Please Review, any suggestions appreciated

I live in Atlanta, GA, I started using CPAP 7/16/19. The only routine medications I take are levothyroxine for an underactive thyroid (recent blood tests reflect my thyroid is within normal limits while on the current dosage) and Vitamin D3. After starting CPAP therapy, very quickly I felt the positive effects, and my AHI went from 57 (my sleep study) to under 5 initially, and most recently it's down to under 1. Unfortunately, I don't feel like I think I should with an AHI under 1. I get really tired (different tired though then before CPAP), and feel like I need more sleep than I did before CPAP. However, even when I do get a lot of sleep, I still feel tired. Many days this tiredness sets in in the evening, which theoretically is a lot better than earlier in the day I suppose, but some days I feel it all day long. I am including screenshots from OSCAR, hopefully with the data in the way that is easiest to read.

The first screen shot is from 10/24/19, and I felt horrible all day 10/25, extremely tired. Unfortunately, in the left hand panel I can't get the last stat to show in the screenshot, Time over leak redline = 4.428%




The second screen shot is from 10/25/19, and I feel much better today, than yesterday. Unfortunately, in the left hand panel I can't get the last stat to show in the screenshot, Time over leak redline = 25.588%




Additionally, but perhaps a separate issue, I am having a lot of trouble with my nasal passages, sinuses, and lungs. I have learned through this journey, that they are all very sensitive, I think to pressure, and definitely to humidity. The weather here has just changed, and outside humidity has dropped. I settled on a humidifier setting of 3, after making the mistake of going higher and developing full symptoms like I had a respiratory virus for several days. Symptoms disappeared after reducing humidity level down to 3. I experimented with this a little to be sure, and symptoms came back with an increase in humidity setting. This has me gun shy about increasing humidity now, even though outside humidity is clearly much lower, and my sinuses definitely are drier and ache. I tried getting a saline nasal gel, advertised as great for moisturizing, for CPAP users, however I reacted to just two sprays in each nostril, by having symptoms similar to a sinus infection for 24 hours. I now have gone and gotten a saline mist nasal spray, which seems to have a lower concentration of sodium chloride, and have just started trying that...very cautiously, so far, no reaction, and trying to slowly build up. I still have signs my passages are irritated, i.e. sinus pain and headache pain behind my eyes. As far as my lungs, I am needing to clear my throat throughout the day, and a couple times a day, I am coughing up phlegm, not clear, but not a concerning color either.

I have had these issues more often than not since beginning therapy in July, and did not have them prior to then, so I am pretty confident this is not a virus or other illness. I think I may just be really sensitive to inflammation and the pressure of the air traveling through.

Any observations or suggestions with regard to my posted data and either of the two issues I described in this post would be greatly appreciated. Thanks and apologies that this got kind of long, just trying to include enough details to be helpful.

You aren't having that much time over red line threshold. OSCAR defaults to a ResMed leak threshold which is 24 L/min and you are using a Respironics machine.
Respironics doesn't have a static fixed number as a threshold. The threshold varies as the pressure varies or the mask might vary.
So it's making it look like you are having worse leak numbers than you really are. See the LL line over on the Events graph....that's large leak and your lark leaks per the machine's sensors are actually very minimal.

Either turn off this particular statistic or reset the threshold to something more appropriate for your machine at your pressure.
Go to Preferences/CPAP tab and on the right side set the 24 L/min to something around 80 to 90 L/min (it's a conservative estimate) or just turn off that particular statistic and just rely on the LL line in the events graph for leak evaluation.

Are you experiencing very many wake ups during the night? If so, why?
Are even small leaks waking you up?

Do you spend much time sleeping on your back?

Generally, I fall asleep and don't remember waking up (if I do), until typically after 5:00 am (usually when pressure is highest). Then I usually wake up a few different times because air is blowing out the sides and/or the top of the mask. I usually am able to tighten the mask and then fall back to sleep. However, I end up having to really tighten it. I definitely wore out the headgear straps on the last mask before the three month mark when insurance would replace it.

