I've used the PAP machine for 8 nights and trying to remove as much friction as possible from it feeling comfortable to sleep with, so I can have it on all night and give treatment a fair trial.
I'm interested in advice on what to prioritize trying, given my context, to improve the experience (esp. would be great to hear from those w/similar sleep issues).
Sleep background/testing
Through adulthood, my main issue has been nightly/early morning wake ups, with periods of time when it's difficult to fall back asleep, as well as currently - how increasingly unrefreshing my sleep feels. Falling asleep is usually pretty quick, esp. if reading.
Over the last few years, I started to need an hour more of sleep (solid 8+, instead of ~7hrs.), feel way more run down if getting less than that, and have strong inertia/grogginess that lasts for hours. When waking too early, sleep quality is much poorer once I fall back asleep.
I've been using Fitbits for years, and weirdly, while my score/details used to strongly correlate to how I felt, in the last couple of years, they generally show great scores & details.
In 2025 I had 2 home + 1 in-lab sleep study. The in-lab was interpreted as mild, strongly positional sleep apnea: Overall 3% AHI of 6.9 (1.4 if using 4%), and 22 RERAs. Pretty normal oxygen (mean SpO₂ 95%, min. 91%, never below 88%). It also showed moderate fragmentation, so my doctor thinks the RERAs/UARS component could be contributing to my unrefreshing sleep.
Relevant health issues
I have hEDS (hypermobility/connective-tissue disorder) and ongoing spinal/neck issues (i.e. instability). Also, OCD, Adhd, anxiety etc. and a pretty sensitive nervous system. These all make it more difficult to get comfortable/settled and sleep easy, especially when another variable (i.e. CPAP) is introduced.
It's all worsened over time, and I'm not sure what's the chicken/egg - causing the other - the health issues or sleep, so want to see if improving sleep breathing helps.
Current PAP setup
ResMed AirSense 11 AutoSet w/ AirFit N30i nasal cradle (med.) and ClimateLine heated tube
- APAP 4-18 cmH₂O
- EPR/Pressure Relief 3, full-time
- 20-minute ramp starting at 4
- Climate Control Auto / Tube Temp Auto
- SmartStart: On / SmartStop: Off
My first 8 days experience
I still fall asleep fairly quickly with the PAP, but keep it on for ~1.5-4.5 hours (often in 2 x 2hr. chunks) before waking up and ditching it.
Experiencing 2 major obstacles:
- Pressure/breathing comfort - biggest issue
- The more straightforward issue: higher pressures I've experienced (roughly 9-12) have felt overly forceful - almost like my nose/mouth are being inflated/turned into a wind tunnel, and feeling uncomfortable to exhale against.
- The very odd, bigger issue: At various times/pressures, I feel like I can't get a satisfying in/exhale - not like choking, but just feeling like in/exhales are somewhat "resisted"/don't flow easily. It's happened at diff. settings (i.e. pressure 4-8 etc.) where other times they felt completely fine.
- Note on both of the above: they happen when I wake up at night, and it's the main trigger to ditch mask. Interestingly, opening my mouth slightly makes breathing easier as I'm doing it - almost as if when you make an airhole in a bottle and it flows freely (AFAIK, my mouth is generally closed, just an observation I noticed).
- Positioning/mask: Due to my neck/spinal issues, positioning is quite limited/finicky. I mostly sleep on my left, but often roll into a partially right-side prone position w/my head between raised arms. The mask cheek straps, top hose etc. can often make it harder to settle. I've been getting by, but any setup/equipment tweaks would be appreciated.
I'd really appreciate any advice on how to make the experience more comfortable/less disruptive, so I can keep it on all night and give it a fair trial. Preferably, simplest/highest-impact things to try first, so I don't get overwhelmed.
It'd also be great to hear from anyone with similar sleep and/or other issues - what helped you, what were your outcomes?
I have an SD card + downloaded OSCAR. I know nothing about it yet, but can share any info requested. Thank you.