CPAP machine no longer needed? How to tell...

My husband and I have each lost about 50 pounds since we were diagnosed with sleep apnea years ago. We have the Resmed S9 Elite CPAP machines and I installed the Sleepyhead software.

I noticed recently that I had about five days in a row with an AHI score of zero. My husband recently had surgery and was hooked up to a CPAP machine in recovery. He was told that he may not need the machine anymore.

Neither of us mind using the CPAP machines; they've helped us so much. But if we don't need them then we don't need them. We just want to be sure. I was looking at a primer about the software and read that the AHI score wasn't what the person concentrated on.

Any advice about what data will help us determine if we don't need the CPAP machines anymore will be appreciated. Should we decrease the setting gradually? This website and forum has been our best resource for CPAP info.

Thank you.

I would think that only a sleep study would show if you no longer need cpap. As long as you're on the machine you're getting treatment so even AHI of zero from your machine's data wouldn't answer your question.

The coroner will make that call, living in De-Nile will make it come sooner.

A sleep study, maybe often as you can have problems at any time, and would you trust your life to the people that do and read the data, I don't. You could get a machine that collects full data, and use the software to check the results yourself, but that can require a little effort of your part. Testing with a Pulse OX at night can be a indication, with the proper software to monitor overnight.

I find the best and easiest way is to accept your fate and treat Sleep Apnea correctly monitoring the AHI with software, by taking care myself, at least I know who to blame. While it does require O2, it's not rocket science. Jim

I may have some light mask marks in the morning, but they aren't as ugly as swimming in De-Nile all night!

Goofproof wrote:The coroner will make that call, living in De-Nile will make it come sooner.

A sleep study, maybe often as you can have problems at any time, and would you trust your life to the people that do and read the data, I don't. You could get a machine that collects full data, and use the software to check the results yourself, but that can require a little effort of your part. Testing with a Pulse OX at night can be a indication, with the proper software to monitor overnight.

I find the best and easiest way is to accept your fate and treat Sleep Apnea correctly monitoring the AHI with software, by taking care myself, at least I know who to blame. While it does require O2, it's not rocket science. Jim

I may have some light mask marks in the morning, but they aren't as ugly as swimming in De-Nile all night!

Jim,

Why is this type of post necessary?

Kaisgram covered it with her advice to for the the OP to have a sleep study to see if the weight loss has caused the apneas to disappear.

49er

First of all, I agree 100% with 49er - the comments where not called for at all!

Secondly, you both deserve an ATTA BOY and ATTA GIRL for losing 50 lbs each.

Third, I am a novice right now so I can't comment on the right path for you two to go but one thing I would comment on, one of you might be able to get off of CPAP machine while the other might still need it. I would agree that the concrete way you will both what your needs are is to have a sleep study.

I am sure other people might give you other words of wisdom.

Good luck and enjoy your new found weight lost!

Rick

I would be suspect of the 5 days in a row with zero AHI. There have been some issues reported with the S9s. Try unplugging the machine for a few minutes and then re plugging. Then try a few nights and see what the report says. If it is still zero, get a sleep study.

There are some people whose apnea is wholly due to overweight;
The ONLY way to know is with a sleep study.
I have had AHI of 0.0 twice in the last week--but that was with my machine on.
It prevented them from happening by splinting my airway.
Don't stop without a sleep study; don't get rid of the cpaps even if you are pronounced "cured".
With obesity, like OSA, there is no cure--only remission.

Thanks to all who replied. I understand the advice about the need for a sleep study.

What pressure are you at?

Do you use SleepyHead or ResScan?

It it were me, I'd try slowly dialing my pressure back down a little bit at a time and see if I start having apneas.

Unfortunately, you can't drop below 4, but even if you don't get off completely, at least you'll be at a lower pressure.

I'd thought about reducing the pressure. Why is four the lowest pressure? The pressure I was given was ten; it's still set there. I use the Sleepyhead software. I was wondering what I should look for. The AHI score is all I'm familiar with.

