AHI Way Too High - Pressure Help!

[sleepygirl23]

Hi there!
I just got my CPAP machine a few weeks ago. I'm only 24 and in good physical shape, relatively thin and healthy except for my obsessive compulsive disorder (which I do not take meds for anymore)

As far as I know, this isn't anything that runs in my family.

I just started working about a year ago after graduating college. I can't wake up without someone physically pulling off the covers and yanking me out of bed...I sleep through every alarm! Not to mention, I feel totally miserable throughout the day. I feel depleted during work, and I have no energy to do anything when I get home. I should also note that I'm getting my master's degree part-time at night, which has been difficult with my sleep problems.

I have always struggled with my sleep and feeling tired, but in college it was much more manageable having such a flexible schedule. I am concerned about my work performance. I decided to have a sleep study done since my boyfriend also noticed I would often stop breathing during the night and wake up full of sweat.

I did an at-home sleep study with a very well-respected doctor while at a medical treatment center in Florida. I did not tell her that I took a legal herbal supplement for anxiety several hours before bed, and I'm wondering if that skewed the numbers somehow. She was concerned with my results and suggested I follow up at home in Milwaukee with a doctor. Based on the results of the ORIGINAL sleep study, the doctor in Chicago said that I didn't need to repeat the sleep study with him. Instead, he said that I would spend the night in his medical center to test out a CPAP machine. Therefore, the sleep technician was only testing for the proper pressure on a CPAP machine - not testing again for apnea. The Milwaukee sleep technician said that the machine was great and I only had one significant episode during the night. I went to work feeling incredibly refreshed but I don't know if it was psychological or whether it really did work.

Flash forward a couple of weeks: I now have my CPAP machine and I'm not feeling any better. In fact, I think I feel worse. I have the Phillips Resprionics DreamStation. I am not taking the herbal supplement anymore nor did I on the night that I tested the CPAP machine with the sleep technician overnight.

So I have a couple of questions:

1. Is it possible that I don't have sleep apnea, and I have something else? Can the CPAP machine be causing relatively high AHI numbers (8-12) on its own? Can using a CPAP machine actually make you feel worse if you don't have it? The reason I am asking is because the only "test" I ever did was in in-home sleep study, and I had taken an herbal supplement.
2. Does the "in office" overnight stay where the technician uses a CPAP machine to test your pressure also test for your apnea as well? Meaning, let's say that I didn't actually have sleep apnea, but since I was only being tested for proper CPAP pressure and nothing else, would that be detected?

3. I know how to adjust the pressure settings...based on my numbers below could someone suggest (I know that most people on here are not doctors, but please don't just advise for me to go see him - I like him very much, but I recently read a few complaints somewhere that he is out to get money and occasionally misdiagnoses people...so I would like to test on my own before spending significant amounts of money doing ANOTHER sleep study with another doctor)

My pressure is from 6.0 to 8.0 and I use a ramp at 4.0 until I fall asleep. My numbers I'm seeing are still not good, so perhaps that is why I am still feeling so tired?????
Phillips Resprionics DreamStation. I have the full face mask as I am a mouth breather.

12/1/15
AHI 8.2
Usage 5:44 hours
Mask Fit: 100%
Centrals: 9
Obstructives: 8
Hyponeas: 30

12/2/2015
AHI: 8.9
Usage: 4:09 hours
Mask Fit: 100%
Centrals: 6
Obstructives: 7
Hyponeas: 24

12/3/2015
AHI: 8.4
Usage: 4:59 hours
Mask Fit: 100%
Centrals: 10
Obstructives: 11
Hypopneas: 21

12/5/2015
AHI: 12
Usage: 3:13 hours (I accidentally fell asleep without it so I put it on in the middle of the night)
Mask Fit: 100%
Centrals: 7
Obstructives: 5
Hypopneas: 25

12/6/2015
AHI: 4.3
Usage: 3:58 hours
Mask Fit: 100%
Centrals: 1
Obstructives: 5
Hypopneas: 11

12/7/2015
AHI: 8.9
Usage: 5:52 hours
Mask Fit: 100%
Centrals: 3
Obstructives: 13
Hypopneas: 36


Does anyone have any suggestions as to what I can do (besides see my doctor)? I can't get in for a few more weeks anyway, regardless of what I read online about his tendency to misdiagnose. Mainly, I'm trying to figure out if having the CPAP machine is actually HURTING me (and the at-home test was just skewed by the herbal medicine I took that night) and something else is wrong, or if I actually do probably have sleep apnea.

Can anyone suggest whether or not I could try turning the pressure up or down? Or should I leave it as be? ANY suggestions or help would be so appreciated - I feel beyond miserable during the day and I really, really hope that this helps me.

Thank you for everything!!!

