Please help, CPAP therapy not working!

After almost 2.5 years of CPAP usage, I am not sure if CPAP is helping me. Please look at my graphs and let me know if something is wrong with my cpap therapy. I slept for 8.5 hours last night with cpap but I feel really tired and exhausted since morning . I do not think CPAP is working for me. I am not even sure if I have sleep apnea

Some background:
Went to my ENT in early 2018 as I was not feeling rested(burning eyes, tiredness, brain fog) even with > 8 hours of sleep every night.ENT did not find any thing wrong and referred to sleep doctor. Got a sleep study done in April 2018 and they diagnosed with mild-moderate sleep apnea. I attached the screenshots from diagnosis to this email. There is a lot of variation in the results on second night compared to the first.

Used CPAP from APR 2018 - May 2020 even though I was not feeling any improvements at all. The pressure was set in the 8 - 12 range. AHI was < 3

Since May 2020 my usage was sporadic. I tweaked the pressure settings and the set the pressure in the range from 5-8. To my surprise the AHI was still < 3. That is when I started doubting if I really need a CPAP. I have attached yesterday's night graphs

overall I do not feel rested with or with out cpap. I have a feeling that with CPAP I feel worse.

Please let me know if you need more data from OSCAR.

Yesterday's sleep graph: CPAP diagnosis: CPAP usage stats:

First thing...the difference in the results of the 2 sleep studies....easy...your OSA is worse when you are sleeping on your back (supine) and the second night the amount of time you spent on your back was considerably less.
This is quite common for OSA to worsen when supine or even during REM stage sleep.

Do you wake often during the night?

Do you take any medications of any kind? If so, what?

Any other physical or mental health issues going on?

Why did you limit the max pressure to 8 cm? The machine wants to go higher and in fact spends a lot of time hitting the 8 cm mark...it's going there for a reason related to airway issues.

Your AHI is greatly reduced from the sleep studies so it is working....now why you aren't feeling as good as you expect is a different ball game to try to sort through.
So it's working but not to your satisfaction....that is unfortunately a common complaint and takes some work to sort out what the problem might be and then how to fix it. To fix a problem you first have to identify the problem.

Thank you Pugsy for the reply! Appreciate your help!

I agree that supine position is worse. I starting sleeping on my side after observing that from my sleep study

I do not not wake up much during the night with or without CPAP.

I do not take any medications. I take the following supplements, multivitamin, fish oil, vitamin D and vitamin C

No mental issues as such. I have non allergic rhinitis. I used to use Flonase every night but stopped since May 2020. Vitamin C has been helping me with my non allergic rhinitis. I have a BMI of 24.5 and try to exercise at least 5 times a week.

No particular reason why I capped it at 8 cm, I just looked at my previous history from the dreamstation mobile app and set it at 8. I can change the maximum value to 12.

Also, I think it was 8 cm for about 10 minutes during the night. I am trying to understand if that would have made any difference

I am trying to get to the bottom of the problem as well but unfortunately could not find any patterns. I have no known allergies(got tested for allergies twice), ENT doc did not find anything that could be causing my fatigue/brain fog/tiredness. My general physician could not find any thing abnormal from blood work.

Thanks again! Please let me know if you need any other details.

Actually it is more common to set the max to 20, so unless there's a reason not to do it, I'd try that, or at least 15.

If you look at your pressure graph the times where the machine hit the max correspond with the times there are more hyponeas flagged.
Now are those flagged hyponeas/OAs responsible for your unwanted symptoms??? That's the million dollar question isn't it?
Since it wouldn't be impossible for those events to be a factor then the first thing I would do is see if reducing those events made any difference in how I felt or not.

Exactly what symptoms are you having still yet that you wish you weren't having?

I agree the upper limit should definitely be set to 20. I will update it.

I looked at my previous sleep session graphs and although it is hitting the max limit of 8 sometimes, most of the days it is not even close to the 8cm.

Please take a look at the the graph day before yesterday 03/16. Please ignore the session which started at 9.30 AM, I just slept on my back after I woke up with the machine for an hour.
The reason I started doubting CPAP therapy was my AHI remained similar when my CPAP was set to 8-12cm and 5-8 cm. Also, my average SpO2 was 95 during the sleep test.

My main symptom is I do not feel rested even after 8+ hours of sleep every night. I feel tired, burning eyes, can't get my self to focus on simple things. My symptoms were same before and after CPAP.

I didn't feel better until I got my leaks down to zero.