Apnea getting worse????

When I first started cpap in July '09, my pressure was set at 14cm, and my AHI was @ 8.5. See my Dr a month latter and he changes my pressure to 16cm. My AHI drops down to @ 6.5. As time goes by, my AHI starts to rise. Not by much, but consistantly. I start to "tinker" with my pressure setting, and bring it up to 17cm. My AHI drops down to @ 6.0. Once again, my AHI starts to rise. A little more "tinkering", to a pressure of 17.6 and my AHI drops to @5.0!!!!! Yea! I'm happy!!! I think I found the proper pressure setting!

UNFORTUNATELY......
That is no longer the case! My AHI is once again on the RISE! It is now @ 7.0!
I know that's not a terrible number, BUT, I'm getting tired again! For the past week or so, I'm been taking "unexpected" naps during the day.

Is it normal for your apnea to get worse?
Nothing in my lifestyle has changed, including my weight(I've even lost a few pounds). The leak rate on my mask has remained consistant the entire time, so that's not an issue.

If it's normal to get worse, HOW bad can it get, and will it ever stop getting worse?

I'm not versed enough to know whether your treatment parameters are expected to change over time, but I don't think so--nothing I've read or searched for indicates that. I am sure that having your apnea increase is not something you are expected to just live with. I think you should consult with your doctor again on this, unless there is something in that relationship that isn't working.

I see you have software. You might post a chart for the forum to look at. Good luck!

I don't know that any study has been done indicating that there is a clinically significant difference between 8.5, 7, or 5. Even on a PSG, which would be more reliable than the data from a CPAP, I don't know if it is a significant difference (I haven't seen a study that would show that anyway). Wish I could find that reference to how the cutoff of AHI of 5 was established... It was like a compromise between two bigwigs, one wanting X, one wanting Z, so they compromised on Y. It is arbitrary and there is nothing magical about 5. They could have made it 6 or 4 or 2 or whatever...

But you feel worse, so something may need tweaking.

I just wanted to share some advice on your mask leak, The more pressure added the more the mask will leak unless you tighten it more to you face, which will make it more uncomfortable,
Last night I had a noisy leak by my nose, If I pushed it manually it would seal, So after examining the adjustmet to push the mask closer to my face it was already maxed out! So I just added two rubber bands to help secure the seal, and no more leaks and I slept over 7 hrs last night!

Komodo wrote:... Is it normal for your apnea to get worse? ...

It's certainly not unusual. Of course, you might also be seeing more central apneas as the pressure increases. If you continue to have a higher than acceptable (5 or less is acceptable) AHI, then you really should talk with your sleep specialist. Perhaps APAP will help. Or BiPAP. or BiPAP Auto. Or ...

Here's hoping you are able to work this out and get even better sleep.

Fellow Apneer wrote:... I just wanted to share some advice on your mask leak ... Last night I had a noisy leak by my nose, If I pushed it manually it would seal, So after examining the adjustmet to push the mask closer to my face it was already maxed out! So I just added two rubber bands to help secure the seal, and no more leaks and I slept over 7 hrs last night!

Thank you for sharing your experience. That's what makes this forum so different than many others. When you get the chance, you should register on the forum. So, welcome and thanks for posting your experience!

Have you considered that the higher you set your pressure, the more likely it is that you've started mouth breathing while sleeping and you're making it worse by bumping the pressure? Have you tried a full face mask?

Julie wrote:Have you considered that the higher you set your pressure, the more likely it is that you've started mouth breathing while sleeping and you're making it worse by bumping the pressure? Have you tried a full face mask?

When I started raising my pressure past the 16cm level, I did notice a dramatic increase in mouth breathing. However, I didn't see a dramatic rise in my leak rate. Without checking the data, I'd say it went from a 0.5 to a 0.6 average. I have tried using a FFM (Comfortgel Full, and Quattro) and my numbers go through the roof.

I've often thought about de-creasing my pressure, but have wanted to become stable on a set pressure before attempting it. So far, every time I start to become stable, my numbers start to go up again.

JohnBFisher wrote:

Komodo wrote:... Is it normal for your apnea to get worse? ...

It's certainly not unusual. Of course, you might also be seeing more central apneas as the pressure increases. If you continue to have a higher than acceptable (5 or less is acceptable) AHI, then you really should talk with your sleep specialist. Perhaps APAP will help. Or BiPAP. or BiPAP Auto. Or ...

Here's hoping you are able to work this out and get even better sleep.

Yeah, it's something I'm DEFINATELY going to talk to him about, but my next appt isn't until May. I wanted to run this past the forum members first, and try to get an idea of what to tell my doc. I find that I get more/better info here than in his office!

Komodo wrote:
Without checking the data, I'd say it went from a 0.5 to a 0.6 average.

That average (!) leak rate -- even the 0.5, let alone the 0.6, puts you beyond the machine's ability to supply enough pressure to treat your apneas properly.

I would start dropping the pressure to where leaks were controlled - you're not getting the pressure you need at these "super-high super-leaky" pressures.

O.

ozij wrote:

Komodo wrote:
Without checking the data, I'd say it went from a 0.5 to a 0.6 average.

That average (!) leak rate -- even the 0.5, let alone the 0.6, puts you beyond the machine's ability to supply enough pressure to treat your apneas properly.

I would start dropping the pressure to where leaks were controlled - you're not getting the pressure you need at these "super-high super-leaky" pressures.

O.

Those leaks are from my mouth, not the mask.
Before you say to tape my mouth, or use a chin strap, I can't. I have COPD and do a lot of coughing. When I do use a FFM, my leak rate is ~zero~ (but my AHI is 28-35! )
ALSO... I thought the same as you, that the leaks were effecting my AHI, but once I got the software, I saw that the leaks DIDN'T align with any events. Just the oppisite, all my events occur while there are no leaks. (mouth leaks that is)

You have COPD and you're fighting to exhale against a perssure of 17 on an Elite???

I'm no doctor, and I may be all wrong about this, but I always thought COPD made exhaling difficult anyway, and was a priori grounds for using a good bi-level.

I suggest you ignore leak rates for now and try a well fitted FF mask, even if it's one from Cpap.com under the insurance scheme.

JohnBFisher wrote:

Komodo wrote:... Is it normal for your apnea to get worse? ...

It's certainly not unusual. Of course, you might also be seeing more central apneas as the pressure increases. If you continue to have a higher than acceptable (5 or less is acceptable) AHI, then you really should talk with your sleep specialist. Perhaps APAP will help. Or BiPAP. or BiPAP Auto. Or ...

Here's hoping you are able to work this out and get even better sleep.

Hi,

Could I ask you to elaborate please on the issue of the central apneas getting worse as the pressure increases, so that I can understand why that might happen. (During my sleep study I was observed to have 3 cental apneas.)

Thanks.

Komodo wrote:. When I do use a FFM, my leak rate is ~zero~ (but my AHI is 28-35! )

Can anyone speak to why that would be? Others, myself included, have noticed a pattern where AHI goes up with FF mask. But why would that be the case if leaks are well controlled? It really makes me wonder how valid the data from these machines are.