicked off when the sleep center gave me 2 new masks to try which just didn't agree with me.

i breathe thru my mouth, so without tape, i have to use a FFM. currently using a dreamware hybrid FFM and this has worked the best for me as i do side sleep for ~60% of the night and having the hose come off the top of my head is much better for the side position.

my obstructive AHI is very low but i seem to suffer from central apneas as i fall asleep so my numbers range from 2-4, with 85% CA. you are lucky in that you don't seem to have that problem at all and your numbers look excellent. as hard as it is i'd say to just persevere in not taking the mask off if you can help it. it sounds like you're already mostly there.

another thing you can do is install some kind of camera so that you can see what you are doing at night, how many times you are (visibly) waking up, etc. i also use a spare iphone with SomnoPose to record my position. the position data is very jittery so i do suspect i am waking up a lot and so despite the CPAP i still have sleep fragmentation. i need to do a better job of attaching the phone to my chest though as some of the noise in the data could be caused by the phone just flopping around.

[G. Szabo]

The days previous to yesterday it seems like I took the mask off without realizing it  ...                   
....  Should I be doing anything to address it? I feel like's it's become a habit.

I  would train myself to avoid it. You can try to set the leak alarm so you can put the mask back on when you accidentally remove it. 
Otherwise, Your results are excellent! Give yourself some time to settle and see the results a few weeks from now.

[Deborah K.]

Some folks have said that if they use some tape to attach the mask to their face, the tape removal wakes them up enough so that they can put it back on.

[AUniqueUsername]

Update: I'm still not feeling great. I think I feel marginally better than before, but it's hard to tell. I've attached the data for today, including the data from an pulse oximeter. I would greatly appreciate it if someone took a look at it to make sure everything is normal. I would also like to know if there is anything else I can do to improve my sleep.

[G. Szabo]

...  I've attached the data for today, including the data from an pulse oximeter. I would greatly appreciate it if someone took a look at it to make sure everything is normal. I would also like to know if there is anything else I can do to improve my sleep.

I am happy that you can keep your mask on without interruption. Your HR and saturation data are in the regular/acceptable range.   
I suggest increasing the minimum pressure to 8 cm for a smoother night with fewer pressure adjustments.

[AUniqueUsername]

Thank you very much for giving it a look. Glad everything is looking normal, I'll adjust the pressure as you suggested. That means that whatever is causing my insomnia is not the direct result of sleep apnea, right?

[G. Szabo]

... That means that whatever is causing my insomnia is not the direct result of sleep apnea, right?

I do not have the expertise to answer this question. Let's see how you feel about the new setting.

[AUniqueUsername]

I've tried out the higher pressure. Strangely, at first I thought I felt a little better overall, but after a few days I kept waking up in the middle of the night. Sometimes I get the feeling the air is being "sucked out of me" when I exhale, leaving me feeling suffocated. I'm not sure if this was always the case or I just now noticed, however. The oximetry data is incomplete because I took it off in my sleep, I guess. Also, I probably should've said this earlier, but thanks for your transparency on being unable to answer my previous question.

[G. Szabo]

Sometimes I get the feeling the air is being "sucked out of me" when I exhale, leaving me feeling suffocated. 

You can try setting the EPR=2 so that you exhale against higher pressure. This might address your above observation.
This suggestion also deals with your increased number of CAs. Their number should decrease.

[AUniqueUsername]

I gave turning the EPR down to two a shot and I have mixed news. On one hand, it feels much more comfortable, the previously described feeling of "being suffocated" has completely gone away (which is pretty great!). On the other hand, I seem to be opening my mouth when sleeping now, something I've never had a problem with before. I've got a chin strap and full face mask as a possible resort, although I've never found them very comfortable.