Thanks for your comments, Dr. Park. They will certainly help me over the coming months as I decide what to do about alternatives to CPAP. However, your comment about a "vicious cycle" made me have another perspective about the interaction between body and mind, so to speak: it may take a prolonged period of CPAP use to calm my nervous system, even if the breathing problems are being addressed. Thus, I may be on the road to recovery, and yet not feel much benefit. It does seem that it is a lengthier process to calm one's nervous system than it is for it to be stimulated in the first place. Perhaps more time is the answer. Thank you again for your help and all your work.
You have some great insights about your own condition. If you have UARS, it's not surprising that CPAP isn't helping you. Sometimes it does help, but in most cases, either it doesn't help or can even make things worse. The problem is that by definition, your nervous system is hypersensitive, so wearing a mask with straps on your face can cause you to wake up more often that it actually helps.
I agree with your comments about CBT. It's a great way of addressing all the bad sleep habits and behavioral issues that most Americans have, but it does nothing for your physical and anatomic problems. If you came in to see me, most likely, I would see a very narrowed space behind your tongue, especially when on your back. If your airway improved significantly when you thrust your jaw forward, then this would make you a good candidate for a mandibular advancement device. Overall, in my experience, oral appliances have better track records in treating UARS. But this is totally dependent on the particular dentist's expertise. Not all dentists are the same. There are also various orthodontic techniques that not only move your teeth around, but can change the shape of your jaws as well.
You're right in that sometimes it's hard to know what's medical vs. what's cognitive or behavioral. Ultimately it's a vicious cycle. But my entire sleep-breathing paradigm states that anatomy plays an important role, and if you can change the anatomy definitively (using either CPAP, dental devices or surgery), significant improvements can occur. Hope this helps.