CPAP Therapy Tips

What Do These Readings on My CPAP Machine Mean? (AHI, Leak, Pressure, Usage)

Modern CPAP machines are incredibly sophisticated and capable devices that can provide a wide range of specific results recorded as data throughout the night. It’s important to understand and monitor the CPAP machine readings so you and your doctor can be assured your CPAP therapy is working as it should.

Although these machines can vary by function, complexity and price, the best are those that include a variety of statistics about your sleep patterns each night. Many come with a smiley face that lets you know everything is running properly and a frowning face to let you know there’s a problem.

While these are fairly easy to interpret, you should really understand what the acronyms connected to the numbers are. Therefore, we’ll go over some common readings that many CPAP machines measure, including

  • AHI
  • Pressure
  • Leak
  • Usage

AHI

AHI stands for Apnea Hypopnea Index. It illustrates the average number of hypopneas and apneas per hour for the timeframe. These terms represent the following:

  1. Hypopnea is a partial collapse of your airway.
  2. Apnea is total absence of airflow through your mouth and nose, even when there’s an effort to breathe (as in obstructive sleep apnea) as measured at the abdomen and chest.

The Apnea-Hypopnea Index (AHI) measurement is usually delivered within the setting of a sleep study report. It’s the number of times per sleep hour that your upper airway (soft palate at your throat or tongue) partially or completely collapses, causing a drop in blood oxygen levels or a slight arousal from sleep.

The Apnea-Hypopnea Index is typically used for classifying how severe your sleep apnea is. It’s also used to determine how well treatment is working — like a CPAP device, for instance.

The severity of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), according to the American Academy of Sleep Medicine Task Force follows the below categories.

  • Normal: Fewer than five breathing episodes per sleep hour.
  • Mild Sleep Apnea: Five to 14.9 breathing episodes per sleep hour
  • Moderate Sleep Apnea: Fifteen to 29.9 breathing episodes per sleep hour
  • Severe Sleep Apnea: Thirty or more breathing episodes per sleep hour

To calculate AHI, you add the total number of apnea episodes, including hypopnea episodes, and divide by the number of sleep time minutes. You then take this number and multiply by 60.

Here’s an example:

Divide hypopnea + apnea by sleep time and then multiply the number by 60.

  • Apneas (200), Hypopnea (200) = Total number of episodes is 400
  • Actual sleep time (420 minutes) (seven hours x 60 minutes)
  • Divide the 400 by 420 = .95 x 60 = AHI 57 (severe apnea)

In this example, an AHI of 57 falls into the severe sleep apnea category.

Sleep is analyzed in children with more stringent criteria. More than one episode per sleep hour is considered abnormal.

Pressure

This is the pressure the device is set at. It can be a variable pressure for APAP machine, fixed pressure for CPAP machine or a dual pressure for BiPAP machine.

Each individual is unique, therefore it seems sensible that CPAP therapy offers different pressure settings and not everyone would require the same setting for their obstructive sleep apnea (OSA). You can adjust the CPAP pressure to fit your own particular needs. And, while a low setting may be good for you, it might not be good for another person.

If your sleep study indicates you have OSA, you’ll require a “titration study” to find the level of pressure you’ll require to maintain your airway while you’re sleeping. The sleep professional may perform the titration study the same night as your sleep study or you might schedule it for a later date.

Titration refers to slowly adding more of something until you achieve the desired effect. The sleep professional:

  • Monitors your sleep during your titration study and slowly.
  • Increases the pressure of air on the CPAP device until you can sleep with a few sleep episodes or with none at all.

Throughout the night, your pressure needs may vary, therefore you would need an overnight sleep study so the technician can determine and prescribe the proper pressure level.

The CPAP pressure level will be prescribed to the highest level you require during the night. The doctor prescribes the highest pressure in hopes of preventing as many sleep episodes as they can. But, with this approach, however, you’ll receive the highest pressure all the time even when you only require it for part of the night.

APAP machines adjust the pressure on a breath by breath basis. This you might find helps your treatment.

Factors Affecting The Pressure Setting You Need

Your upper airway anatomy and the nature of your airway obstruction play the biggest role in figuring out the required pressure setting. Different amounts of air will be needed if your sleep apnea occurs due to:

  • Deviated septum
  • Blocked nose from allergies
  • Tongue falls back into your airway
  • A collapsing soft palate

Also, being obese or overweight could exacerbate things. In fact, when individuals lose around 10 percent body weight, they may need to turn down the CPAP settings.

Medications that relax the muscles of the airway (i.e. benzodiazepines), alcohol and sleeping your back could add to your pressure requirements temporarily.>

REM sleep towards morning could relax your muscles and exacerbate sleep apnea.

