2 day user, mask or machine issue?

[MikeHof]

I have switched to nasal pillows and have had fits with them. Tried different sizes and the medium is what I've been using the most. Not sure how the data looks but overall I feel the same or worse since I started almost 3 weeks ago. What is this data telling me? My AHI without the machine at the Sleep Study was around 57.

[Julie]

I have an idea for you - some people use a soft cervical collar overnight (the pharmacy should have them) which does two things, keeps their head up more so their airway is not blocked by it's falling towards their chest whether thru habit or anything else - and they've found it makes quite a difference to obstructive events, and it also keeps their jaw in place better than it would be otherwise - doesn't stop all leakage, but again helps a lot. The colars are not expensive and I wonder if you'd give them a try - not much to lose after all.

[Pugsy]

Your pressure is not sufficient to prevent those clusters of OAs.
For those times you see those clusters the pressure isn't holding the airway open...either sleeping on your back or REM stage sleep.

Do you sleep on your back at all or maybe some of the time?

You might try Julie's cervical collar idea. It might help keep the airway open a little better with your current pressure.

You need a machine that will go over 25 cm pressure....your machine will go only to 20 cm.
If you increase your pressure to 20 cm and you can't break up those clusters...your chances of ever feeling better are slim.
You are using 19 cm now and I don't think that 20 cm is going to break up those clusters but you can try and see if it does.

Feeling better...you need 7 to 8 hours of sleep with those clusters broken up plus you need good hours of sleep not fighting a mask. Multiple wake ups due to mask issues or in fact any reason, will make you feel like crap even if your AHI is 0.0 (which it obviously isn't).
Some of your wake ups could be related to the apnea event clusters and those need to be fixed anyway.

[MikeHof]

How would I go about getting a different machine? through the doctor or the place I get my equipment? I have had an ocassional night or two where my AHI was in the 2-3 range but I don't know how I achieved it. I'm really unsure how to go about getting this taken care of but I suspect they won't do anything since I'm in my first 90 days of treatment.

[Pugsy]

Normally it's both the doctor and DME involved with a different machine.
The DME can't do anything without the doctor okaying it. The doctor isn't the supplier so he can't give you a machine...you need both people but you need to start with the doctor.
This is assuming you want insurance to pay for the machine.

Your pressure needs aren't going to change in 90 days.

Now if you can continually get those low AHI nights...then you might get by with the machine you have.
If the clusters are related to supine position and you can stay off your back... it might work.
So if you can figure out
1...are those clusters related to supine sleeping
2...can you make sure you stay off your back (easier said than done)
you might be able to use this machine

Though let me tell you...at your pressures bilevel would be so much more comfortable and you would likely sleep better.
Even if you can get by with 19 or 20.