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There are a ton of acronyms used. Could you suggest some you would like to know more about? I could fill pages if I listed ever one I see.
Masks only need to be replaced when they don't work any more and, with a little TLC, this is usually a couple of years. Replacing stuff that is still working is a waste. Most of my patients never replace their hose unless it wears out ,as there is no need.
If your cushions aren't lasting 3 months that is very unusual. If you have oily skin, try cleaning your face before putting the mask on. It can increase longevity of you mask cushion and help prevent leaks.
Replacing mask cushions 1 - 2 times/month would be a massive waste, but your manufacturer would send you a Christmas card. Even the manufacturers only suggest once/year.
Well, I can't endorse the idea of proceeding without consulting a health professional, but in theory if you set the max pressure at 15 that should prevent it from going too high for comfort (and you previously prescribed pressure indicates that you don't need more than 15). You can then set the minimum pressure at whatever level is comfortable for you to fall asleep. Start at 4 and bump it up if it is a bit too low. Watch your AHI closely to make sure it's still adequately treating your OSA. Among the data it spits out should be a 90% pressure (or possibly 95%, I can't remember which). This is level which is the equivalent of what a fixed pressure CPAP would need to be set at to produce the same result. If your 90% pressure is significantly lower than 15 after a month or two then your previous pressure may have been a little too high. In theory, as long as the auto does what it is supposed to, you will still be treated adequately.
Exactly which mask are you using?
I know this sounds counter-intuitive, but a lower pressure on exhalation DOES have an impact on your treatment. If your pressure on inhalation is 15 and exhalation is 13, you only get the effect of CPAP of 13. This is backed up by plenty of research and my years of experience in using CPAP and BiPAP. Exactly why this is the case is something that I'll let others try to explain, but there is no doubt if you have a higher pressure on inhalation an da lower pressure on exhalation (such as in BiPAP, C-Flex, EPR etc) it is the lower pressure that is your effective EPAP pressure.
This is one of the reasons why I don't like C-Flex, EPR and similar pressure relief features. Suppliers and retailers are told by the manufacturers that they can turn them on whenever they like without worrying about it, but I've seen them cause so many problems. Someone with a CPAP of 10 who has C-Flex on 3, is only actually getting a CPAP of something between 7 and 8 , and this will largely get ignored while the patient struggles with poor control of symptoms and high residual AHI that no one can explain. The other problem is that that small pressure change can be enough to hyperventilate someone and induce Cheyne-Stokes respiration. I have seen this happen with my own eyes.
In short, features like this can cause all sorts of problems unless they are used appropriately by a trained professional. They certainly can be used to good effect if used appropriately, but too often the appropriate amount of care an attention is not taken. It doesn't help that manufacturers never tell anyone about any of the problems that can result.
Sorry, that was a tangential rant.
A common step for someone with successful CPAP therapy (by which I mean a very low AHI like yours) and who is still tired, with no other clear explanation, is a test for narcolepsy. You may want to discuss this with your doctor.
I have applied oxygen to people with obstructive events, central events, hypoxaemia, respiratory failure and pretty much anything else you can think of. Very occasionally oxygen can reduce central events, but it is rare. In most cases PAP therapy of some sort is required.
Wow. The above comments have summed up the situation nicely for you. The only thing I'd add is that the minerals in the water would not get into the innards of your CPAP, as Wiredgeorge theorised, for 2 reasons.
1 - the minerals don't evaporate into the air, which is why they get left behind in the humidifier chamber.
2 - The air from the humidifier doesn't flow through the CPAP. The air flows from the machine, through the humidifier and then out. This is a very deliberate part of the design to avoid the possibility of water condensing in the sensitive parts of your machine.
That is brilliant. 0.4 events/hour is, as you suspected, basically none. Give yourself a big pat on the back. You treatment is working like a charm.
9 cmH2O is still a pretty low pressure and I would be very surprised if it was causing problems to that extent, especially given your low AHI. Your chin strap shouldn't need to be uncomfortably tight. You could wear it a little looser and check you leak rate to see if you are mouth leaking. Mask leak could well account for the differences in pressure.
Tiredness is a symptom of about a million things. Persist with your CPAP therapy, it sounds like it is working and, as suggested above, it may simply be a matter of time. If this is not the case you could start looking into other causes of your tiredness.
