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I suggest that you not be too concerned about the numbers. Have you have an in-lab study, or were you just handed an automatic machine? If you have a proper titration in a sleep lab then you can be confident that your breathing has been demonstrated to be OK at a certain pressure. If you have not had a study, then you could try to get one to see exactly what is going on. Automatic machines are NOT infallible. Indeed, I frequently come across patients for whom an automatic machine is unsuitable. There are a number of things which confuse automatic machines causing them to react inappropriately (either delivering too much pressure or not enough).
Ask all the questions you can think of at your sleep study - answering question is part of their job. Also, the more you know about what's going on the more you will feel in control of the situation. Be very cautious about using sleeping meds. If you have OSA many of them will make it worse (by relaxing you they make your airway more likely to collapse). Also, they can be very habit forming, you can develop tolerance over time (they stop working) and when you stop taking there can be a rebound effect where you cant sleep at all for several days. Always be very cautious about sleep meds and talk to you doctor at length about them.
A few hours can provide enough data to draw some reasonable conclusion about your sleep in some cases. If you are obstructing every 30 seconds for 2 hours then it is safe to say that you have OSA. It may take more sleep to get a good picture of how your OSA varies with sleep stage and position, but sometimes even this can be pretty well represented in only a couple of hours. It is very variable. It is also worth remembering that you usually sleep more than you think you do when having a sleep study. The real question is are the people who are involved with your sleep study genuinely interested in your health (doctor, technicians etc) or are they in it for the money. I work t at a facility which is free to the public and we don't sell anything, so our only interest is in the health of our patients. However, I know of a lot of places that are established purely as cash cows for doctors. This can lead to a lot of people getting poor advice and the wrong equipment, which is why I post on this site. The better educated people are, the less likely they well get ripped off and the more likely they will get the best treatment possible.
I can tell you that there is currently no approved and effective surgery for treating sleep apnoea (at least that is the latest word from all of my professional medical sources). There are a number of surgeries practiced, but they all have very low success rates, are very painful, have a high level of post operative infection and in the rare successful case the problem can return in a few years. This is why reputable doctors all advise against it. Sorry. Just the way it is.
The small flow of air you mention is generated by the machine to cool the humidifier. You will notice a little snowflake symbol flashing on the screen to indicate as much. It will last until it thinks it is cool. Ignore it. It's fine. I'm not sure why ResMed felt the need to add this feature when millions of CPAP machines around the world have operated perfectly fine without cooling their humidifiers.
A large leak can reduce the sensitivity of the detection apparatus of the CPAP machine in some cases, so that may be why you have more events with the full face mask. However, there is a documented phenomenon in which people need a high pressure to eliminate obstruction when using a full face mask than when using nasal. One theory is that it is a "reverse MAS effect" with the pressure on the lower jaw from the bottom of the full face mask exacerbating airway collapse. Whatever the cause, I have seen it happen with my own eyes in some of my patients.
You could try taping your mouth shut with a nasal mask, at least for a few nights. If your residual AHI goes up then you were probably obstructing before with the nasal mask but the leak was stopping the machine from registering it. If your residual AHI is still low with the mouth taped shut then that would suggest your breathing is fine with the nasal mask the higher AHI with the full face is due to the reverse MAS effect. In the latter case you could keep using nasal is if it is more comfortable. A mouth leak is not necessarily a big issue in itself if CPAP is still effective.
If someone has had a proper sleep study then the pressure they are prescribed is the minimum required to keep them breathing properly. Lowering the pressure will almost certainly induce some level of obstruction - that's precisely why it's set as it is. It would be very unwise to adjust the pressure without consultation with a sleep physician. It may reduce mouth leak and it may make CPAP more comfortable, but it won't be properly controlling the OSA.
The range of machines and masks you have to choose from depends very much on the facility you go to. I can tell you that all modern CPAP machines are basically the same. They all quiet, roughly the same size (with the possible exception of a Fisher & Paykel being smaller if you use a humidifier) and all have the same range of functions.
The most important thing is to ask lots of questions and make sure that you get all the support you need. Support is often crucial for first time CPAP users, so ask all the questions you want and get the best setup for you.
Which mask do you have currently?
Is the bleeding from inside your nostril? If so, humidification can help with this. If you do not have a humidifier, try one, and if you do hae one, make sure it is correctly adjusted.