CPAP Leak

Usually measured in liters per minute, there’s a built-in leak differential by masks since they all have variations because of the exhalation port. However, if there’s an excessive leak, it could indicate a mouth leak or poor fitting mask.

There’s a certain amount of leak coming from the mask that’s considered normal. The manufacturer of the mask determines this amount and it’s called the “intentional link” value. If your mask is leaking and its six to nine months old, consider replacing it. If it’s new and is leaking, it could be due to an incorrect fit.

Masks could cause air leaks if they are:

  • Too old: As the masks silicone cushion gets older, it deteriorates and starts becoming too soft to hold the seal. For a lot of masks, you can remove and replace it to extend the mask’s life. When a cushion has become softened to where it doesn’t hold a seal any longer, you might be able to tighten it up enough to stop the leak when you go to sleep, however, the seal will loosen and leak during the night.
  • Too big: If air is leaking into your eyes or at the base of your nose, that typically means the mask is too wide or long. You may also experience a leak under your nose if you have facial hair.
  • The wrong style: You could simply be using the wrong CPAP mask style for your unique facial structure, type of breathing, sleep style, and sleep apnea severity.
  • Changing their position because your pillow pushing against the mask. You can purchase special CPAP pillows designed to reduce the contact of the mask with the pillow, even if you sleep on your side.

Today’s CPAP machines are designed to cope with some degree of an excessive leak by blowing more air into the semi-closed system to preserve the desired pressure setting.

When the excessive leaking reaches the level where the machine’s manufacturers believe the machine will not properly maintain the therapeutic pressure setting, the leak is said to be a “Large Leak”.

Each manufacturer defines and flags unique defines what’s constitutes a large leak, and are reported as Total Leak Rathis rate includes both the excessive leak and the intentional leak made for preventing re-breathing the CO2.

Most machines categorize a normal leak rate if the leak registers 20-24L/minute or less, but you should always know what constitutes a higher than normal leak rate on your machine.

Usage

Your CPAP usage is determined by how long you wear the mask. Modern devices can differentiate the mask actually being on the person ―or if the person just turns it on but doesn’t wear the mask. This measurement helps to assess compliance, and is a factor that insurance companies measure for coverage purposes.

Compliance tracking machine can track usage hours, but may not track advanced features, such as AHI and leaks. Manufacturers designed compliance tracking machines to meet Medicare’s requirements mandating durable medical equipment providers show the equipment was used for Medicare’s set minimum number of hours. Without this data, DME providers can’t continue being paid by Medicare.

A usage threshold determines the minimum time that you must use your device in order to be compliant.

Interpreting Your CPAP Readings In Conjunction with How You Feel

It’s important to understand and monitor your CPAP machine readings. But it’s also important to assess how you’re feeling after you’ve been using CPAP therapy for several months. For instance, do you still require naps or are you feeling less tired? Are you able to sleep through the night or if you’re still waking up frequently? These questions can be a clue as to how well your CPAP therapy is working.

This self-assessment can help determine if the CPAP therapy is working optimally for you or not. If not, you may require adjustments to your CPAP therapy, whether it is a new CPAP machine, alternate CPAP mask, or other CPAP accessory.

cpap bipap and apap therapy

David Repasky has been using CPAP treatment since 2017 and has first-hand experience with what it’s like to live with Sleep Apnea. He brings the patient’s perspective to the CPAP.com blog and has received formal training in CPAP machines, masks, and equipment.

19 Comments

  1. When reading your sleep report: For the IHA reading. I understand that 1 means one event per hour, but what does .1 mean? Less than 0 events? So then. Basically .9 would be less than 1 event per hour?? Please explain this to me, please. Mine is usually between .2 & .4
    Thanks, Judy

    • Hey Rich, sorry to hear about the leak rate that you are experiencing. Have you changed your cushion on your mask within the last 3 months? If not, you should. Please make certain that you are using the correct size mask also. Also, make sure that you have no leak coming from your hose. You can check for hose leaks by turning the machine on and running your hand up and down your hose to see if you feel any air blowing out.

      If you would like to go through troubleshooting over the phone in an effort to determine where the leak may be coming from, please feel free to contact us at: 1-800-356-5221.

      Enjoy your day!

    • Hi Rich,
      120 mL/hr is actually quite small. If it was 120 L/min then I would be concerned. Speak to your HME and verify what those numbers mean.

      Have a good day!

      Mia Tatman, RRT

  2. Hi… I’m a new user of CPAP machine.
    So basically the goal of using CPAP is to have a less than 5 AHI ?

    That means you can adjust the pressure that makes you comfortable as long as your AHI <5 ?

    Yesterday I lower the pressure and I got a little lower AHI as a result. I like less pressure because it makes me more comfortable. Is that oke ?

