Sierra

It is possible that obstructive apnea is not a problem at all. The AHI due to obstructive apnea was only 1 at diagnosis. That usually does not take much pressure to correct.

When I look at your SleepyHead leak rate charts you previously posted, I think it either has to be mouth leaks or the mask simply being displaced off your nose. When you get up in the morning have you tried blowing air out of your mouth to see how secure the mouth tape is? You should not be able to force the tape open. On the mask displacing, the first approach is to slightly tighten the mask straps and try to find a happy spot where they are not too tight but not so loose that the mask displaces. I also find it helpful to sleep with the mask hanging over the edge of the pillow. I use a fairly soft down alternative pillow that deflects fairly easy and does not push back. I also use a satin pillow protector so my head slips around easily on the pillow without deflecting the mask off my nose. I know there was some previous discussion about EPR. My experience is that the maximum pressure is not as high with the EPR turned off. That is about all I can think of for now...

Flex provides a smoother transition from inhale to exhale. The effect is rather minor compared to the EPR on a ResMed. However, I would adjust it to minimum or turn it off if that is a choice. See page 4-15 in this Service Manual.

My thoughts are that your machine in Auto may be chasing the hypopnea events which could be central in nature. This results in a higher pressure and can cause centrals and more central hypopnea. Simply setting the machine into fixed CPAP mode and running it at 7 cm would be worth a try. The other choice would be to set the minimum at 6 cm and max at 7 cm. Obstructive apnea does not seem to be a big problem for you, and it may take very little pressure to control the obstructive part. Avoiding high pressure would help too. SleepyHead would allow you to display the pressure record for the whole night and see where the machine is taking it.

What brand and model of a machine do you have? Is it in Auto pressure mode? If so, what are the minimum and maximum pressures set at? Are you using EPR or Flex? If so what is it set at?

A reduction from an AHI of 11 to 8 is not a great improvement, and does not meet the general guidelines to be under 5. I noticed from an earlier post your sleep study indicated your obstructive index was 1 and the hypopnea index was 10. The issue with hypopnea is that they are almost always assumed to be obstructive, but they can actually be central or clear airway in nature. CPAP pressure does not help with clear airway events, and it may in fact make it worse.

I would go back to your doctor to report your results, and ask if the maximum pressure can be reduced to see if that helps, or ask if your machine can be set to a fixed pressure significantly lower than what your machine is currently going to.

If you have a compatible machine you could view your results on a PC or a Mac using a SD card reader to transfer the data to SleepyHead. That would be very revealing as to what is going on. This version of SleepyHead is no longer being developed, but it still works.

EDIT: I believe that image you posted is from DreamMapper and suggests you have a DreamStation machine. Is it an Auto version, and again what are the pressure and Flex settings?

I have tried the F&P Brevida after reading good reports about it. Yes, the straps are better and are adjustable. I found it irritated the part of my nose between the two nostrils and went back to the P10, now with the Swift FX headgear. I convinced my wife who was using a Mirage FX mask to try the Brevida. The Mirage had to be adjusted so tight that it was leaving large marks on her face from the straps. She had a little trouble finding the right cushion size for her, but after that got sorted out, she really likes the Brevida. I think how a mask fits is quite individual. However, between the Brevida and the P10/Swift FX I think the Swift FX headgear is better. And for me the P10 cushions are better. The other strong point is how quiet the P10 is with the way the purge air is diffused. My wife has a bit of an issue with knocking off the diffuser on the Brevida but so far has found it. We need to order some spares.

The one issue to consider about a nasal pillow is that I believe the reason it works quite well is that it minimizes the contact with the face/nose. Once you start to cover the nose surface I think problems start to increase. I think the DreamWear has kind of a hybrid nasal pillow that does not go into the nostrils, but has an oval hole that kind of covers both nostrils. No experience with it. Not sure if they use that on their full face version of the DreamWear or not.

My solution to the occasional nose irritation is to use some 1% cortisone cream for a few days. Overall I think it is mainly a matter of getting used to it, once the fit is good.

There is one oral only mask sold by Fisher & Paykel. Based on the odd forum post, people either love it or hate it. I would expect you would have to use nose plugs with it, and you would lose the benefit of breathing through your nose. Not sure if it is the one or not, but I have seen an oral mask mentioned that is kind of like using snorkel equipment, in that it goes inside your mouth and in front of your teeth. That one is a love it or hate it too.

"Trying to decide if I want nasal pillows plus the mouth covered or both covered with no nasal pillows."

Functionally it makes no difference. It is just what is comfortable for you. In general a full face mask is much less comfortable than a nasal pillow mask in my opinion. It tends to be bigger, and the sealing surfaces are more extensive. Generally nasal pillows don't leak. Getting a mask to seal to your face is much more difficult. The mask tends to float around, and when the face seal leaks they make rude noises. Many use and like them though. I just couldn't get comfortable enough with them to get a good nights sleep.

Thinking about this further, I would bring your attention to your results:

"17L/min leak, 0.4AHI, 0.2AI, 0.0 centrals. The numbers are beautiful. I feel better, but need more sleep."

This leak rate of 17 L/min does not suggest to me that mouth leaks are a big issue for you. If the leaks are just an annoyance that wakes you up, then I would still suggest trying tape. The 3M Gentle Paper tape is specially designed to be gentle to the skin. I have never suffered any irritation from it.

These seem like good masks, but I have not used either. I would read the user reviews at Cpap.com. I believe they have a return insurance for masks.

I don't think any of the CPAP manufacturers recommend the use of SoClean. The therapist is probably just telling you what the manufacturer recommends.