Petrodon,
Welcome to the forum.
First, some reassurance: Everything on your list has been dealt with by many forum members. So none of your problems are "unfixable" even if they seem that way right now.
Petrodon wrote: I did not realize that I was so subject to anxiety and claustrophobia. I have a mid-grade pressure (11 cmH2O), but I'm getting frustrated. I cannot seem to calm down in the mask, I normally fall asleep quite quickly, but now I go through 10-15 mini wake ups before taking the mask off in frustration and fear. And my fear can be summed up in one word, suffocation,
I think that you are caught in a bad "positive feedback loop" here: The frustration and fear of suffocation came from the mask feeling weird and hot on the face, but it now leads to more anxiety, which leads to more discomfort and worry, which leads to more anxiety, and so on and so forth.
Breaking the anxiety cycle is the top goal for now. How to do that will depend on a bunch of things, but a good starting list is your short list of major complaints and worries:
I have tried multiple cushions and I still feel like the mask rides up, cutting off my nostrils.
Sounds like its time to try a whole different MASK rather than just different sized cushions on the one you have. Most DMEs have a 30-return mask swap program for newbies. It's time you went back and started trying OTHER masks.
Wearing the chinstrap, I don't like the feeling of wearing so much on my face.
Do you know FOR SURE that you
frequently mouth breathe when you are sleeping? Unless you know FOR SURE that you do a significant amount of mouth breathing, my suggestion is to ditch the chin strap for a night or two or three, and then look at the leak data from your PR System One Pro using SleepyHead. If the leaks are not wildly out of control when you don't use the chinstrap, then ditch the chinstrap for good.
My face feels hot and I get itches around and under the cushion.
You might consider switching to a nasal pillows mask. It touches your nostrils, which might not be so great for the "I'm suffocating" feeling, but it does let you scratch your nose without moving the mask. If you are using a heated hose, turn the temperature down, maybe WAY down. If you are using a heated humidifier, turn the humidifier down.
I don't care for the ramp feature much, I feel a bit starved for air at the beginning.
Then don't use the ramp. Seriously: Ramp is there for your comfort. If it makes things worse, ditch the ramp. If you can't stand to start at 11cm, then increase the Starting Ramp pressure up to something that is comfortable---like 7-9 cm.
I forced myself to sleep on my back for the sleep study but actually sleep on my stomach, which makes it hard to sleep naturally for me with the mask on. I wanted an accurate study so that the minimum pressure needed would be right.
Well, sleeping on your back probably made your OSA worse and you may be a wee bit over titrated rather than under titrated.
As for stomach sleeping: My hubby now uses a PAP. He was a bit worried about whether he'd be able to continue stomach sleeping. (He flips from tummy to back to tummy to back .... all night). He's had no problems at all with figuring out how to sleep on his stomach. The idea is that you have to turn your head and let the mask hang off the pillow. Google "Falcon sleeping position" and you'll see a very CPAP-friendly stomach sleeping position.
I cannot seem to find the right humidification level, I have tried almost every setting from 1-5 with no discernible relief.
Is the problem that you feel like you are sleeping in swamp? Or are you waking up with a very dry mouth and nose even when the humidifier is maxed out?
I bought a Pad-a-Sleep pad for the cushions but it hasn't helped.
If the mask is more comfortable without the padacheek pads, don't use them. If the mask is equally uncomfortable with or without the pads, you need to either refit the headgear and make sure it's not too tight OR you need change to a different mask.
I dread going to bed at night, I try every day to wear the mask, but feelings of despair seem to creep up, I know I just need to adjust but it's hard to do.
My deepest sympathies. There's no easy fix for this one. I struggled for months with this issue. I will say this: Report this issue to your sleep doctor and make it CLEAR this is seriously affecting the quality of your life. If you are willing to take sleeping pills, sometimes a very short course of taking them for 1-2 weeks helps get you over the hump. If you don't want to do sleeping pills yet, make sure that you force yourself to get up at the same time every day. For a lot of lessons I've learned the hard way about dealing with this issue, see my
Taming the CPAP-Induced Insomnia Monster
I am using SleepyHead to track my progress and the data is reassuring, my AHI is usually less than 1 but only when I wear the darn thing.
Good data can help keep you motivated. At least it did me. But you are correct: The only time your AHI < 1 is when you wear the darn mask.
I am considering both a full face and nasal cushion mask, but both have positives and negatives, a full face mask would eliminate the chinstrap, but is even more intrusive. (Though not at the nostrils where I am having issues.) A nasal cushion would eliminate the itchiness on the nose but I would still need the chinstrap and I would have something over my nostrils.
Again I have to ask: Why are you convinced that you MUST wear the chin strap?
I really think the first thing you ought to do is ditch the chinstrap for a week and find out just how bad of a problem leaks might be without it. Some people do manage to learn to sleep without opening the mouth wide open. And some people manage to learn a way to place their tongue where even if their lips open up, not much air is lost.