Help with arousals and CPAP exhaustion

[Aud6778]

I was told to post here by the reddit community. Hello! I am some months into CPAP but I am feeling worse and worse.

Quick facts:
Low AHI high RDI (7 and 17)
No centrals on sleep study
Young, thin, female
Many PLM's detected on sleep study (PLMI 30), but many corresponded with "Spontaneous arousals" (AI 14)
Allergic rhinitis, I use breatheright strips and nasal sprays
Already wear a soft cervical collar
Terrible aerophagia over 13cm, even up to max 12 I tend to get some awakenings from air in my stomach
Low EPR/PS generally made me feel worse.

I'm exhausted. I get a full night of sleep (I'm talking 9-10+ hours sleeping) and need a nap, waking up foggy-headed with CPAP - I get about two hours of daytime before I feel just awful. I'm so exhausted it's making me extremely depressed, I can't do anything. I can also no longer sleep without it, because I can't breathe as well. Lose lose. 

Attached is a sampling of the past few days - I tried going back to just straight-CPAP, as I thought maybe the bilevel mechanics weren't helping.

[G. Szabo]

I suggest you keep the cycle on the medium setting because it gives you the ideal Insp/ exp time ratio. Then, hold the trigger at a very high setting.

Start titrating with the following starting parameters: PS=4.0, Pressure 6-10 cm. 
After a few days, increase the PS by 0.2 units, along with the same increase in the maximum pressure. That is: 
PS=4.2, Pressure 6-10.2 cm. 
PS=4.4, Pressure 6-10.4 cm. Etc.

Try to find the lowest flow limit. 

Do not over-titrate; once the flow limit stops reducing, it is meaningless to add more pressure. You might even need to go below the starting parameters like this:
PS=4.0, Pressure 5.8-9.8 cm.
PS=4.0, Pressure 5.6-9.6 cm.  Etc.

[Aud6778]

Oh cheers. Do you think my flow limits look quite bad? I had thought the bilevel was doing well for them. I notice my charts look less steady sometimes with the lower EPAP - I have more arousals, but at the same time I don't have obstructive apnea even at 6.

[G. Szabo]

Your flow limits and some other parameters are pretty good. However, this is the only characteristic I can think of that you can quantitatively measure to monitor the efficiency of your therapy.
The other avenue would be to titrate and record your subjective feelings, which is not as crazy as it might sound at first. You can try that avenue as well.