Confused and Worried

[languageusa]

Issue: Philips Respironics REMstar Pro C-Flex+ CPAP machine

At the very start of my CPAP therapy about 6 weeks ago, the daily AHI numbers were recorded by my CPAP machine at the levels as low as 1.1, 1.8, 3.4, etc. with a weekly average AHI of 4.1 events per hour at an average device pressure 11.4 cmH20. During the following 5 weeks or so the occurrence of events per hour at an average device pressure 12.0 cmH20 elevated to rather high numbers––monthly average AHI of 14.7, with individual daily levels, presumably, reaching much higher AHI levels. No air leaks have been detected by the system in the course of this six-week therapy period. During the first “good” week, I was sleeping most of the time while the machine was running. During the following 5 weeks, however, my sleep pattern somewhat deteriorated and I was spending more time being awake while the machine was running. This increase in the number of AHI events seems to be connected to the change of the sleep pattern described above.

Furthermore, just recently my CPAP machine was running for 9.5 hours (I felt rather comfortable with the new mask and stayed in bed longer than usual), but that was virtually a sleepless night––I actually slept for, may be, 3 hours, if not less. So, the actual “sleep” AHI number was presumably much higher.

The next night I did not sleep at all. The machine was running only for 2.5 hours and I was completely awake during those hours. The AHI was 35.9. Once again, I did not sleep a second during that time.

Yet another fact: the other day I was just testing a new mask in the afternoon. The machine was running for approx 10 minutes. No sleeping, of course -- just testing. Yet, the AHI showed 3.5.

All these facts point to the fact that my machine, for some inconceivable reason, senses some “events” during my awake moments/hours and treats them as the sleep apnea events (false positives) adding them to my AHI average. It is a common knowledge that sleep apnea is not existent in a person when he/she is awake. So, is that something wrong with my machine, or this is a manifestation of some medical problem?

My doc is of no help at this point and he tends to increase the CPAP pressure based on the compromised AH index.

Any explanation, please. Thank you so much!

[Dawei]

That no air leaks detected by the system has me wondering. No air leaks whatsoever, even though you switched masks during this period? Not sure if your machine is data capable (others on the board do know), but if so, looking at your leak rates during periods of use would be very helpful in beginning to understand what's going on.

[PaulaO2]

AHI during awake hours are invalid. Ignore those. Your machine cannot tell if you are awake or asleep.

It starts working when it is turned on, not the second we fall asleep.

[PaulaO2]

languageusa, I deleted the duplicate post you made in the Forum Help section.

[Dawei]

I agree with Paula. What still has me wondering is that given--the machine starts working when it's turned on and it doesn't know when you're awake or asleep, however, when it's on it's looking for cessations of breathing that last more than 10 seconds when it records an apnea event. I'd conclude that when there is no cessation of breathing (usual awake situation), no events are present nor should any be recorded by the machine.

[zimlich]

You might want to have the Equipment Provider have a look at the machine. I know this is distressing and hope you get it resolved soon. Good Luck,
Mary

[trish6hundred]

Hi languageusa,
WELCOME! to the forum.
You might have your machine checked just to see what is going on with it.
Hopefully, you can get this very frustrating problem resolved.
Best of luck to you.

[languageusa]

Thank you so much for all your replies!

“AHI during awake hours are invalid. Ignore those.”
Cannot ignore those since by looking at the generated AHI I cannot brake it down and determine the “sleep” time and “awake” time. This is just a single average number. Even if I were able to ignore the awake hours, I would never know my real, actual AHI level, and the CPAP therapy based on the inflated AHI numbers is not an intelligent way of treatment.

“I deleted the duplicate post you made in the Forum Help section.”
Paula, sorry about that. I first placed my post in the wrong section and did not know how to delete it.

"I'd conclude that when there is no cessation of breathing (usual awake situation), no events are present nor should any be recorded by the machine."
Yes, but then I have a problem machine, unless I produce “cessation of breathing” when awake –– could it be possible? Actually, this is what worries me. I will see my doc only in a month.

Again––thank you all!

[PaulaO2]

I didn't mean ignore them as in take them out of the equation. I meant don't worry about them.

The way we breathe when awake is different than what we do when asleep. The machine, which doesn't know the difference, keeps trying to figure it out. When you lay in bed awake, your breathing will alter depending on what you are thinking about, when you roll over, when you sigh. We hold our breath, breathe faster, slower, etc.

And it is not unusual for a new user to experience a slight rise in AHI. Your body is having to adjust. Your 'normal' has changed and it will try to go back to that until new patterns are set and the new normal (and a much better normal!) is established.

However, if you feel the numbers are not right, then speak to your supplier.

[Dawei]

languageusa--My guess is that a person would certainly notice it if he/she stopped breathing while awake for at least 10 seconds each time. When I force myself to do so, it's a clock-watching challenge and doesn't feel very good either.