First week on CPAP, my AHI is still high

I've been on CPAP for a week after my sleep study showed an untreated AHI of 11.

The first couple of nights I woke up feeling better than ever, I thought it was definitely working for me.

However, after the third night, my sleep has not been refreshing and I'm feeling discouraged. I was convinced I was breathing through my mouth, so I went to my provider to exchange my nasal-only mask for a full face mask. My provider said they would give me a full face mask if I really wanted one, but they said my compliance with the nasal only mask was so good that they didn't recommend it because my mask fit data apparently showed no leaks and a full face mask has more chance of leaking (according to them). They said despite the recent high AHIs, my "numbers are good", so keep it up since it's only been a week. So I'm sticking with the nasal only mask for now since I can sleep 8 hours a night with it, pretty much no problem. It's just that this sleep is not refreshing and I'm growing discouraged.

My AHI's for my first week are
4.39, 3.80, 4.74, 11.17, 7.64, 7.75, 6.98, and 9.66.

I've posted some of the sleepyhead data for the 3.80 night (my 2nd night, when things were good), and last night (9.66).

Also, full disclosure, I've been too lazy to ever clean my cpap equipment since I've received it. I will do so tonight, but can not cleaning the equipment really have that drastic an effect after 3 days?

Thanks for any help and advice.

Do you really need exhalation relief at those low pressures? I would turn it off. The extra pressure on exhale may help drive the AHI down further.

See my sig for help on how to post screenshots that are more helpful.

And raise your minimum pressure by 2cm.

I am not one to tell you what pressures or other options to set on your machine. The numbers the DME and doctors are seeing are well and good, but it is only you that knows what is actually happening during the night. This is a learning process which does take some time to find settings and masks-especially the mask, that works best for you. One mask may look good by numbers, but still not working for you. Educate yourself as much as possible. I am still in my infancy (3 months) for PAP therapy. AHI's anywhere between .5 and 2 and has definately made sleep quality and daily life benifitting. Because this is something I am convinced I will need to do for the rest of my life I am still tweaking mask for making therapy as comfortable as possible into the future. I say try them all until you find the right one. There is some really good advice being offered in this forum. You will learn who and who not to listen too. Pugsy is a great one. Use all the information you find here to tailor your therapy to your needs. Time and patients are key. Good luck

Pugsy and Pale Rider are both very knowledgeable. The main difference is Pugsy will spoon feed you in small doses with a lot of explanation. Pale Rider takes a much more direct approach. He will tell you like it is with no extra details or embellishments. Both are very good sources of information.

It's true that full face masks are much more leak prone that the nasal masks.

Even with no leaks, many patients (including myself) report a dry mouth.

What I think is happening -at least in my case - is that my mouth is open, but the pressure coming in through my nose is keeping my airway sealed (in the same way that it would be sealed when you're eating).

Hang Fire wrote: ↑

Sat Jun 23, 2018 11:16 am

Do you really need exhalation relief at those low pressures? I would turn it off. The extra pressure on exhale may help drive the AHI down further.

It really varies depending on the individual. I need exhalation relief even with my low pressure in order to get better sleep. It doesn't make much sense but I cannot argue with my body.

prodigyplace wrote: ↑

Mon Jun 25, 2018 5:08 pm

Hang Fire wrote: ↑

Sat Jun 23, 2018 11:16 am

Do you really need exhalation relief at those low pressures? I would turn it off. The extra pressure on exhale may help drive the AHI down further.

It really varies depending on the individual. I need exhalation relief even with my low pressure in order to get better sleep. It doesn't make much sense but I cannot argue with my body.

I wasn't asking you.

Exhalation relief - at least on standard fixed or automatic CPAP - is strictly a matter of personal preference. Do whatever you're comfortable with. I didn't like it because I've been using CPAP long before such a thing existed. That's what I was used to. Thus, I found the change in pressure very annoying, so I just turned it off.

Honestly when pugsy comes in she'll be able to speak to it more, but I wouldn't call your numbers "great", they're just 'effective' but 5 apneas an hour can still disturb your sleep. If you're not having centrals I'd consider a slightly higher minimum. 5 seems a bit low.

The other thing I heard from you is that you felt great the first few days... this happens to quite a lot of us, most people I've heard mention it have severe apnea... What I believe is happening is that with severe apnea (non-cpap treated) your body is constantly storing adrenaline and energy for wakeup's at night, you may not even remember these wakeups because with a low enough O2 saturation you can black out. When you first start therapy, the very first night... you didn't really use that adrenaline and energy which your body thought you needed to survive... so the next day you feel full of energy and adrenaline that you didn't use. This may last for up to a week. then your body "normalizes" doesn't store quite as much energy, but also still has the "habit" of "conserving" energy during the day, and without the adrenaline back up just bursting loose, you get back to the dull drums a bit. especially if you're not completely treated... with now a partial recovery, you wake up easier from even mild apnea's and still don't get a great nights sleep - so now you could be dealing with poor sleep instead of adrenal fatigue etc... suffice it to say, I believe it takes a while for the body to normalize.. and it also helps to optimize treatment. though 5 AHI is considered "effective" treatment most of us feel better at below 2 or even 1.