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[Pressure] AHI vs. exhaustion
Hi, I'm new, so pardon me if this has been covered before. I have read through a lot of the board, but there is so much information. I've been lurking here for a couple of years, but just joined.

A big thank you for all of you who gave information for how to camp with a CPAP and a deep cycle marine battery. I am thrilled to be able to camp and breathe.

My question: I have a Resmed S9 Elite, and have been using it in 100% compliance for 2 years. This July, I started waking up with "those" headaches again, called the doc, and sent my SD card in for reporting. She called me and said my AHI was below 3 and that was fantastic.

So how come I felt like crap.

After reading about adjusting your own pressure, I upped my pressure from 10.0 to 10.4...not waking up with the headache, but still feeling constantly exhausted.

A few mornings ago, as I was waking up (feeling like I couldn't face the day) I realized that when I was lying on my back, and breathing out, my airway blocked completely.

I raised the pressure to 11.0 and have woken up the past two mornings with no headache and feeling like I can take on the world.

My question is, how come if I could tell I couldn't breathe out through my nose (because of blocked airway), this wasn't registering on the SD card (also, my machine was set to summary info only, which I've changed).

Should I be going by how I feel, or by the numbers?
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To distill the efficacy of therapy to a single number is convenient; but does not tell the whole story.
How you feel is more important.

Your story is why an auto machine is better for most people. Given a little more max pressure, you wouldn't have run into the issue.

Since you have the Elite, perhaps you could put that in your profile...



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Hi catwhisperer59,
WELCOME! to the forum.!
I think it’s good to go by how you feel, but it sure doesn’t hurt to look at your numbers. It’s good that when you raised your pressure a bit, the headaches went away, now to get rid of the exhaustion.
Hang in there for more suggestions and answers to your questions and much success to you as you continue your CPAP therapy.
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How you feel when awake is what good sleep is all about.
Zeroing in on the proper settings with straight CPAP is much more difficult than with an auto machine. This is especially true since most of us don't sleep the same throughout the night let alone the week or years.
As you go through different sleep stages each night or move from side to side or back sleeping, your pressure requirements may change. The same is true with seasonal changes in the weather and humidity.
Over a period of years your body will change too.

If it were me, I would raise a ruckus until my doc prescribed an auto as medically necessary. Then I would do the same with the insurance company until I could swap the CPAP for an APAP.
I was lucky enough to find this group before I got my machine, so I started with an S9 Autoset.
If I could not get cooperation from the medical mafia, I would find a supplier like Second Wind and pay to swap my machine for an APAP.
Your sleep plays a major part in determining the quality of your life.
Do what ever is necessary to make it the best you can.
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Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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(11-08-2015, 10:16 AM)catwhisperer59 Wrote: Should I be going by how I feel, or by the numbers?
Both are important, the lower AHI is the better how I feel ... YMMV
Low or high level of unintentional leak rates can affect both too
What are the leak rates and AHI breakdown of events on the old pressure and the new pressure?

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remember that AHI is an average count and has nothing to do with how long they last or total time in apnea.
My doc told me that headaches were caused by CO2 retention while sleeping. If you were not breathing then your CO2 would go up and raising the pressure would clear out the CO2. This sounds just like what happened with you (and me)
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Have you activated the user flag options in SH? I find I can have AHI's of zero and almost always less than 0.5 unless sanding or sawing or otherwise doing something dusty yet am often tired. (but MUCH better than pre CPAP). The use flag option often shows me many micro disturbances even at AHI/0. These micro-disturbances tend to correlate with elevated leakage rates an ongoing battle for me.
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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You should go by how you feel. AHI is just one variable that needs to be optimized (to below 5).

The other 2 things that the machine can not detect are:
1) Your O2 levels. This needs an oximeter to
Monitor. Sometimes your AHI fixes itself at a pressure of let's say 10cm BUT your O2 levels come up to normal range at 11cm. Another way to raise O2 levels is to use EPR. Higher EPR means more O2 (for same EPAP level).

2) Microarousals: These can only by detected by EEG. A microarousal is where your body gets out of a deeper sleep stage to a shallower one. This helps the body to oxygenate itself by warding off apnea events. But makes you feel like crap in the morning because you didn't have enough deep sleep (REM, SWS) where the brain refreshes itself.

So once AHI is optimized, you need to sometimes tweak a bit more. And since we don't have a oximeter and a EEG, we can only go with how we feel in the morning.

Hope this helps.
PRS1 Auto & Dreamstation Auto w/ P10 and straight pressure of 7cm. 
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All the above are good points, but you assume that your machine says 10.0 it is actually blowing at 10.0. Your machine may not be working properly, it can happen. We just had a patient come in today, with a pressure of 14 and his CPAP was only blowing 11.4 and he was snoring and feeling like "crap" (his words). Ask your DME to check your machine with a digital manometer.
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