Seeking help with optimizing CPAP therapy.

[JovialJovian]

Hi, this is my first post ever on this board so apologies if I miss some essential info.

I'm 6'7/185lbs/28y/o male and I got diagnosed with mixed sleep apnea, around 16 AHI, in February this year (was around 210lbs at that time). My main symptoms are daytime sleepiness, frequent awakening at night, fatigue, depression and brain fog. I've been using ResMed AirSense 10 Autoset with AirFit n30i mask since March with mixed results - on some nights my sleep is great and I feel alive next day with a lot of energy and not needing a midday nap, but on the others I sleep as if I didn't use the device at all - and I can't pinpoint what makes the difference between those two. I also frequently struggle with air burping which wakes me up, but I'm not sure how much does it impact my sleep quality. It seems to be mainly triggered when I lay on my side.

Improvements I've tried so far but are hit or miss:
- Mouth taping - Supposedly helps with air burping and mouth breathing; I follow a guide found on YT from a guy called "TheLankyLefty27" (can't post the exact link because of the new users limitations), but I usually wake up with the "breathing hole" torn up to the whole width of my mouth, didn't notice any significant difference
- Wedge pillow - For reflux which might exacerbate air burping (?); Didn't notice any significant difference
- Simethicone before sleep - Somewhat helps with air burping
- Vitamin D - Seems to help with sleep overall (?)

I'm attaching two screenshots from OSCAR - neither of them are from a "perfect" night but I felt better after the one with 2.63 AHI.

By looking at that data, do you have any ideas what might be a problem causing bad CPAP performance on some nights? I appreciate any help and input.

[Sleeprider]

Overall, therapy looks good, particular for someone diagnosed with mixed apnea. With pressure from 6-12 and EPR 2 AHI is good A disrupted sleep pattern with a therapy break after 3 AM and some difficulty with starting therapy where central events seem to be focused along with some breaks to make adjustments. I find a tidal volume for a young individual with a 6'-7" height to be unusually low, but there is really nothing we can do with that, and it seems to be compensated by a relatively high respiration rate to result in a minute vent in the 5.8+ area. Residual events are primarily central as expected with your diagnosis.

I don't see any advantage in making significant pressure changes to your settings. You might want to try EPR at 1 to see if it reduces the CA events slightly, however if that increases aerophagia or decreases comfort due to flow limitations then return to EPR 1. As you know leaks remain a challenge to be worked on. I don't endorce wedge pillows because it puts most people in a position where chin-tucking can increase obstruction, and a better approach is to incline the whole bed slightly. Leaks are mainly from your mouth, and you can try doing some exercises to teach you about air control and tongue position. Learning to talk while using therapy is one way that good control is mastered, and drinking sips of water through a straw can train you to swallow and control air pressure separation from the mouth and throat. In the long-run if you don't control mouth leaks using nasal pillows, a full face or hybrid mask may be something to try. Most of the things you have tried appear to have been effective and resulted in much better than average therapy.