4 days into CPAP...is it helping? AHI way too high? 26 on day one, still at 13.79!

[jen61]

Last night was my 4th night using my CPAP. I thought I was doing good until I downloaded Sleepyhead and uploaded my data. Wow! The first couple nights it said my AHI was in the 25-26 range. Last night it was 13.79. I'm using the nasal pillows and I thought it was working okay, but sometimes I wake up with my mouth open and air blowing through. I use the chin strap but maybe it doesn't always work? All that data on Sleepyhead is confusing as well. On the main screen it tells me my AHI is too high (call my doc) and I have leakage. Could the leakage be causing the high AHI? This is all new to me. My machine is on auto, and my average pressure is around 13 or so, but has gone as high as 19. Any advice/help is greatly appreciated.

[chill]

Hi Jen, and

I will leave the mouth leaking to someone else, I don't suffer from that. The leaks may impact your therapy, depending on how large they are. If they are sufficiently large, they prevent the machine both from detecting what is happening with your breathing and from increasing the pressure enough to treat it. So the leak won't be causing the high AHI but they could be preventing a lower AHI, if that makes sense.

Clearly, your AHI is still WAY too high. You can find some more information on SleepyHead here and how to organize the charts and take a screenshot. You will need to make some more posts, but after that if you can show us some screenshots from SleepyHead we can offer some experience based advice.

Also, your machine is properly named the DreamStation Auto CPAP, if you update your profile that will reduce future questions. Your pressure range should be visible in SleepyHead at the top, left of the screen. Mine looks like this:
Philips Respironics DreamStation
Auto CPAPModel 500X120 - etc.
PAP Mode: APAP (Variable)
Min 11 Max 14 (cmH2O)

[PoolQ]

IS it working, well yes. Could it be working much better, you bet ya.
Chin straps do not always work, if you fight them they will not stop you.
When the system is trying to deal with large leaks, the ability to detect apneas os not working very well at all.

There is a link at the top of the page about manuals, bet your manual and find out and post your settings. That will help a lot

If you can't get the leaks under control, you will need to consider a full face mask (FFM)

search the forum for leaks and see what others have tried and see if you can find a solution that works for you

[eseedhouse]

The fact that your AHI seems to be trending downward is a good sign, I think. It takes time to get used to CPAP and sometimes it's best to work toward success gradually. You need to get comfortable sleeping with the mask on your face and sometimes that means accepting a higher than optimum AHI (but still better than it was before) for awhile. Sometimes going straight at a problem isn't as effective as sneaking up on it from behind.

[chill]

OK, with a range of 4 - 20 your machine is set at Wide Open. That is typically what is done when doing a home titration test. It can be hard to get used to at both ends of the range. Personally, I find starting at anything less than 6 or 7 leaves me feeling that I don't have enough air. With an average pressure of 13, I think it would be pretty safe to raise your lower end to 6 and then 7 if you tolerate it. I think when I started my minimum was 7, now it is 11. I don't notice the pressure at all, you too will get there in time.

As for the high end, you said it gets up to 19 at times. Without seeing some data from SH, we have no way of knowing if that is due to the leaks or your needs. But I feel pretty confident in saying that 19 in the first four days is probably hard to get used to and it also likely to cause leaks. What keeps the mask in place at four, probably won't work so well at 19. I can't comment specifically on the P10 as I have not used it. You may want to consider dropping the maximum pressure to somewhere in the 12 - 14 range for a while while you adjust to sleeping with the machine and then using SH to decide if you need it higher or can lower it further. You may not be getting optimal therapy at 12 - 14, but in my opinion, getting used to the machine and dealing with the leaks is more important right now.

[PaytonA]

OK, with a range of 4 - 20 your machine is set at Wide Open. That is typically what is done when doing a home titration test. It can be hard to get used to at both ends of the range. Personally, I find starting at anything less than 6 or 7 leaves me feeling that I don't have enough air. With an average pressure of 13, I think it would be pretty safe to raise your lower end to 6 and then 7 if you tolerate it. I think when I started my minimum was 7, now it is 11. I don't notice the pressure at all, you too will get there in time.

As for the high end, you said it gets up to 19 at times. Without seeing some data from SH, we have no way of knowing if that is due to the leaks or your needs. But I feel pretty confident in saying that 19 in the first four days is probably hard to get used to and it also likely to cause leaks. What keeps the mask in place at four, probably won't work so well at 19. I can't comment specifically on the P10 as I have not used it. You may want to consider dropping the maximum pressure to somewhere in the 12 - 14 range for a while while you adjust to sleeping with the machine and then using SH to decide if you need it higher or can lower it further. You may not be getting optimal therapy at 12 - 14, but in my opinion, getting used to the machine and dealing with the leaks is more important right now.

I agree with chill except on the rationale for the pressure getting up to 19. Leaks do not cause the pressure to go up. With leaks the machine will increase the flow in an attempt to maintain the pressure but the reason for pressure increase is an obstructive event, snore, or flow limitation.

Best Regards,

PaytonA

[chill]

Agreed, the leaks won't make the pressure go up by themselves. I was thinking they could cause it to mis-interpret events (score events where there were none) and that would cause the pressure to increase. Also increases in pressure that wake her up would cause awake breathing that the machine could also interpret as justifying a pressure increase. But without data this is all just speculative.

[PaytonA]

I agree. Just wanted to make sure that any new people would understand.

Best Regards,

PaytonA

[trish6hundred]

Hi jen61,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy and hang in there for more responses to your post.

[MitchS]

Hello Jen. Welcome!

Getting started with CPAP can seem overwhelming at first, but it gets easier as you go. It is mostly a matter of trial and error to find what works best for you.

I would like to share a few things that have helped me get my mouth leaks under control when I first changed from a Full Face Mask to my P10. By changing to the nasal pillow I went from fighting large leaks most nights to very rarely having a large leak.

Is your chin strap properly fitted? I find mine needs to be as tight as possible without being uncomfortable. Where the chin cup rides can also make a difference. I find the strap will pull my jaw back allowing my mouth to fall open unless the strap fits under my jaw instead of around my chin. Some people find they have to do exactly the opposite to achieve the best results.

One of the forum members has developed a technique she calls the "Tongue Suck Technique" that a lot of members find useful. By using her technique a lot of people are able to learn control their mouth leaks without a chin strap. I haven't mastered the technique well enough to eliminate the chin strap, but it does help.

1. Place the tip of your tongue on the base of your front teeth.
   
2. Place the base of your tongue against the top of your mouth.
   
3. Create a slight suction in your mouth and hold it.
   

For some people it becomes second nature and is all they need to eliminate mouth leaks.

I have found that on nights that it seems that no matter what I do my mouth leaks, I can shove a pillow up under my chin and cuddle it to hold it in place. This adds just enough resistance to keep my mouth from opening. I have also found it useful to put my P10 on, get it adjusted and then put my chin strap on over the the P10. This makes the mask much more stable and helps keep the P10 straps in place.

Other members have found they can control mouth leaks by wearing one of the soft foam cervical collars you can get at pharmacies and online.

As for your high AHI, it may be helpful if you download the free SleepyHead software and post some charts so the experts on the board can look at them and give you some tips on what is actually going on and on how to solve any issues you may be having. You can find links to the software in my signature below or at the top of the page. Also be sure to sleep on your side and not your back. Sleeping on your back tends to cause apnea events and raise AHI numbers.

Good luck on your treatment.