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Unexplained loss of effectiveness
I have been using CPAP therapy regularly for about 8 months. Contrary to most newcomers (time taken to get used to it), I was comfortable from Day 1 and got amazing results. I was waking up fresh, alert and daytime lethargy was gone. Even my BP (which was always high in the mornings before therapy) was significantly down (became normal).

However lately (maybe the past month), the effectiveness has reduced by about 50%. Though I don’t think I am snoring (it’s not possible with nasal pillow mask on) have woken up a few times at night with that familiar feeling in my mouth/tongue and not as fresh in the morning as in the first 6-7 months of therapy (and just as I suspected, the BP is also slightly high).

I am very puzzled – there is no indication of any leak, have not touched the settings and more importantly, the readings (which I check every morning) is exactly how it has always been since the beginning of therapy. AHI of around 1.5 and average pressure of around 10.5. My doubts are more technical – how does the machine calculate the AHI, can it be wrong (how can I have 50% of the symptoms of apnea that I was suffering from earlier with a fantastic AHI of 1.5?). Secondly, even though the average pressure indicated is still the same I suspect that it is failing to increase sufficiently when required. That’s based on feelings - in my mouth itself and also the strong air pressure that the machine was generating earlier (especially in when removed in the middle of the night) seems to be missing – now it just seems to be at the same level.

Would be grateful for any insights, suggestions.
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Hi bornagain,
Are your using your machine in the auto mode, and what is your pressure range set at compared to your average and 95% readings?

Your AHI is good, but if you downloaded Sleepyhead software, you would see much more data, and then we could get a feel for what is going on.
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Hi OpalRose

Yes, I am using in auto mode with setting of low 7.5 (I don't even use ramp feature since its comfortable enough) and high is 20, I think (don't remember clearly since I have never gone to settings myself). I do have the Encore Viewer but confess I have not taken the trouble to upload from the SD card and check. Partly because I already know (from checking every morning) that statistics from all these months will be AHI in the range of 1.2 to 1.8 and average pressure something like 10.5. No "large leak". I am ignorant about anything else that can be analyzed with the data.

But will take your advice and my next step will definitely be to check the data and hope it throws up something that can be easily addressed in setting.

Thanks a lot for your interest and response.
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Hi bornagain,
WELCOME! to the forum.!
Hang in there for more suggestions and answers to your questions.
Much success to you with your CPAP therapy.
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it might be that you need to tighten your pressure range up (good time to say when making changes to do them in small increments and only one change at a time and leave it there for a week or 2 so you can see the effectiveness or lack thereof), could be you need to change your cushions or wash them or both, could be several other issues. Downloading the data in sleepyhead as has been suggested and posting it here so we can see it and help you better would be a great idea. Stick with it and we will do our best to help you out.
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How old is the mask? My insurance sends a new mask and hose every 3 months. They wear out, and AHI rises after a few weeks, then goes back to normal with the new mask (I have not had to change the hose).

There may or may not be a correlation between how you feel and how well the therapy is doing. Certainly not one-to-one. Some of us never "felt bad" in the first place, so don't expect improvement in that area under therapy. If you do get improvement, that's great, but it is not a guarantee, because there can be lots of non-OSA reasons why someone might feel bad. Not being one who ever felt "better" after xPAP, I still can't imagine those who do being able to predict what their AHI was for the previous night based on how they feel when they wake up, at least with any sort of accuracy.

We are in the therapy for a number of significant health improvement reasons, but feeling "better" may not ever be one of them for some of us. So I would look to other remedies to improve how you feel (just stay with xPAP for all the other benefits).
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Honestly, if all else fails, bring your machine to the DME and ask them to TEST the pressure. Call first. If they don't have a manometer, they probably don't have a clue and no way to test in any event. In that case, ask them if there is anybody they send machines to locally who has the ability to test the pressure in an auto-machine.
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(06-24-2015, 03:03 PM)Mosquitobait Wrote: Honestly, if all else fails, bring your machine to the DME and ask them to TEST the pressure. Call first. If they don't have a manometer, they probably don't have a clue and no way to test in any event. In that case, ask them if there is anybody they send machines to locally who has the ability to test the pressure in an auto-machine.

There is really no need to go to a DME to test pressure. Remember that the measurement is cm/h20, all you need is a metric ruler, some clear plastic tubing and some water. Lookup pictures of a U tube manometer online, it doesn't get much simpler really and since rulers are pretty accurate and water is pretty consistent in weight your results will be as accurate as any commercial manometer if you're careful.
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