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Some short answers to your questions:
-Nose or oral-nose mask which is better?
It's entirely down to personal taste. They both do the same job, so it's entirely down to which you prefer to use. If you can breathe through your nose fine then a smaller mask may be less hassle, but it's all down to your preference.
-Proper Size of the mask
The one that fits the size of your face. Without your face to measure against I can say no more. You can get sizing guides for some masks, but after so long fitting them I find my instincts more reliable (which I know is of no use to you). Being fitted by an experienced technician is the ideal.
-Recommended Level of humidity
Again, entirely personal taste. The humidifier is there to stop your mouth getting too dry and to prevent your nose from becoming congested. If these things are not an issue for you then the ideal humidifier setting is probably 0. Otherwise, set the humidifier in the middle of its range and then remember the rule: "if you're dry turn it up and if you're wet turn it down".
My pressure set is 12 . Could it will decrease? after how much time??
Your pressure will probably remain the same unless you lose weight, in which case it could probably come down.
As far as I am aware, the machines will correct for altitude but the have to adjusted MANUALLY to do so.
CPAPs and related equipment (masks, humidifier chambers, tubing etc) only really NEED to be replaced when they don't work any more. How often this is varies wildly from one person to the next. I have some patients who manage to wear out a mask in 3 months and others who have the same mask for 10 years and it still looks pristine and works a treat. Those replacement frequencies you quoted, Sierra, are just ludicrous, and there is no doubt in my mind that is simply a ploy by the manufacturers to push more product. 2 hoses a month! You could open your own shop at that rate, especially if you had a large family all on CPAP machines. Even the manufacturers only recommend replacing your mask once a year.
CPAP is very simple mechanically. As long as your machine blows the right amount of air, your mask and tube get it in to you and you sleep well, that is all that needs to happen. If your gear works and you're happy, why keep wasting money and resources on replacing it unnecessarily? In an age when it has become so obvious that we need to reduce the amount of waste we generate if we are to avoid destroying our planet, such profligate waste is very unethical. And if there was not this push for people to replace their equipment unnecessarily, we could instead replace stuff that actually needs replacing and still have far less wastage. Doesn't it seem stupid that one person is struggling with a busted old mask, or a new one that is totally wrong for them, when someone else (theoretically) has a cupboard full of new masks which they will probably never use? Maybe I'm just a silly idealist.
Do you have a humidifier? That is good for preventing nasal congestion.
I have been meaning to post about this for a while now. There have been a few masks come out over the last year or 2 with magnetic clips, such as the ResMed AiFit F20, The ResMed AirFit N20 and the Respironics DreamWear full face. The idea has its merits as it makes them much easier to use for people with reduced dexterity, however, it comes with a major caveat. If you have a pacemaker, defibrillator or other implanted device in your upper chest, neck or head area you must not use a mask with magnetic clips. The magnets in them can seriously interfere with the operation of your implanted device. There is a warning to this effect nestled deep in the instruction manual somewhere, but other than the the manufacturers do little to highlight this problem.
We had a patient who used one of these masks with a pacemaker and reported to us that, as every morning when he got up he felt really strange in the chest. we discovered that this was because, when he took off his mask, the magnetic clip would pass near his pacemaker and reset it to 120 beats per minute. Needless to say, we took that mask away from him and found an alternative. It can also interfere with hearing aids, cochlear implants and similar. If in doubt be cautious and do some research.
So be careful and spread the word.
"I don't sleep on my back and the NREM OA events of 2.9/hr was actually while I was awake, waiting for day to break."
I know you may have felt like you were awake, you might even swear it on all that is sacred, but I would practically guarantee that you slept a little at least. For any respiratory events to be scored on a study, be they apnoeas, hypopnoeas or any others, your brain must be in sleep for at least 10 seconds, as identified by an EEG. In simple terms, the human brain pretty much sucks at monitoring its own sleep. It's not what it was built for.
Adjusting your machine for altitude is usually fairly simple, depending on the individual machine.
The AirFit is basically a carbon copy of the Respironics DreamWear full face (but don't say that in front of a rep unless you like 5 minutes of indignant yelling). The DreamWear full face does come in a large. It may be worth a look.
The one thing that springs to mind with a Simplus is a problem common to most full face masks, and that is having the top straps too high. The top straps should be running straight back, just above your ears. If not, I suggest loosening the velcro tabs on the very top of your head and bringing the top straps down to that position just above your ears. You should also pull the bottom strap down at the back of your head so that they are nice and low. Sometimes when people over-tighten the straps at the top it pulls the mask up and off the top of the head.
Of course this is all speculative and it's hard for me to say much of value without actually being hands on with the mask. Is it old and wearing out? Did it used to fit better?
CPAP machines are generally only warranted by the manufacturer for 2 years, but most of them last 5 - 10 years. It's really up to you to decide how annoying the noise is. A new machine will not do anything that yours can't (assuming that you get the same type of course - auto or fixed). A new machine that is a little quieter and helps you get to sleep may well be worth every bit of what you spend on it.
I notice that your 95% pressure is the same as your max pressure, and your median pressure (at least I assume that's what md pressure is short for) is just below it at 14.22. This means that your machine is spending a lot of time maxed out at 15. Your AHI may be high because it needs to go higher but can;t because it has hit the max pressure set. Increasing your max pressure may well help. As for why this started so suddenly, I'm not sure. Have you been sleeping on your back a lot all of a sudden? Have you bought a new pillow? Perhaps you gained 30 kg one day and didn't notice? Did you decide to start drinking a couple of bottles of scotch before bed? Ultimately "why" it has happened is not as important a question as "how can it be fixed". Increasing your max pressure would be a good first step. The detailed data from Sleepyhead may also give a hint at what's happening. In fact I'm surprised Sierra hasn't already asked for it. Sierra? You there?