Four is as low as the machines can be set for, most people here find it too low to handle. I also use AHI to judge my treatment, but unless the total mask vent rate is correct the data can be false. I consider a total leak rate of 38 lpm to be good fore me @ 15 cm. The higher the pressure the higher the total leak rate, I hope this doesn't injure 49er's options. Jim

Congrats on loosing weight, I can't, many think that's the cure, for a few it is, for many it's a excuse to quit. I'm a lifer.

Four is the default pressure setting of almost all machines, just as 20 is the highest (for 'regular' c- or apap machines). And because doctors are either too ignorant or lazy to come up with a proper titration range, many newbies on apap are told to just leave things wide open (at 4 and 20) and see what sticks.

gadgetgrl wrote:I'd thought about reducing the pressure. Why is four the lowest pressure? The pressure I was given was ten; it's still set there. I use the Sleepyhead software. I was wondering what I should look for. The AHI score is all I'm familiar with.

Imagine hooking yourself up to a CPAP mask and disconnecting the other end of the hose from the machine. When you exhale, your exhaled air would go down the hose, and you'd rebreathe the same stale air. It would be sort of like breathing in and out into a bag over your head. You'd eventually lower the O2 and increase the CO2 until you suffocate.

In order to prevent this, there are holes in your CPAP mask. When the mask is under pressure, air leaks out of these holes. The higher your pressure, the more air leaks out of these holes and the better the O2/CO2 situation is.

Think of it as breathing into a bag over your head, but the bag has a small hole in it. The more pressure, the easier it is for the CO2 to escape.

Most masks are designed to give you enough fresh air at 4 cmH2O pressure. If you go lower, you may have O2/CO2 problems.

For some reason, people may feel they can't breathe at low pressure, even if they don't have any apnea events. It seems strange because, with no CPAP at all, you're getting a pressure of 0 cmH2O. Maybe it's psychological, maybe it's the CO2, or maybe there's some mechanical effect I'm not considering.

Either way, if you drop the pressure, you may find that you feel uncomfortable, even if you're not having any apneas.

The S9 machines have been known to sometimes get stuck reporting AHI 0.0. Now while it isn't impossible to have an AHI of nothing it would be unlikely for it to happen night after night. Even people with no OSA diagnosis will have some sort of apnea event from time to time anyway. They just don't have very many.

So the first thing I would do would be to eliminate that little chance of the machine getting stuck by unplugging the machine from the electric source and then plug back in so that the machines internal software has to sort of reboot. Just like what we do sometimes for a computer that has some cobwebs.

Then use the machine normally. If the AHI is still 0.0 the reduce the pressure by 1 cm to see if it's still going to show 0.0....and keep reducing the pressure until I couldn't comfortably reduce it any more.
With the loss of weight it is possible that the OSA either has reduced in severity to the point that less pressure is needed or maybe no pressure at all is needed.

Since there is some therapy value even at the 4 cm (lowest the machine can go) the the final step to determine if OSA is no longer present a person needs an in lab sleep study to verify that the apnea events are no longer present in numbers where treatment is needed.

It would hurt nothing to reboot the machine and start with slightly lower pressures if you are still seeing 0.0 AHI. Worth a try for sure. Even if you found that your OSA didn't totally go away there's a chance that you might not need that 10 cm pressure. Maybe you could get by with much less pressure and less pressure is always a nice thing to have happen.

First thing to do though is reboot the machine. We have seen this little quirk all too often to not try that first.
I always hate to rain on someone's parade when they are seeing 0.0 night after night but since there is a chance that the machine is acting up I think it is best to eliminate that possibility first.

I'd hang onto those machines and masks for quite some time to come... weight gain can sneak up on you real fast, especially after a year or two of success when you start to relax and get careless. BAM, you're fat again. Trust me, I know about this stuff and I'm a super exercise nut. Of course, I'm hoping you keep the weight off and don't need CPAP any more, but still....