Horrible AHI!!!

[Pugsy]

Why so many bathroom breaks during the night? Any chance you are male and of an age where the prostate gives problems in that area?
The fragmented sleep alone is likely a huge contributing factor to not feeling so great.
You simply aren't getting good quality sleep. Probably not getting the optimal amount of time in each sleep cycle.

I don't know if your meds are impacting how you feel during the day since you didn't mention the names but you might do some research on each and look at multiple sources to see if they are known to affect sleep quality or cause fatigue or sleepiness or alertness issues.

[pitman]

yep you hit it on the head. I am male and 63 and frequent pitstops are routine, especially carrying an extra 75 pounds.

I really appreciate your time and help.

So the machine settings appear to be as good as possible, more or less?

[Pugsy]

On paper the machine settings appear to be doing a good job.

The Flow Limitation ugliness could well be from the nasal congestion stuff and more pressure is unlikely to do much with it and would likely make the aerophagia issues worse.

You have crappy sleep quality and unfortunately the cause of the crappy sleep quality is from something that the cpap machine isn't designed to fix. It's easy to get good numbers but good numbers don't always equal perfect sleep.

My suggestion, which I know is easier said than done, work on improving your sleep quality...getting more solid blocks of sleep with less frequent wake ups and fragmented sleep.

There's a good article here where the doctor talks about why sleep quality and architecture is important in how we feel.
While he is talking about alcohol and it's affects on sleep quality...you can substitute anything for the alcohol and it means the same.
https://www.sleepfoundation.org/article ... tity-sleep
In my case I just substitute "pain" for "alcohol" and it explains why I don't always feel so great despite a nice low AHI.