Suspected UARS - need help calibrating settings

[shenstone]

For a bit of background about me:
I'm a 22 year old slim male who doesn't really drink or smoke and I mostly sleep on my side. For a number of years I've had classic sleep apnoea/UARS symptoms including severe daytime fatigue and tiredness. 

Having just started my first 9 to 5 full time job I've found it very challenging to get through a whole day of work because of the tiredness. My GP referred me to an ENT who subsequently requested I do a sleep study. AHI came back as 4.5 (so no sleep apnoea) and I have attached the sleep study. 

I also had a Naso-endoscopy done whilst awake (not a DISE) and the ENT said I had something like a 90% airway restriction because of my tonsils when I breathe in and that was quite clearly contributing to whatever was causing the problem. My ENT then said its highly likely that I have UARS as a result of this. 

As I want to at least try all non-surgical options before I opt for surgery I did some research on here and found that the ResMed AirCurve 10 VAuto is probably the best option to try for UARS in terms of PAP therapy so I managed to get my hands on a refurbished unit I imported from the US. (I live in the UK and the NHS doesn't provide CPAP/BiPAP for UARS free of charge).

I've tried using the machine whilst I've been awake quite a few times now as well as managing to have it on for only about an hour the past couple of nights. The problem seems to be it feels like I'm having to try quite hard to breathe in though my nose. I almost feel like I want to open my mouth to allow for additional airflow. This feeling of having to breathe harder than I normally do seems to be keeping me awake as well.

I've used the default settings I've seen recommended in a few posts on here to begin with: VAuto Mode, Min EPAP: 4, Max IPAP: 20, PS: 4. I've also had to set trigger and cycle to Very High or it was taking a lot of respiratory effort to get it to pick up when I changed from breathing into breathing out and vice versa. It did make it more comfortable after changing that. I've also attached the hour or so of data I managed to capture whilst I was asleep to see if that points to any obvious issues. 

I'm wondering if maybe I either need to change a setting like the PS or maybe I need to just change to a full face mask so that I find it easier to breathe? Or could it just be that I need more time to acclimatise to BiPAP? Any ideas or advice would be greatly appreciated to help me feel comfortable enough to sleep for a longer period.

[Gideon]

Because of the reported obstruction try a min EPAP of 7

[Sleeprider]

Shenstone, your results on CPAP are great with no evidence of flow limitation, and your background diagnostic does not look bad either. I agree with Gideon that a higher EPAP minimum pressure may provide more airflow to resolve your complaint, but I also think you should consider using a nasal pillows mask with the largest cushion size you can obtain a good fit with. Nasal pillows provide a direct application of positive air pressure to your nostrils, while a nasal mask distributes that pressure to the outside of your nose, an the edge of the mask actually lies along the sinuses which can cause some nasal obstruction. I think if you switch to something like the Resmed Airfit P10 your experience would be quite different.

[shenstone]

Thank you both for your suggestions - I will give the EPAP increase a go tonight.

Sleeprider, I'm definitely adding the P10 to the list of masks I'm considering. I did however notice when I took the mask off and tried to breathe only through my nose it was still uncomfortable which makes me wonder if I naturally breathe through my mouth as well.

Just out of interest, what situations would a full face mask would be recommended?

[shenstone]

I've now switched to the P10 as suggested (which I find to be much more comfortable).

The only issue is that I'm getting quite a few leaks now, and my AHI seems to be about the same as in the sleep study.

I've also invested in a hose lift which I thought would help the leaks but it doesn't seem to have reduced them.

I've bumped my PS up to 5 and bumped my EPAP to 7.4 (as those changes seemed to make it much more comfortable).

Any suggestions for fixing the leaks and lowering the AHI?