[Nom]

An AHI > 12 is considered mild sleep apnea. There's no question you've got it, especially if that's the number you're getting *with* a CPAP machine. I would definitely be turning the pressure up to see if that helps.

There's no magic number, unfortunately, so you really have to turn it up until you find a number that works. Also make sure your mask is fitting properly, because any leaks means you're not getting the full pressure.

[thecpapguy!]

A CPAP unit can definitely cause your apnea to increase. When a CPAP induces an apnea it can become known as Complex Sleep Apnea which requires a more advanced machine to assure that the apneic problem is resolved, but remember that this is typically a worst case scenario and can typically be countered by adjustments to the current pressure settings and possible mask fit issues.
When you complete a CPAP Titration Sleep Study a few things are monitored, but yes - the amount of sleep apnea your having in contrast to what pressure setting you are is recorded on a titration table assuring that the optimum pressure is used to counter the apneic events lowering them to a controlled state (less than 5 events per hour or less). So, usually when you leave a titration study your pressure is confirmed.
Your download information is certainly troublesome with the high amount of central and obstructive apnea in contrast with a hypopnea. Typically to correct central apnea you need a lower pressure. To correct an obstructive apnea you increase the pressure entirely and to correct a hypopnea an increase in pressure or an increase in the lower APAP pressure is typically required. Your download is a little difficult as it shows you need quite a few different types of pressure changes. A detailed download of your CPAP unit is needed, which would definitely help decipher when you are having your apneic events and if they are are true events or not. In odds, it looks that your central apnea events are likely going to naturally dissipate as the last two nights of use they have lowered, but that the obstructive and hypopnea are going to persist. You likely would need an increase in pressure to assure your comfort and controlled apneic events providing balance to your apnea hypopnea index (AHI).
Sorry for the novel in answer, but I hope this offers you some help!

[HoseCrusher]

Your questions...

1) No.
2) Yes. The pressure test is to determine how much pressure is needed to eliminate your apnea events.
3) You should set your starting pressure to 5 and set the ramp time to no more than 15 minutes.

In order to evaluate your pressures you need to download the data and study it. Many here use Sleepyhead and you may want to check that program out. It is free. I don't know if your machine offers data but if it does you can review your data and see where you stand.

A person without apnea doesn't suffer any ill effects when using a CPAP machine. They don't need the machine but using it doesn't produce apnea events.

Taking a look at your data should reveal how effective your pressures are and suggest any adjustments to pressures.

[Julie]

There is no point in using the ramp if your starting pressure is 5 - 4 being the default low setting for the machine - there is almost nothing to ramp up to (4-5) but during that ramp time you're being treated at sub therapeutic levels, if 5 is supposed to be therapeutic (considering how low it is now). I would want to start (rampless) at at least 6 or so, and raise the high pressure setting to e.g. 10, as you now have it needlessly low at 8. I would also try not back-sleeping if possible to see if it makes a difference (it can) and come back to this thread after a few nights with the changes.

[blownaway]

You are only sleeping 4-5 hours a night. For someone your age, that is totally inadequate so no wonder you're tired. Why are you sleeping so little? Yet you say you sleep thru alarms and have hard time waking up. Are you using the machine only part time while sleeping or do you really only sleep for such a short time? What you say and what your numbers reveal are conflicting.

[sleepygirl23]

An AHI > 12 is considered mild sleep apnea. There's no question you've got it, especially if that's the number you're getting *with* a CPAP machine. I would definitely be turning the pressure up to see if that helps.

There's no magic number, unfortunately, so you really have to turn it up until you find a number that works. Also make sure your mask is fitting properly, because any leaks means you're not getting the full pressure.

Thank you! I turned it up last night and I had a few instances when I actually woke up (consciously that I remember) in the middle of the night with a mild/slight panic from the pressure, until I realized that I had my CPAP on. I wonder if this means that it was too high? It did not happen with the lower pressure and the instances were only a couple of minutes. Thanks for your help! I appreciate it!

[sleepygirl23]

A CPAP unit can definitely cause your apnea to increase. When a CPAP induces an apnea it can become known as Complex Sleep Apnea which requires a more advanced machine to assure that the apneic problem is resolved, but remember that this is typically a worst case scenario and can typically be countered by adjustments to the current pressure settings and possible mask fit issues.
When you complete a CPAP Titration Sleep Study a few things are monitored, but yes - the amount of sleep apnea your having in contrast to what pressure setting you are is recorded on a titration table assuring that the optimum pressure is used to counter the apneic events lowering them to a controlled state (less than 5 events per hour or less). So, usually when you leave a titration study your pressure is confirmed.
Your download information is certainly troublesome with the high amount of central and obstructive apnea in contrast with a hypopnea. Typically to correct central apnea you need a lower pressure. To correct an obstructive apnea you increase the pressure entirely and to correct a hypopnea an increase in pressure or an increase in the lower APAP pressure is typically required. Your download is a little difficult as it shows you need quite a few different types of pressure changes. A detailed download of your CPAP unit is needed, which would definitely help decipher when you are having your apneic events and if they are are true events or not. In odds, it looks that your central apnea events are likely going to naturally dissipate as the last two nights of use they have lowered, but that the obstructive and hypopnea are going to persist. You likely would need an increase in pressure to assure your comfort and controlled apneic events providing balance to your apnea hypopnea index (AHI).
Sorry for the novel in answer, but I hope this offers you some help!

