[CPAP] Should I focus on fixing leak, pressure, mask fit?

[costis]

Started therapy since June. AHI was 20, because of hypopneas mostly, 42 Male. I likely have it over 10 years, perhaps since ~20s years and can't state how much I regret I didn't look into that before.

Experienced a handful of amazing days, like feeling 15 years younger, hormonal changes (wanted to hug people more..., appetite changes etc... ), but I still have no consistent results.

TLDR: Attaching 3 screenshots for any kind of recommendation! On average, I feel just a little better than before, hence my concerns.
The AHI 0 was the only one, can't reproduce it with same mask/pressure.  



Rant

Oxygen Desaturations
A handful of days, when I notice oxygen desaturation to ~90% because I unconsciously remove mask during sleep, I feel even worse before the therapy!
Before therapy SpO2 was dropping to 85-90%. I can't for the love of deities have consistently >95% during sleep!
I also notice I have drops to 80% during the day when I start doing some physical activity, like walking outside home, but after some minutes SpO2 returns to normal >96%. 

Masks
I try to replicate those amazing days but can't! I want to feel like that the rest of my life!!!! Tried various settings. Have 3 nasal pillow masks (P30i, Dreamwear, Brevida) and awaiting for my first full-face (Vitera).
Have rented an oxygen concentrator using it in the minimum setting just to see what's happening... No luck to keep SpO2 over 95%...
One nostril is a tad smaller than the other one, perhaps that's the cause... Will also get a cervical pillow.  

Have the feeling that different masks/sizes might need slightly different pressures. Is this correct?

Wanting to convince machine rental company (Dutch insurances work like that) to give me a second mask (3 bought on my own). They say I shouldn't change pressure, and they set my pressure to 8-14. If I try it for 2 weeks they will authorise perhaps. I tell them I feel I suffocate with that, I feel like I am breathing through a small hole, I don't want 8, but on the other hand some nights I can tolerate that better than others. 

EPR
Lowenstein calls it SoftPap, I think it disrupts my sleep, because I try to breathe in when it lowers pressure and I don't like it. Should I insist in case my body learns to breathe with that?


Pressure
What (minimum?) pressure is too high?

[cdplatt]

Your leak rate is high.  That will prevent effective therapy and interrupt your sleep.  Is air leaking out of your mouth (dry mouth is a symptom)?  If so, you may to use methods to keep your mouth closed - chin strap, cervical collar, mouth tape.  Making sure your mouth stays closed can make a big difference with nasal type masks.  A full face mask may also address the problem.  You may try different size nasal pillows to get a better fit with your nostrils if air is leaking there.  Or you could try nasal cushions instead of pillows, though pillows, if they fit properly, should give you a better seal.

Once you have leaks under control, then other adjustments may be made to improve your therapy.

[costis]

Is air leaking out of your mouth (dry mouth is a symptom)? 

Thanks for helping me prioritise I have experienced that, indeed! Especially with high pressures (over 8), some times I wake up with the mouth open and I think I do a sort of "circular breathing", like if the air enters the nose and exits the mouth, but I am asleep and not in full senses to be certain.
I have tried mouth taping, but it's annoying for the some times that I want to cough so I stopped using it. I used wound adhesive tape Leukosilk (can't post link) which was slightly better than normal "brown tape", and can also take it off to cough couple of times before it loses adhesive property on a clean skin. Didn't cost ~19 Euro as in Amazon, but only ~2.5 from local store.  Sometimes it worths it walking a bit... 

I started logging the equipment/conditions of sleep so I'll start taping again. Thanks!

What's the upper pressure limit of nasal pillows you think? I have a lot of nasal pillow sizes and I think I'll make a benchmark video to get systematic data, instead of just waiting night after night...

[HalfAsleep]

I’m not sure what you mean by your last paragraph. You could determine if your mask leaks, by hooking up the unit and mask while you’re awake, since the pressure is fixed. Then, you’d know if it leaks around your nose. This way, you could try different nasal pillow sizes at one sitting if you wanted to. Choose the best.
After that, address the mouth leaks. It sounds like you’re going in the direction of tape.
Get the mask leak rate down, and then post another Oscar.