High Pressure required on System One APAP...what does that m

Hi,
I'm new to CPAP therapy, just entering my third month. Over this time, I've found that the only way I've been able to get my AHI down (and its averaging around 3.3) is through raising the pressure. I have a System One CPAP with AFlex. While when I started, I could tell that a pressure of 14 felt better than 13 and kept my airway more "open", it's like my airway has adapted, as now, i'm up to 17.5, and that feels like the only pressure that keeps me "open". In any event, I haven't been able to get my AHI down any further despite continuing to raise pressure. What does this mean in terms of treatment? I know that anything under 5 is considered "good" but my AHI was only 7 when I started and i was feeling HORRID. And still I only feel rested on days when my AHI is under 3, and I only REALLY feel it under 2. I've only had a few days when it's been under 2, and I can't figure out if I did anything different. I do know that my mask i think wakes me up and has to be on pretty tight at these pressures I guess.

Anyway, would I benefit from a different machine, or different settings, given my pressure settings are so high on CPAP with AFLEX? My AFLEX is 2, and I think but this hasn't been statistically tested that an AFLEX of 1 tends to be worse for me but who knows. If I switched to CFLEX, might that help things? Or should I keep continuing to creep pressure upwards to try and get AHI down below 3 consistently. If I keep going up, does that mean a BiPAP machine would be better suited for me? Would insurance pay for it, or would I have to get a new sleep study to justify?

Alex

Oh and incidentally, I think I've GAINED 10lbs over the past 2 months because of medication, despite CPAP improving my apnea. I'm 225, would a 10lb gain make a difference to airway pressures?

What is the normal event category break down of the AHI that you are seeing go higher?
How much of it is clear airway?

A 10 pound weight gain "might" cause a little increase in pressure and might not.
Now sleeping position and/or REM stage sleep may cause an increase in pressure needs at certain times during the night. Like if you happened to need more pressure when sleeping on your back or during REM stage sleep.
Like me on this report...sometimes I never see much of a pressure increase and sometimes I need a lot more pressure.
In my case it is REM stage sleep where my OSA is worse. Sometimes REM events seem like they are on steroids and need a lot of pressure to keep them prevented.
Here is an example of one of my nights with my PR S1 APAP machine.

If I were you, I'd look at what mask I was using - a nasal one, or a full face? And find a way to check out if you're mouth breathing at night when you sleep... losing the cpap air that way as a result of higher pressures rather than addressing why you've been needing them higher. You may not have slept with your mouth open in the past, but once on cpap, a lot of us change and using a full face mask lets us breathe however we need to (especially with a cold) and not lose therapy air.

It may not be the case for you, but you could experiment (if no one's usually around to see what happens) by taping for a couple of nights, or trying a chin strap (which I otherwise don't think can always do the whole job as air can be lost from your lips even if your mouth is otherwise 'closed').