Clear Airway / Flow Limitation

[MikeR20]

Hello all,

Have several questions so I'm going to try to be concise and clear.
Sorry in advance for any mistake.

Context: 24M, not overweight, did a sleep study which indicated Mild OSA, 26 AHI. Before this, I slept on my back, where the Osa is more prevalent. I do not Snore.
1 month in the APAP treatment (8-13), of side sleeping with mouth taping and nasal decongestion spray, and I'm still struggling to get restful sleep.  I always wake up tired, to several degrees, and usually wake up 6 hours after I fall asleep and the majority of the nights I fall asleep again.  I 100% complain about the treatment and the mask in itself does not cause me trouble getting to sleep. I believe the tiredness is 100% due to sleep since I have done extensive blood work and other exams.
I usually dont have major leaks, and had some days (5) with Cheyne Stokes Respiration does this indicates something?

Questions: 
1- Over the last weeks I have been lowering ERP to try to reduce treatment-induced Clear Airway Events. 2 days ago I switched from EPR 1 to Off, and I felt exhausted in the morning. This is especially weird since I slept more than usual (weekend). Is it right to assume that I should increase EPR and discard the early-day data due to the body adapting to treatment?
 
2- Do I need to increase pressure? On the 12th I increase the max pressure from 12 to 13.


3- Should I be concerned with Flow Limitations? EPR up should help from what I have read here. Could a deviated septum contribute to Flow Limitations? Still haven't done an endoscopy or DISE. Would a pillow mask be better than a nasal mask?

4- It appears that whenever I briefly sleep on my back the AHI skyrockets. This is my favorite sleeping position, which I have ceased since started the APAP. Shouldn't the APAP allow for black sleeping, even if mechanically is not optimal? Is a hedge pillow mandatory?

Any comment or tip would be really helpful
Thank you, sorry for the long post.

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ERP/ AHI History

[MikeR20]

If any other graphic is needed, please let me know.
I also occasionally get air into my mouth, chipmunk-like. Is this due to a certain position?

[staceyburke]

In my opinion you should use EPR. If you look at your pressures- your pressure goes up with your flow limits. This.quick changes of Pressure cannnot be good for deep sleep or staying asleep and you are only getting to your max pressure because of flow limits. For those reasons I would move EPR to 3. 

With ELR 3 you do not need to raise the max pressure. 

Sleeping on your back is causing positional apnea. No pressure can help positional apne, you just have to stay out of the position. If you can’t stay out of the position then you will need a collar. I have a link about that in my signature. 

Cheyne st. Is just periodic breathing. When sleeping breathing is usually very consistent - it is usually not important.

[MikeR20]

Thank you for the feedback staceyburke
Will definitely try it, and post the feedback so someone can find it useful