Will the issues ever end?????!!!!!

I have a friend who has had their cpap machine for a little over a month now and they still cannot get the mask adjusted right. They have used a ResMed Mirage Quattro Medium, and now they are using a Mirage Quattro small. On top of that they are still not sleeping well at night. Could it be because their pressure is too low and not keeping the airway open?

If they aren't comfortable with the mask and not sleeping well due to fiddling with it or leaks or whatever there is not much chance of feeling better if for no other reason than just poor quality sleep.
Mask issues....fit, comfort and leaks are the hardest part this therapy.
To evaluate pressure needs....whole different story there.
What machine does your friend use? Does it have any data? Use software to see if the pressure is optimal for the time the mask is on and not being a problem?
If leaks are huge then pressure is not optimal but it is because of the leaks and not necessarily the initial pressure settings.
Have to evaluate all of it instead on one tiny part.

Tell her to come join this forum. it's helped all of us.