[Treatment] Please Help - CPAP Leak - Unrefreshing sleep with low AHI and good usage

[Knightfire]

Hello Apnea board community,

I need help analyzing my CPAP leak, and also to improve my sleep. Still sleepy after using the CPAP for more than three years daily with AHI < 1

CPAP helps, but I still need to power through everyday. Coffee, Modafinil works but only for a couple of hours. 
My body feels fine, just have to fight mild sleepiness often during the day.
I'm just looking for advice and opinions

1. Leak
I'm using P10 Nasal Pillow Mask and CPAP, Air Sense 10 Elite. Is it leaking through my mouth?
I have been taping my mouth, nasal strips, and using a cervical collar
Even replaced the mask, tube and water tank recently


Screenshots of Overall, Zoomed Start and End
For overview, I will post three more screenshots in the reply

2. Sleep Quality - Need Advice and Opinions
I have strong suspicion that the root cause is from chronic partial nasal congestion / mild deviated septum / allergies
Last year felt like hell until I borrowed a APAP machine from my provider
It increased pressure from 6.0 to 9.0. The difference was night a day, even though the AHI is about the same < 1.
I am waiting for ResMed 11 to be available before upgrading to APAP
It's been three months since then, I feel much better, but my energy window is still limited

Medical Background
Blood work is normal. In my 30s Average Height and Weight. Don't think I've been super awake, but relatively functional

Cleared by: Endocrinologist, Cardiologist
Allergist: Season allergies for spring, summer, fall
ENT: Mild Deviated Septum from CT. No active infections. Follow up appointment next month
Optometrist: dry eye
Sleep specialist: ADHD, and Idiopathic Hypersomnia but No Narcolepsy type 1, or Depression

Diagnosed with 'moderate' Sleep Apnea 3 years ago without CPAP
Mostly RERAs and Hypopnea
Follow up titration test: Air Sense 10 @ 6.0 cmH2O
Downgraded to 'mild' last year
Recently diagnosed with Mild Deviated Septum

Experiments

1. P30I - Not bad but nose hurts when I wake up
   
2. F30I - a lot of RERAs, less when I use a nasal strip
   
3. F20I - uncomfortable
   

1. Nasal strips
   
2. Adjustable bed frame
   
3. CPAP hose holder
   
4. Mouth Taping
   
5. Cervical Collar
   
6. EPR - Disabled
   

   
   
   


P.S. Anyone sometimes have Chipmunk cheeks?


Please and thank you,

Knightfire

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Overview and Summary from OSCAR

[SarcasticDave94]

The therapy seems to be fine by the numbers. I think you might add comfort if you were to add EPR back into your therapy.

FWIW the ResMed 11... Release date later this year I think, but OSCAR support will likely not be out for it immediately. New PAP devices have issues when first released. If you're up for a new PAP I'd go for the AutoSet now.

[Knightfire]

The therapy seems to be fine by the numbers. I think you might add comfort if you were to add EPR back into your therapy.

FWIW the ResMed 11... Release date later this year I think, but OSCAR support will likely not be out for it immediately. New PAP devices have issues when first released. If you're up for a new PAP is go for the AutoSet now.

Thanks! IIRC at 10.0 pressure I can use EPR at 3?

I just find it interesting that 6 to 9 pressure makes a difference. Even though the AHI are both ~0.25

That's a good point about new models. 
My CPAP provider just recommended to wait a bit. I have some credit left

[SarcasticDave94]

As long as your pressure is at least 7, EPR 3 has room to work. At your current 10, EPR 3 will get you a 10/7 pressure, inhale to exhale.

[multicast]

Just curious about the tidal volume and the minute ventilation. Is you weight less than 80 pounds?

[Knightfire]

Just curious about the tidal volume and the minute ventilation. Is you weight less than 80 pounds?

Nope why? Around 140 pounds

edit:
Data this week:
Minute Vent: min: 0, med: 16.4, 95%: 21.50, max: 28.60
Tidal volume: min: 200, med: 200, 95%: 320, max: 640

[Gideon]

not alarming but the volumes are on the light side. A topic for your doctor,

[SarcasticDave94]

If I'm correct, a BPAP like the VAuto may be helpful on increasing minute vent and tidal volume due to pressure support.

[Gideon]

EPR is off, the first step would be looking at which setting is more comfortable, EPR OFF vs EPR On (fulltime).
I'm not convinced there is a problem. Is this just a low normal breather which is what it looks like to me.
Slowly titrating EPR up against user comfort is fine for now.

Do you have a recording Oximeter? if the volumes are causing an issue it would likely show as a DeSat.

[Knightfire]

EPR is off, the first step would be looking at which setting is more comfortable, EPR OFF vs EPR On (fulltime).
I'm not convinced there is a problem.  Is this just a low normal breather which is what it looks like to me.
Slowly titrating EPR up against user comfort is fine for now.

Do you have a recording Oximeter? if the volumes are causing an issue it would likely show as a DeSat.

I do. No DeSat. Just partial congestion, mild deviated septum, and allergies
My sleep doctor requested an Internist to get a second opinion

Almost everything test I have on paper is fine. Some are borderline but still normal. 

Even after three years CPAP use with low AHI and daily usage. I still have Excessive Daytime Sleepiness. I just want to wake up refreshed consistently
I was miserable before I switched my pressure from 6.0 to 9.0 in Jan using AutoSet for Her, although at both pressures AHI < 0.25.
I think I should just buy the AutoSet today

MSLT last year (two years on the machine) - fell asleep 4 times in 10.xx minutes (no-sorem). Normal, but borderline. Luckily. my sleep doc was concerned

I'm mindful about sleep hygiene. My profession allows me to sleep and wakeup without an alarm. 
No insomnia or anything. Usually just blank out within minutes and wake up. Could be anywhere between 5 to 10 hours. Duration doesn't mean I wake up refreshed
Interestingly vivid dreaming returned with the pressure increase