[split] AHI Score Does Not Go Down on CPAP

[jennie54]

I'VE BEEN USING CPAP NIGHTLY FOR ABOUT 5 STRAIGHT YEARS - DIAGNOSED ABOUT 8-9 YEARS AGO BUT TOOK ME QUITE A WHILE TO ADJUST TO THE MASK AND THE PRESSURE. ORIGINALLY THE PRESSURE WAS SET AT 10, THEN 11 AND LAST YEAR IT WAS UPPED TO 12 BECAUSE I WAS STILL HAVING AHI'S THAT WERE NOT IMPROVING. MY DOCTOR WANTS IN 5 OR BELOW. LAST YEAR IT WAS A BIT OVER 6, AND A FEW MONTHS AGO IT WENT UP TO 7 EVENTS/HOUR AND TODAY IT WAS UP TO 8 AHI'S! I DON'T UNDERSTAND HOW I HAVE BEEN COMPLYING 100% WITH THIS THERAPY FOR A SOLID 5 YEARS AND STILL DON'T HAVE THE NUMBERS DOWN TO 5. I'VE EVEN LOST ABOUT 25 LBS. SINCE STARTING CPAP THERAPY AND HAVE CHANGES MASKS SEVERAL TIMES AND HAVE A NEWER MACHINE BUT MY NUMBERS DON'T IMPROVE. I DON'T HAVE A PROBLEM WITH AIR LEAKS VERY OFTEN - BUT I DO MOVE AROUND A LOT WHEN I SLEEP AND ADJUST MY MASK QUITE OFTEN TO MAKE IT MORE COMFORTABLE. I ALSO HAVE INSOMNIA AND MOST NIGHTS IT WILL TAKE 1-2 HOURS TO FALL ASLEEP EVEN AFTER PUTTING THE MASK ON. WHAT AM I DOING WRONG? STILL SO TIRED DURING THE DAY; FEEL LIKE I'M FIGHTING A LOSING BATTLE! I WAS ALSO RECENTLY DIAGNOSED WITH MODERATE COPD (BY MY SLEEP MEDICINE DOCTOR AFTER YEARS OF COMPLAINING TO HIM ABOUT MY CONSTANT FATIGUE AND SHORTNESS OF BREATH WITH MY SLEEP APNEA) I ALSO SUFFER FROM CHRONIC SINUSITIS AND HAVE ACID REFLUX. ANY SUGGESTIONS WOULD BE GREATLY APPRECIATED!

[eseedhouse]

Please don't write in all upper case, and consider the odd paragraph break. I gave up reading your message because my old eyes just get all mixed up trying, and I read a *lot*. If you have some kind of handicap that prevents this then please accept my apology in advance.

[chill]

Try this:

I've been using cpap nightly for about 5 straight years - diagnosed about 8-9 years ago but took me quite a while to adjust to the mask and the pressure.

Originally the pressure was set at 10, then 11 and last year it was upped to 12 because I was still having AHI's that were not improving. My doctor wants it 5 or below. Last year it was a bit over 6, and a few months ago it went up to 7 events/hour and today it was up to 8 AHI's!

I don't understand how I have been complying 100% with this therapy for a solid 5 years and still don't have the numbers down to 5. I've even lost about 25 lbs since starting cpap therapy and have changed masks several times and have a newer machine but my numbers don't improve.

I don't have a problem with air leaks very often - but I do move around a lot when I sleep and adjust my mask quite often to make it more comfortable. I also have insomnia and most nights it will take 1-2 hours to fall asleep even after putting the mask on. What am I doing wrong?

Still so tired during the day; feel like I'm fighting a losing battle! I was also recently diagnosed with moderate COPD (by my sleep medicine doctor after years of complaining to him about my constant fatigue and shortness of breath with my sleep apnea) I also suffer from chronic sinusitis and have acid reflux.

Any suggestions would be greatly appreciated!

[pholynyk]

Thank you, Chill.

I wonder if Jennie54's post should be moved to its own thread, to avoid confusion as to whom a reply is directed. Mods?

[chill]

I agree that it would be best moved to a new thread. In the meantime, I will attempt some replies.

It is not unusual to have increasing pressure needs. Age, weight gain, medications, allergies, many things can affect this. If your machine is 8 or 9 years old, it could be that the machine is slowly failing. They don't last forever. If the reported AHI is correct (it might not be if the machine is no longer working correctly), then is is way too high. Your doctor might be aiming for under 5, but most of us here find that much lower than that results in better sleep and better awake time.

Complying just means using the machine. It does not guarantee that the machine is functioning correctly, has the correct pressure settings for you, or is even the right machine for you. I think you need to get more assertive with your doctor, or find a new one. Have you had a sleep study recently? If not, the rising AHI seems to justify one.

Insomnia certainly won't help matters and as the machine can't tell that you are not asleep, it will count the AHI as if you were. So the rising AHI might just be you thrashing around more trying to get to sleep. Insomnia can be hard to treat. Sleep hygiene is important as you probably well know. For me, sleep compression therapy was what finally cured me. It was brutal at the time, but has been effective long term. You might want to consider it.

I am not the one to speak to COPD. Sinusitis makes it harder to use nasal masks and pillows. Nasal rinses with Xylitol can really help that as can medications. Acid reflux is common with sleep apnea. Mine has greatly reduced since I got effective therapy. Your therapy does not sound effective at all!

[Sleepster]

I've complied with the requests and split the thread.

Jennie, you need to look at the three numbers that add up to the AHI. One of them is the clear airway (CA) index. If that number is the largest of the three, raising the pressure will likely raise the AHI, not lower it.