[Treatment] mask & settings struggle walk

[R.Ky]

Hello,

being diagnosed with OSA last year (MiniScreen Polygraphy: AHI 30,8, RDI 31,3, AI 12,0, HI 18,8, no CA, longest Apnoe 48sec, Snore-Index 46,9; Age 54y, BMI 23, bearded), tried to solve that with positioning helpers for a while - switched to APAP two weeks ago.

Bought a ResMed AirSense 10 Autoset with ResMed HumidAir Humidifier and ClimateLine tubing, as I like a cold sleeping room.
Tried a F&P Brevida nasal pillow mask first, watched what APAP did, adjusted the settings step by step, enjoyed better sleep, first.

At higher pressure I woke up with dry mouth, my partner didnt like the noise of fresh cpap'ed air streaming out of my mouth.
So I tried the F&P Evora FF mask, which gave even higher leak rates.

Started tongue training, knowing that this needs months till reasonable success, ordered a soft cervical collar.

Yesterday I had a strange sleeping therapy - I found myself this morning quite tired, without mask (must have taken off during the night), OSCAR showed the worst results with AHI 52. Only a short time of 8min was without OA.
When comparing that picture with the night before, it seems many OA events were hidden in LL.

Any suggestions how to solve that problem?
Any more information needed?

Thanks,

Ralf

Total view
   

Detail: End of 8min of normal breathing, switch zu OA
   

Last week, a better day with low leak rate, Brevida nasal pillow mask.
   

[R.Ky]

I switched back to the F&P brevida nasal pillow mask, had a short but much better night:

   

Noticed some awakenings due to leakage, felt a little "blown-up" by EPR=3, but was quite fit in the morning.
Will prefer open-mouth-leakage with nasal pillow.

The Soft Cervical Collar shall be delivered tomorrow. Curious how much that will change, how big the positional causes are.

[Lucid]

Hi, R.KY  I'm partly responding to this just to bump it up into view again.  I don't have the expertise to explain the differences in your charts on different days.

It's not relevant to the leak issue, but it's advantageous if you can do without ramp, since that's basically time without therapy.

[R.Ky]

Thanks,
had tried a shorter ramp which was too short before.
In the graph you can see that Auto-Ramp took just 8min to target pressure, which seems quick enough for me.

Compared with my too-late-to-bed time (due to some work issues) or the 20min open-mouth-leak this time-w/o-therapy does not seem to be the problem.

Today the SCC was delivered, i am curious if this makes the Evora bearable.

[Lucid]

I see what you mean about the Ramp time.  Definitely a good idea to try the SCC!

[R.Ky]

So new pillow plus SCC gave low leakrate with Evora FF mask, but not with Brevida nasal cushion mask.
With Evora, large leaks begin around 6:30, together with SWJ
   

With Brevida the nightly leaks came back, sadly.
The flowrate detail shows some Apnea classified as CA which I don't understand - it looks similar to the neighboured OA.
Any explanations from the experts?