[CPAP] Extreme difficulty with CPAP after trying everything

[biboombap]

I was diagnosed with moderate sleep apnea (AHI ~21) almost a decade ago and prescribed a CPAP machine (resmed 11). At no point has using the machine ever helped me feel better, and I'm at a loss. FWIW Oscar gives an acceptable number of events on therapy (1.5 AHI nasal or full face + collar, 3 AHI with full face only)

Here are my issues with all the options I've tried.

Nasal mask: either dryness/allergies irritates to the point where my nostrils fully close up, or I get rainout from humidification (I do use a heated hose and hose wrap). Afrin is only a temporary solution.

Full face mask: difficult to fall asleep, irritates throat from dryness, or I get rainout. I also get bad bloating from aerophagia.

Oral appliance: could sleep, but apparently didn't help my apnea at all.

Soft cervical collar: decreases positional apneas, but difficult to fall asleep and neck pain after.

The diminished amount of sleep I get on CPAP from all these side effects seems to outweigh any benefits. I usually feel more and more tired using it until I give up and stop for a week or two. 

Should I look into the more invasive options? Any advice appreciated.

[G. Szabo]

Should I look into the more invasive options? Any advice appreciated.

You will get more help when you post your OSCAR curves.
Until then, I suggest using high humidity to reduce irritation and ignoring rainouts. It helped me!
You can set the humidity manually to 6, for instance, and simultaneously, you can set your hose temperature up to 30 C so the rainout decreases. 
Nasal clogging can be mitigated with a nasal rinse with a salt solution. Low-cost tools for this are available on Amazon.
Also, using APAP with EPR instead of CPAP can help with aerophagia.

[biboombap]

Here's an example. This is one of my best nights on record. The flow rate graph seems to thin out for long periods sometimes, and my tidal volume is always under 400. (I'm a 5'11" guy weighing 170lbs.) Could any of those be a factor?
https://imgur.com/V0XVVt0

[G. Szabo]

Your tinning flow rate is similar to my one when I was trying to use nasal pillows. I am about to post a detailed record about it. 
To summarize, nasal clogging is most likely caused by leaks, which generate a U-tun air flow in your nasal cavity and dry it out. The less probable scenario is silicon intolerance. The outcome is clogging. In my case, the tinning/clogging happened systematically after 3-4 hours of the nasal pillow setup.     

For now, my advice is to stop using the pillow. Use a cradle instead. Alternatively, use a nasal mask without a pillow or cradle. Use high humidity with a heated hose.

Once you resolve the clogging, we need to revisit your pressure setting. Because of the clogging, you currently need a higher minimum pressure. However, you might not need it at all without clogging.

[biboombap]

@GSzabo: Thanks for the advice and apologies. I hadn't updated my mask type in my profile, so I just did so. I'm using a full-face mask currently (including in this data.) Do you think that an air leak could still be causing the issue? Or could the flow rate clogging be caused by something else/positional apnea?

[G. Szabo]

Would you mind posting three-minute windows of your flow rate curve at the following times: 2:45, 3:15, and 3:30?

You should increase your minimum pressure to 14 cm. and use EPR=3 full-time.

Also, next time, turn off your calendar and organize your OSCAR according to the advice of WIKIPEDIA.t

[HalfAsleep]

Try your cervical collar looser. Since it’s not for neck therapy, it doesn’t have to be tight. It only has to keep your mouth from dropping open in the night, which will cause it to be dry. Some folks also use xylimelts.
I use a collar with an FFM. It helps the dry mouth some nights. It took a while to get used to it, but I also rarely have positional apnea these days.

Have you been to an ENT lately to check out your nose?

[biboombap]

Would you mind posting three-minute windows of your flow rate curve at the following times: 2:45, 3:15, and 3:30?

You should increase your minimum pressure to 14 cm. and use EPR=3 full-time.

Also, next time, turn off your calendar and organize your OSCAR according to the advice of WIKIPEDIA.t

Got it. Here's the flow rate curves:

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Try your cervical collar looser. Since it’s not for neck therapy, it doesn’t have to be tight. It only has to keep your mouth from dropping open in the night, which will cause it to be dry. Some folks also use xylimelts.
I use a collar with an FFM. It helps the dry mouth some nights. It took a while to get used to it, but I also rarely have positional apnea these days.

Have you been to an ENT lately to check out your nose?

I'm planning to go to an ENT the next month. Never got a sleep apnea related ENT visit done, although I do have a deviated septum.

[Phaleronic]

Place the machine lower to the floor and rig or purchase a hose hanger to have the hose able to move above your head, then you'll be able to use the humidifier efficaciously. I can post a picture of how you should set this up if you'd like.

[G. Szabo]

Your first high-resolution plot is similar to my one when I had nasal congestion and was using a nasal mask with mouth taping.

Two or three distinct regions can be seen on your whole night flow curve. The thinner regions correspond to congestion, and you see the damped oscillation pattern there. You might switch between nasal and oral breathing throughout the night. When nasal breathing becomes difficult, you switch to oral breathing. But this is just my guess, and it is not too practical for you.

Leaks reduce humidity, so you want to mitigate them. You should use as high a humidity as you can tolerate. Consider my earlier comments about mitigating dryness as well.