Do you have the latest CPAP machine? The latest generation is a dramatic improvement over the older generations, especially with the exhale relief, this yields less discomfort and more compliance. I can't recommend it enough.

Any particular suggestions? I need to go shopping soon.

I swear by my Resmed AutoSet S10. They have too many S10 models, so be sure to get the AutoSet (or higher), as it dials the pressure up and down. I'm kicking myself for sticking with an older S8 model for far too long, all the misery I endured was entirely unnecessary!

Proper pressure is the key to compliance. This machine has auto-set, so the minimal required pressure is used; it has better algorithms for it (compared to S8); and it has exhale relief (it drops the pressure when you start exhaling). It's easier to exhale, thus reducing the overall pressure.

An additional way to reduce the pressure is a neck pillow. I use one with a silly name of Dr Dakota. Aside from keeping your chin from falling down, it keeps your neck straight, and so it opens up the airways. It's a big deal if you have bad posture, like I do. This was a dramatic improvement for me.

Further, reducing the pressure will reduce leaks, and thus reduce pressure further, as the machine won't need to compensate as much. A virtuous cycle, if there ever was one.

And lastly, reducing the pressure allowed me to use a nasal pillow mask, which is very comfy, easy to maintain, and has the lowest leaks of all designs I have tried. I can't use it at high pressure due to mouth leaks, but I can handle it at the low pressure, and due to mostly zero leaks now ... the pressure goes down even more.

Combining all of these, I brought my leaks to zero (like, 90%th percentile), and AHI to less than one, like 0.6 is in there most of the time. That's only one event per the 90-minute sleep cycle.

Good luck!

Thanks for the extensive answer! I did an at-home CPAP trial after a sleep and they gave me some POS machine and I hated it. Unfortunately getting anything more fancy is going to require jumping through insurance hoops. rolleyes Pretty new to this whole thing.

My posture definitely makes a big difference, I'm at 9 AHI sleeping on my side but 50+ on my back untreated. I'm gonna duct tape pillows to myself or something. Glad you found something that works for you!

> and they gave me some POS machine and I hated it

I really hate that they do this. I had a friend who also got stuck with the same situation and did not have a good experience as a result. They should send you home to try the top-of-the-line model and then let you duke it out with your insurance company! ;)

Pay cash. You can get a refurb at $600. It's totally worth it.

Speaking side-sleeping, I have sewn a sock with a tennis ball to the back of my sleeping tshirt. It worked well, but it's hard to wash. So I bought this contraption: https://www.amazon.com/stream/ref=nav_upnav_mobile_T2_Detail...

Side-sleeping is a big deal, but it's even better with a neck pillow.

Better link, I hope. https://www.amazon.com/gp/aw/d/B00DTLLYQ6/

Believe it or not, I also snore on my side. sigh

Of corse. But a better question to ask is if your AHI takes a plunge. If it goes down from 20 to 10 for example you are halfway there to control your apnea.

A good CPAP machine will tell you what your AHI is. Even the S8 does, though you have to get to the system menu (hold down and right arrows for five seconds).

Where do you get refurbs?

I saw some on google shopping. Didn't try ordering though.

Also, check craigslist. In Seattle there are several people selling them right now at $400.

Mine's about 4 years old or so (?), perhaps I need to upgrade.

yeah, the newer ResMeds do look quite a bit more high-tech lol. I have a ResMed S8 Elite (https://www.google.com/search?q=resmed+S8&tbm=isch) with humidifier (the latter DOES make a noticeable difference).

I had an s8 as well until recently. S10 is much better.

What is "exhale relief"? A reduced PEEP?

See my long reply to a sibling comment.

Yeah, it sounds like it's a dynamic PEEP adjustment.

I don't know if this helps, but most people have to try a few different CPAP masks before they find one that's really comfortable for them. This is pretty much the normal usage pattern, and most insurance that covers CPAP at all also cover multiple masks, so I don't know why doctors don't push it more.

For the record, there should not be any air hissing out around the edges of your mask. If there is, you either need to get a different mask or at least adjust the straps on your current one. My experience is that full-face masks absolutely don't work with a beard; a nasal pillow mask works much better, but I do need to keep my mustache trimmed short or it chafes a bit.

Also, I don't know much about the allergy angle, but you're theoretically supposed to change the air filter regularly; there might be filter options designed for allergy sufferers.

Nasal pillow mask is (relatively) the bomb IMHO. Don't even try anything else, you will be disappointed.

Good point about the air filter; I need to get a new one

You might also try being rigorous about regular cleaning, if you don't already. In theory you're supposed to thoroughly clean the hose, mask, and reservoir daily. I'm lucky if I manage it every other month, and it works fine for me, but I don't have any major allergies.

That's crazy. My restlessness graphs don't look much different than yours -- is the sleep apnea what's waking you up after 5-6 hours?

If you wake up after 5 or 6 hours well-rested, that's all you needed.

If you feel like shit when you awake, and yet can't go back to sleep to catch up on the deficit, then you may have some variety of mood-affective disorder. The excess adrenaline makes and keeps you awake as soon as you rested a little bit in the first 5-6 hours. It also makes you dehydrated, and longer-term it forms a vicious cycle due to accumulated sleep deficit. This condition requires attention of a medical professional, which I am not.

I'm... not sure. Sometimes I have trouble falling asleep (insomnia), although SOME of that can probably be attributed to late-night device usage (I use Flux, but the iPhone won't have "time-based screen yellowing" until the next iOS release.) My girlfriend, who sleeps in the same bed as me, also gets up around 6, and sometimes that wakes me (not most of the time, fortunately).

Seriously. I sleep like a baby and often show 30+ times restless.

There is research that shows that at least with outcomes measured by BP, CPAP and mandibular devices are almost as good: http://jama.jamanetwork.com/article.aspx?articleid=2473494

That's fine for BP, but what about elevated cortisol levels as a result of repeated breath cessation? In my case a MAD was not helpful, unfortunately