1st night woes

So here are some observations on the harrowing first night. Part journal part request for pointers.
airsense 10 with humidifier (not used night 1 ) set 5 to 15
airfit 20 mask

1) My first hour, I was literally suffocating, trying to breathe in and out of the nose mask. It kept feeling like I was pushing against a wall,
and I remembered all the posters saying to relax it will come. But even my rental was not this bad. I couldn't take it anymore and I took off the mask and gasped
as I started regathering my periodic breathing.
2) I started to pull off piece by piece the mask apparatus to see if I could still breathe. Even with the very last piece (the nose sealer) and no pressure I still could not breathe hardly at all.
That didn't make sense, it was M and the measurements on the template lined up perfectly. Thankfully, I had the kit with 3 sizes and went to a L. I could finally breath, and even felt the air rushing in.
I was also thinking that the way they designed it was sub-optimal (just thinking). They have the hole in front of the nose button, while the nostrils have to fight a seal well on the bottom and bounced the air in and out.
It would feel better if the hole was facing down or at an angle, aligned with the nostrils so maximum air can flow direct through the tube. I'm also thinking that the nose air flow 'blockage' from the too tight seal, likely caused the device
to be tricked into thinking 'less air' was demanding, and so supplied less pressure (just thinking).
3) I was also getting very congesting and could hear gargling and would have to get up and blow nose frequently.
4) I noticed with the larger mask, I could feel a flood of air, and the more I hand loosened the seal on the nose, the more generous the air would flow. But, if I loosened too much, I could feel a breeze of air leaking onto my face.
If I tightened seal too much, I felt sealed, but felt that struggle again to breath freely (esp. out). It was a tradeoff.
5) Eventually, I did sleep and the air was great, but quite often I would wake up with air breezing on my face and would have to slightly re tighten or adjust. Or I had dry cold mouth. I awoke with a very congested (plugged) nose.
6) fitibit shows worst sleep in a long time, all kinds of awake(s) (as I would expect) Very little REM. I didn't actually sleep continuously till around 5 or 6.
7) Sleepyhead shows (get this) AHI 1.01. Leak rate shows a few mesas around 24. I guess that is ok? I expected a lot of leakage, as I said, "looser mask equaled more pressure delivery an free-er flow."

I read some threads saying they should max the ramp at the start, as that is when you need the most pressure to relax. My Dr. did say I should start at 6 and I stubbornly said to leave start level at 5. Maybe that is part of the struggle.

I hope it gets better. I'm sure some old timers will chime in, "yeah, it's saving your life." Hopefully ,there are more understanding and helpful comments.
Any thoughts appreciated (even scolding and lecturing).

I don't do nasal masks, but as to your first point...

When I started this stuff, my prescription was for a pressure range of 4-20 cm (wide open). The reason I found this board is because I felt the suffocation. Through advice here, it was suggested to bump my bottom pressure to 7 cm. Instantaneously fixed that problem.

Mask fittings and adjustments are tricky. It takes a while to figure it out. Eventually, you'll hit the sweet spot.
Also, if I am remembering right, the machine will not score apneas unless you are asleep, so that may be an explanation for the low AHI. I may be wrong, though.

Good luck

This sensation of not being able to breathe tells me that the ramp is counter-productive (in your case). You would use the ramp if you got the sensation of "too much air." If you feel like "not enough air," disable the ramp.

Or, you could set it to your needs, for me my needs were OFF, because I don't want the settings to limit my XPAP treatment ever. Jim

What ARE your pressure settings? Too often the lowest min. pressure is set at 4 or 5, which no one can really breathe easily at, and we invariably have to bump that to something a bit more reasonable like 6 or 7 (often going higher over time). The upper setting is not so relevant and can be left from 15 to 20 for now.

Thanks everyone for great feedback.

@Julie. It is set 5 to 15. My Dr. office said they looked at charts and maybe I should start 6, I stubbornly wanted to start lower (thinking analogously to glasses strength). Maybe I should try bumping up to 6 or 7 as you say, and
see how it goes.

Does anyone get scolded from the dr office for changing on your own?

Yes, but so what? We all do it - just as children take care of their own diabetes!

interesting point xxyzx. Yeah, definitely exhaling is worse (and harder), esp at the beginning.
I don't know enough to know if I can adjust epap separately yet, though. And doing it by lowering pressure range seems like it might be counter productive.
So much to tinker with.

Your 5 and 15 aren't epap ipap...it is you min and max pressure on an auto machine. the machine doesn't have a 15cm IPAP and 5cm EPAP.
Without flex or epr feature being turned on. An auto cpap will have the same inhale and exhale pressure it will range at a constant pressure between 5 and 15, depending on the AHI events.

If you feel you are building up co2 and suffocating, you increase the min pressure, if you find it hard exhaling, just relax and let it happen, don't force the exhale. you don't fully breathe out with xPAP, the lung is always slightly inflated.

You can use flex or EPR to reduce the exhale pressure, which some people find more comfortable.

even though you aren't forcing an exhale breath, it's not unusual to get a sore chest muscle the first week, as you naturally get use to breathing out under pressure.

you are going to get use to it, my min pressure was your maximum 15 and my max was 20, when I was on cpap

Bumping it up to 6.6 was magical! (didn't want to start all the way at 7 but I was able to slowly sweep and feel right away at each step).
I could breathe great after that. Thanks (esp Julie on this one)!