I have been on cpap since May 20, 2008, and I was able to upgrade to a Remstar Auto by switching my DME.  Every morning I check the available data and I am getting rather discouraged.  My numbers started out good, and my leaks were in the acceptable range for my mask and have pretty much stayed since I got this machine.  My leak rate is 33.3 and I have a Resmed Swift Mirage  II nasal pillows mask.  I just looked at my machine and I have used it 13 nights.  My AHI started out pretty good 3.1 to 3.9.  Now my 30 day reading (really only 13)  is at 4.6 and my 7 day is at 5.4.  This is rather frustrating.  My husband who also just started his cpap is have great results (thank God), but I am rather jealous.  He has been getting great sleep since day one of usage.  I know that everyone is different and re-acts to using the machine differently, but I am still tired all day because I am still having episodes.  My pressure was set at 11 during my sleep study and I told my doctor that my new machine has the auto feature, so we decided that maybe we should try using the auto side and put in a range of 11-14.  You would think this would be better because it compensates for sleeping positions and raises the pressure if needed.  Also, I tried taping my mouth shut in the event I was doing mouth breathing or lip flutters in my sleep.  Any help would be appreciated.


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Diagnosed with moderate OSA on April 28, 2008 (had for many years undiagnosed)
Total hypopneas 122, AHI 36, AHI in REM 84, O2 as low as 78%.
Remstar Auto M-Series with A-Flex and humidifier, pressure set at 11cm
Resmed Swift Mirage II Nasal pillows

Well, for one thing, since you are getting more comfortable w/your equipment you may well be more comfortable now w/changing sleep positions during the night. CPAP therapy w/that mask and hose does tend to encourage back sleeping and unconscious reluctance to move much during sleep in many of us.

Your titrated pressure was 11, your auto pressure range is 11 to 14. What is your A-Flex set to? WHAT is your reported pressure which w/the Respironics will be the pressure AT OR BELOW which you spent 90% of the night?

Are you experiencing any dryness of your mouth or nasal passages? Since you've tried taping your mouth shut it may be that you need to adjust your humidifier up or even down a notch or so.

You say your leak rate has remained pretty constant around 33.3 L/M and I assume you've checked your mask literature and that is w/in the acceptable realm for your pressure settings?

Some people just do NOT do well w/the constant pressure changes of an auto and find that that causes arousals. Most of us end up using our autos in CPAP mode except when we want to check our pressure needs.

AND as you mentioned some of us take longer than others to really settle in and feel relief from the exhaustion and tiredness that plagued us before CPAP therapy. My first 30 nights on CPAP were the worst 30 nights of sleep I'd ever gotten. And then things gradually improved from there.


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

"What is your A-Flex set to? WHAT is your reported pressure which w/the Respironics will be the pressure AT OR BELOW which you spent 90% of the night?"

I don't use the A-flex setting, I didn't like the way it felt.  I use C-Flex setting at 2.  The pressure at 90 % of the night is 13.5

"You say your leak rate has remained pretty constant around 33.3 L/M and I assume you've checked your mask literature and that is w/in the acceptable realm for your pressure settings?"

Providing I am reading the chart right, I am in the acceptable leak range at 33.3

Pressure             Flow
(cm H2O)       (± 6.0 L/min)
4                         20
8                         29
12                       37
16                       43
20                       49

I have had a little dryness in my mouth (which is why I decided to tape it shut), and I usually use the humidifier at level 2.

Thanks for such a quick response.


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Diagnosed with moderate OSA on April 28, 2008 (had for many years undiagnosed)
Total hypopneas 122, AHI 36, AHI in REM 84, O2 as low as 78%.
Remstar Auto M-Series with A-Flex and humidifier, pressure set at 11cm
Resmed Swift Mirage II Nasal pillows

KeystoneRebel I would give it a while longer, another few weeks or a month, and if your still feeling tired or getting worse and your AHI's don't go back down or maybe even go up higher, you need to see your Doc again. During your sleep study did you have any Central Apneas? Or were they all obstructive? Just wondering, as with a small portion of people CPAP can actually increase Central Apneas. Also are you having any difficulty with adjusting to exhaling against the CPAP pressure? As CrohnieToo mentioned some people have a hard time adjusting to the constant pressure of CPAP. If your definitely not feeling any benefit from your CPAP or even feeling worse, then maybe your Doc will need to make some changes. Good Luck to You and keep us posted on your progress.


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White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 9.0, min PS 6.0, max PS 16.0

"During your sleep study did you have any Central Apneas? Or were they all obstructive?"

     No centrals, all obstructive and I also had shallow breathing.

"Also are you having any difficulty with adjusting to exhaling against the CPAP pressure?"

     When I use the C-flex at 2, I have no problem.  I even forget I have the mask on, or think my machine is broke, until I open my mouth. (then reality sets in..lol)


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Diagnosed with moderate OSA on April 28, 2008 (had for many years undiagnosed)
Total hypopneas 122, AHI 36, AHI in REM 84, O2 as low as 78%.
Remstar Auto M-Series with A-Flex and humidifier, pressure set at 11cm
Resmed Swift Mirage II Nasal pillows

KeystoneRebel do you notice any sinus issues coming on?  My AHIs are up and down while going through a sinus infection and the related symptoms.


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REMStar Pro M w/ c-flex and heated humidifier
ResMed Swift LT nasal pillow
Encore View Software
12 cm H20, 13 cm H20
CPAP start date: June 4, 2008

"Do you notice any sinus issues coming on?"

Well, sort of.  I have been having trouble with some allergies now for almost a week.  I have to take a daily Zyrtec to make the days bearable.  If I don't take one, I break out in hives.  On really bad days, I have to add a Benadryl.  Also some nights my one nostril gets plugged, so I know I have some sinus issues.  But, I generally have always had sinus problems, the hives are the new thing.


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Diagnosed with moderate OSA on April 28, 2008 (had for many years undiagnosed)
Total hypopneas 122, AHI 36, AHI in REM 84, O2 as low as 78%.
Remstar Auto M-Series with A-Flex and humidifier, pressure set at 11cm
Resmed Swift Mirage II Nasal pillows

Then they may be related.  I'm not sure how, but I intend to talk to my sleep doc about it.  My sinus issue has just about run it's course and my AHI's are back under 5 for the last two nights.  You might want to read the sticky on sinus irrigation.  I started doing that and it seems to help.  During the day I use a saline nasal spray several times.  There have been some studies that show this helps those with constant sinus issues.  At least it's kept my sinuses clear in spite of the infection and the swollen glands.


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REMStar Pro M w/ c-flex and heated humidifier
ResMed Swift LT nasal pillow
Encore View Software
12 cm H20, 13 cm H20
CPAP start date: June 4, 2008