8 Months of PAP Therapy and still working on it...

[NotQuiteAsleep]

Hello,

I've been on APAP therapy since 08/2022 after completing an in lab sleep study. Before starting PAP therapy I was extremely tired and sore all over and unable to function. I'm currently doing better but not quite where I would like to be. I still feel run down and some days I am achy all over. I've used a P10, N20, Evora Full, Pilairo, Brevida and currently trying a Bleep dreamport. Additionally, I tried a soft cervical collar, but I couldn't find one that was a great fit since I am tall and have a skinny neck. Currently using a knightsbridge chinstrap to try an keep my mouth closed at night. I'm struggling with mouth leaks even with the chin strap. I've got a bit of a bight issue with a gap between my upper and lower teeth in the front. 

Some days, things feel alrightish, but then other days I wake up and feel like I got hit by a bus while sleeping despite a low (<0.5) AHI. Last night my AHI was low and my mouth leaks were less than usual, but I would like to improve them still. I woke up and felt achy all over. My machine only reported a small handful of hypopneas and 1 obstructive apnea. However, there are somethings that I suspect are events but not being flagged by my machine. From 4-5 am my breathing looks to have been shallow. I'm thinking maybe my O2 levels dropped, but I do not currently have a sleep spO2 monitor. What do you all think? Is there anything I can do to improve my sleep? I usually sleep on my side and last night I slept on my side all night that I was aware of. 

Sleep study summary:
IMPRESSIONS
This overnight sleep study shows obstructive sleep apnea with a RDI (respiratory disturbance index) of 13.0 events/hour, an AHI of 8.6 events/hour. The RERA (respiratory effort related arousal) index was 4.4 events/hour. The lowest oxygen saturation was 90.0 %.
Sleep apnea was worse in the supine position, AHI 16.6 , RDI 19.0 events/hour. Non supine AHI was 4.9, RDI was 10.19 .
No periodic leg movements (PLMs) during sleep. (PLMi 0)

APAP Machine: BMC Luna2
Current Settings: See picture. I do have Reslex (like EPR) at 3

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[Psychotech]

if your having problem with pillow/nasal mask have you tried full face mask, yes your breathing seems shallow at the 4am mark, try lung exercise with spirometer
NOTE: prolong use of cpap weaken lung muscles specially for intake of air so at times you should do lung exercise

[NotQuiteAsleep]

Thanks, I'll look into the breathing exercises. I do also have severe asthma with daily symptoms, maybe I should have included that in my original post. I typically take albuterol before bed, it does help me sleep better and stay asleep longer. 

I have used a full face mask, the F&P Evora. I had insane leaks and was not able to get a good seal. I do have a beard. The nasal pillow masks feel the best as tend to have nasal blockage/inflammation that increases when I lay down. Without CPAP I felt like I could barely breathe through my nose some nights. The nasal pillows or bleep masks puff up my nasal passages and help significantly. I did not have the same experience with the full face mask.