My first question is in regard to your humidification. Do you have a warm air humidifier (WAH)? This should help drying out and your sinus problems that occur when using your CPAP. If you do have a WAH have you tried adjusting the temp.. To do this hold down the button that turns on the warmer. You should hear two beeps and the display will change to a flashing number (1, 2, 3, 4, or 5). Once you enter this field use the HEAT and/or RAMP buttons to turn up or down the temp..Finally either push your START/STOP button or just leave the unit alone for about two minutes and your new settings will be saved. If your warmer is at 1 or 2 then try 3, 4, or 5. The temperature of your room or warmer can affect humidification and sometimes cause "rainout" or basically a flood of water in your mask therefore you don't want to adjust your warmer too fast. For example if it is set to 1, don't jump to 5 right away instead, increase it one number a night and stop once you see moisture in your mask in the morning. If water puddles inside the tubing during the night it will get very loud and disruptive, if this occurs turn down the temp. to the last comfortable setting. If you do not have a WAH then ask your doctor for a prescription for one, Respironics makes a WAH that is made to fit directly in front of your CPAP.(But I would bet you already have one) Also make sure you are turning on the warmer. Either turn on your CPAP or within 15 minutes of going to bed, simply push the HEAT button for 1 second, you will hear a beep and a green indicator light should turn on in the lower right hand corner.
For your ear problem try exhaling (through your nose) one deep breath as you place the pressure tubing on to the mask with the CPAP's blower turned on, this sometimes helps to keep the pressure balanced inside your ears, after one deep exhale resume normal breathing.
If you have red marks on your face in the morning, that indicates you are over tightening your mask. Start over and loosen your mask completely. Adjust the bottom straps first and then the top straps, you should do this with your CPAP turned on and with you lying down in your normal sleeping position (if you have such a thing). A last resort option would be to boil the gel of the mask for 3 min., cool off for 10 to 15 seconds under cool water, then wear your mask for 5 to 10 minutes. It is not necessary to have your CPAP attached to your mask at this time. This should help customize your mask for your nose. If this doesn't work suggest a different mask, such as nasal pillows which may not leak as much, a very popular mask at the time is the Swift nasal pillows made by Res-Med.
You may have some difficulty returning your mask due to reimbursement for a new mask but your doctor should be able to arrange some help with this matter. Medi- care will pay once every 6 months for a mask replacement, once every 2 months for a cushion replacement.
Are you aware of the Ramp function? This will turn your pressure down to 4 and within a set period of time (5, 10, 15, 20, 25, 30, 35, 40, or 45 minutes) it will increase to your prescribed pressure.
As you work out these bugs and start to adjust to sleeping with your CPAP you should find that exhaling does not need to be so labored, this is just your lungs trying to exhale the CPAP air along with your normal respiration, this is a common response and usually will subside as soon as the patient relaxes and forgets about breathing, allowing respirations to occur naturally.
Hope this helps out let me know if you need more information. It may take sometime for a response back from me but I will try to give you as much information as I can. Sleep well and be happy. A.C.Wallace R.PSG.T