Is Your CPAP Therapy Working?

And, when you finally get a good night's sleep, you know that the CPAP machine is working correctly. But how can you know that something is "off"? How can you know if it needs an adjustment -- or replacement?

Let's analyse whether your CPAP therapy is working optimally. We can advise on problems to look for if it's not working well. Keep in mind -- the therapy often needs time to take full effect, so you might not notice a difference right away.

Your AHI Is Key

The Apnea-Hypopnea Index (or AHI) reading is a critical factor. AHI is a measure the CPAP's effectiveness. AHI indicates the number of apneas (pauses in breathing) plus the number of hypopneas (periods of shallow breathing) occurring, on average, each hour.

AHI of 5 to 15 indicates mild sleep apnea; 15 to 30 is moderate, and greater than 30 AHI is severe.

If you've got a low score, you slept better; you had fewer sleep apnea symptoms. If your AHI numbers are high, adjustments are necessary.

Signs Your CPAP Therapy is Working Correctly

With CPAP therapy, the goal is to end the restless nights and lapses in breathing. CPAP delivers a steady stream of oxygen so that can happen.

When your CPAP therapy is successful:

  • Your snoring eases up.
  • You don't wake up gasping for breath.
  • You wake up feeling rested.
  • You don't have morning headaches.
  • You can better focus on work.

Signs Your CPAP Therapy is NOT Working

Snoring and apneas still occur regularly. When CPAP pressure is set properly and providing an adequate oxygen stream, you should stop snoring. That constant air flow will keep the airway open, which eliminates the tissue vibration that causes snoring.

The pauses in breathing -- apneas -- cause you to wake up gasping for air. If that's still happening, it's a sign the CPAP pressure is not set correctly.

If the mask is not leaking, talk to your doctor. The pressure in your CPAP machine likely needs to be increased to be fully effective.

If the AHI is greater than 5, the pressure should be increased. Speak with your sleep doctor about these problems, and about having the pressure adjusted.

You wake up feeling bad. In just a few weeks, some people feel a significant improvement. They have deeper, more refreshing sleep, less daytime sleepiness, concentrate better, and mood improves. Long-term, their blood pressure, diabetes and heart failure will also improve.

If you don't feel better within a few weeks, speak to your doctor as your CPAP may not be working correctly.

Over time, other factors may indicate a need to increase CPAP pressure. These include weight gain, alcohol use, and effects of aging.

Troubleshooting Your CPAP Therapy

Let’s look at the machinery itself for these clues:

CPAP just isn't working. The CPAP is generally easy to turn on. Some machines even start working when you breathe into your mask a few times.

If the CPAP machine won't turn on -- or generate airflow -- take it to your equipment provider. The device may need repair or replacement; if you've dropped it, that could be the case.

Humidifier isn't working. If your humidifier tank does not need refilling every 2 to 3 days, the temperature and humidity settings need to be adjusted.

Evidence of humidifier problems:

  • Water level stays the same
  • The water chamber is not warming
  •  Air from the humidifier feels cool
  • Unit has condensation inside (humidity setting is too high or tubing has a problem)
  • Device is noisy or fails to generate adequate airflow
  • You've dropped the CPAP device

CPAP machines do not last forever. If your machine has become temperamental and doesn't work like before, you may need to replace the device. Generally, an insurance company will pay to replace the CPAP machine every 5 years.

Newer models often are quieter, have enhanced features, and are often easier to use compared to the older generations of equipment.

If Your Machine Isn’t the Problem

You can try a few more things to get the most from your CPAP therapy:

Train yourself to sleep on your side -- which will help keep your airway open while sleeping. You can get a device that provides this type of "positional therapy," and it helps many people.

Make sure your mask is tight before going to bed. If there is a mask leak, you won't benefit from your therapy. By tightening the mask, you can help resolve issues with leaks. Avoid over-tightening as this can be harmful. Look for products designed to stop mask leaks as they can help improve your sleep.

Make sure you have the right CPAP mask. For example, side sleepers need a flexible mask, so a nasal pillow mask would probably be a better fit for them.

Taking these steps can improve your sleep and your AHI levels.

Talk to Your Doctor

After you've been on CPAP therapy for a few months, think about how you're progressing. Do you have more energy, feel less tired, or do you still need an afternoon nap? Do you sleep through the night or wake up gasping?

If you're still having sleep problems, your sleep doctor can help you sort through the issues. It's important to follow up, to make sure you're getting the CPAP therapy you need. Your body requires restorative sleep to stay healthy -- and CPAP can deliver that. Just give it a chance, and sort through the problems. The effort will be worth it, in the long run.