    Thank you.

    • Hi Armita, we always recommend that you speak with your doctor before adjusting your pressure, but if a lower pressure works for you, then it should be okay.

      Please feel free to reach us at: 1-800-356-5221 for further questions, or concerns.

      Have a great day!

  3. Deborah Doughty Reply

    Why should I have an AHI of 59 today amd 95 yesterday if using the cpap machine? I thought the CPAP machine was to help with that. Deb

    • Hi Deb, i’m sorry to hear that your AHI is still reading high even though you are using your CPAP machine. You are correct, the machine is designed to decrease the number of Apneas that you have. Please speak with your doctor for further interpretation of your AHI. It is possible that you need a setting adjustment.

      Please feel free to reach us at: 1-800-356-5221, or e-mail us at: cpap@cpap.com, with further questions, or concerns.

      We wish you the best!

  4. This a great article! I had an AHI of 105 on my sleep study and they said my blood oxygen level was 53% at its lowest level. I was chronically tired and overweight. Through CPAP therapy my sleep is better and I have more energy. Also, I had high blood pressure and that went completely away after CPAP treatment! Lastly, having CPAP treatment meant more energy which helped me lose more weight more quickly! After losing weight i changed to an APAP machine. I suspect I will always need treatment but having CPAP treatment nightly has changed my life! To those of you with Sleep Apnea try to stick with it each night. Eventually you will get used to it! Sleep is very important for your health!!!

  5. My episodes per hour seem to vary if I go to bed later at night. Example before midnight with machine my episodes are 2.8 .But if I go to bed when not working at 3:00 A.M. episodes go up to 6 to 9 per hour with machine also. I am going to tell my Doctor about this.

  6. I’ve only been using my CPAP for about a month. Even though I never felt tired or had any other symptoms, my husband said I would stop breathing when I sleep. I was diagnosed with mild sleep apnea (ahi of 8) so I was given an auto CPAP or APAP. My pressure ranges from 5 to 7 each night and my AHI is down to 0.4 per hour. Since I began using it I feel like I sleep terribly. I wake with headaches and I am exhausted by lunchtime. I will ask my dr when I have my follow up appointment in a week but wondered if feeling worse with CPAP is common?

    • Hey Gina, i’m sorry to hear that you are waking with headaches. In response to your question no, CPAP Therapy is not supposed to make you feel worse. Waking with headaches could be an indication that your pressure is too high, or maybe a sinus problem. Are you currently using a Humidifier with your therapy? If not you may benefit from adding one.

      Please see the link below for more information on headache and other side effects that you may experience. Also, be sure to advise your doctor of the headaches that you are experiencing so that they may make a medical decision on if your settings should be adjusted.

      https://www.cpap.com/cpap-faq/Common-Side-Effects#why-do-i-have-a-headache-when-i-wake-up

      Please feel free to reach us at: 1-800-356-5221, or e-mail us at: cpap@cpap.com with any further questions, or concerns.

      Enjoy your day!

  7. john davis Reply

    alright i have been on CPAP treatment for over 2 months and i took my results in to my doctor this morning . according to the monitored results i have had an AHI of 5 or more ( around 6 to be specific ) 3 days out of 60 the rest were 2 or less . so i ask my doctor do i even need to wear a CPAP and he stated that the AHI was low because i was using the machine . it seems to me if the machine was working my AHI would be 0 . so i guess my question is does the machine not pick up on and notate all apnea issues ,and does it hurt to wear a CPAP if you don’t really need it

    • Hi John, so happy to hear that your AHI is low when using your cpap machine! If you did a sleep study, you might consider checking your results (or asking your doctor) what your AHI was without the use of cpap therapy for comparisons sake.

      If you’re using an auto adjusting machine, it would be worth noting what your average pressure is to provide you with the lower AHI score.

      There is no benefit to using a CPAP Machine, without being diagnosed with Sleep Apnea. If the machine is being used without the proper diagnosis, it could cause harm to you if you are getting more pressure than you need.

      Please speak with your doctor about your concerns, as they may want to complete a new sleep study.

      For further questions, or concerns, please feel free to reach us at: 1-800-356-5221.

      Have a great day!

  8. H I’ve using my dream machine for 4 months now It automatically adjust to my breathing and it communicates with a app to my phone via Bluetooth to monitor .By far the best machine I’ve came across and I also use Flonase everynight before bed .Ahi .3. And since I get awesome sleep 6.50 hrs is all I can sleep with no naps and fully energetic and lost 30lbs.Had to shave the mustache nasal and chin strap works best for me.Good luck everyone.

  9. I dont understand like Ihave a reamed 10 and what dose it mean if it says I have 1.9 events per hour?

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