I spend most of the night sleeping on my back. When I wake up, I will try flipping onto my right side, as that seems to lower pressure needed. It's not that comfortable for me to do that, though. My preferred sleeping position is on my back. I did add a wedge pillow, though, with a memory foam pillow on top of it. That raises me up a little, and I found was comfortable and was helpful in reducing pressure needed as well (though that result has been inconsistent).

It kind of looks like my pressure is all over the place at different points during the night, and seems to also vary a bit from night to night. Is there anything I should be adjusting about that, or does that not matter?

Do you have a copy of your sleep study? If you don't....get it.
If you do can you look to see what your OSA does in REM sleep vs non REM sleep along with supine vs side sleeping.
OSA is typically made worse and/or need more pressure when supine or in REM sleep.
Either could explain the pressure variations you see.

You may benefit from more minimum pressure so that the pressure changes aren't so wide. Should help with managing leaks better too.
Fitting for the starting pressure of 5 cm isn't going to work for a good fitting when the pressure gets to the teens.
Need to fit at higher pressures to start with to anticipate those higher pressures better.

I would look into the thyroid problem again... it might not be as 'underactive' as you thought (or vice versa) and meds can definitely impact sleep.

Thanks to you both for responding, and providing your insight.

I checked my sleep study. I had roughly the same number of events in both REM and Non-REM sleep. AHI was 58.5 during Non-REM, and 55.8 during REM sleep, which equated to an overall AHI of 57.7. I was Supine for 100% of my sleep study, so no way to make comparison there (between supine and side sleeping). Interestingly, what did coincide with my REM sleep were severe drops in my oxygen saturation levels, going as low as 59% at it's lowest (scary).

Before I knew I had sleep apnea, I recorded a full night's snoring in the Snorelab app. That's how I figured out I needed to see a doctor about sleep apnea. While it doesn't measure AHI or events, it measures snoring, but there is a visual depiction of the snoring, much like the flow chart in OSCAR. And also like the flow chart, and how CA's and OA's are depicted, you can see flat lines that coincide with silence in the recording. I had a few that were as long as one minute in duration, though most were closer to 30 seconds. While I couldn't be sure I stopped breathing that whole time, I think it was likely. This, feeling tired all the time, and waking with a severe headache that was gone minutes after waking up (I suppose after returning to normal oxygen saturation levels), were what caused me to suspect I had sleep apnea.

Pugsy, you mentioned perhaps raising my min pressure, I think to a level that would have me fit the mask to a pressure more comparable to what I experience later in the night to help with reducing the likelihood of large leak, or just leak of air that wakes me up. Do you have any suggestions of what to raise it to? I think I can tolerate starting out awake at more than 5, where it is now, but not sure how high to go to start out, before that might create a new issue, potential difficulty getting to sleep.

Julie, I had a test at the end of September that indicated the current dosage of medication I take for my underactive thyroid had me within the normal range. I had been outside of it prior to that, and the dosage had to be adjusted. I was hoping that would solve the feeling tired as that is a side effect of an underactive thyroid, however my tired feeling has continued, and I have been on the correct dosage for just about two months now. You are right though, the thyroid can be very temperamental and can cause issues and symptoms like fatigue.

This has been a lonely road for me, trying to figure all this out. It has thrown me for more of a loop than I expected it would. I have tried talking to friends and family, but I feel that no one can really understand this, and all that goes into the process of trying to get fully acclimated to it, and figure it out, unless they have experienced it. I am grateful to have some people here I can turn to for guidance, support, and advice. Thank you.

At least 10 cm minimum but that might be too big of a jump to make in one step and if it is then I would start with 1 cm more for 3 or 4 nights to get used to it and then another 1 cm more for 3 or 4 nights...and so on.
Watch the reports...might get lucky and not need as much minimum as it looks like you might.

Otherwise...I think there should be some sort of mask fit test available on your machine. If you use it I think it will blow at something around the 90% pressure (which is a number where you were at OR below for 90% of the night). Check your manual for this feature.
I think it blows at the higher pressure for a few minutes to give you time to adjust the mask to the higher pressure. Worth trying even if you don't increase the minimum very much right away.

Thank you, Pugsy. I will definitely try the mask fit test and gradually raising the min. pressure. I appreciate your time and advice.