Thank you! Sounds like I'm just going to have to probably more than likely gut it out until I can get in and see my doctor again. I appreciate your insight!

[sleepygirl23]

Your questions...

1) No.
2) Yes. The pressure test is to determine how much pressure is needed to eliminate your apnea events.
3) You should set your starting pressure to 5 and set the ramp time to no more than 15 minutes.

In order to evaluate your pressures you need to download the data and study it. Many here use Sleepyhead and you may want to check that program out. It is free. I don't know if your machine offers data but if it does you can review your data and see where you stand.

A person without apnea doesn't suffer any ill effects when using a CPAP machine. They don't need the machine but using it doesn't produce apnea events.

Taking a look at your data should reveal how effective your pressures are and suggest any adjustments to pressures.

Thanks for your help...love your username!!! The app that comes with my machine is called DreamMapper. I've heard it's not as sophisticated as SleepyHead. They also have software you can download to go with your SD card for more detailed data. I'm not sure whether or not that it is meant for physicians only, but I would like to give it a try! Thanks for your help!!!!

[Pugsy]

I turned it up last night

Which/what did you turn up (minimum or maximum or both) and to what number and what were the results from last night after the pressure increase?

Right now the only software that will work with the DreamStation machine is Encore Pro and a version was just released that will work.

Please register here at the forum and log in so people can send you private messages explaining how to get the software so you can see in better detail exactly what is going on.

From what little data you have posted I suspect that probably all that was needed was a little more minimum pressure to help prevent they hyponeas (which is the bulk of your AHI) but it's hard to have any concrete ideas without seeing more detailed data.

[Guest]

You are only sleeping 4-5 hours a night. For someone your age, that is totally inadequate so no wonder you're tired. Why are you sleeping so little? Yet you say you sleep thru alarms and have hard time waking up. Are you using the machine only part time while sleeping or do you really only sleep for such a short time? What you say and what your numbers reveal are conflicting.

You're right. I think I should add that when this problem first all came to light (and I got tested) I was getting around 9-10 hours of sleep per night. The past few weeks I haven't been sleeping because I work full-time and I'm getting my master's at night..finals week is upon me. I am wondering if stress could be a factor. Thanks so much.

[sleepygirl23]

I turned it up last night

Which/what did you turn up (minimum or maximum or both) and to what number and what were the results from last night after the pressure increase?

Right now the only software that will work with the DreamStation machine is Encore Pro and a version was just released that will work.

Please register here at the forum and log in so people can send you private messages explaining how to get the software so you can see in better detail exactly what is going on.

From what little data you have posted I suspect that probably all that was needed was a little more minimum pressure to help prevent they hyponeas (which is the bulk of your AHI) but it's hard to have any concrete ideas without seeing more detailed data.

THANK YOU! I registered now!!





So here is last night's data...looks like it is no better, no worse than before. The only difference I noticed in last night (with the higher pressure) is that I woke up consciously a few times, feeling shocked/jolted by the higher pressure...does this mean that I'm not used to it, or that it's just too high for me?

It's very evident I need to go and see my doctor. I just feel super miserable and I can't wait for my appointment in two weeks but that's the earliest I could get in. Any help on some fixes or adjustments I can make (other than sleeping more which is something I HAVE to do) it would be REALLY appreciated.

I would be beyond grateful if anyone has any kind of insight!!! Thank you so much!!!

[Julie]

Please read what I explained to you about the ramp... you're apparently taking 30 minutes(!!) to go from... 4 to 5, which is ridiculous and completely untherapeutic. You don't understand the system well and need to learn more before coming to conclusions.

[sleepygirl23]

Please read what I explained to you about the ramp... you're apparently taking 30 minutes(!!) to go from... 4 to 5, which is ridiculous and completely untherapeutic. You don't understand the system well and need to learn more before coming to conclusions.

Thank you...I honestly had NO idea...the sleep tech who fit me with my mask and changed all of the settings actually set the ramp to 30 minutes for me. I know how to change the pressure but not the ramp. He told me to keep the ramp at 30 minutes...is he totally incorrect? Perhaps the bad reviews I'm reading about the doctor's office I'm seeing are true...

[HoseCrusher]

Yes, he is incorrect.

Don't set the ramp for more than 15 minutes. 10 minutes is better.