If you regularly use your CPAP equipment, you may be reaping the full benefits of your therapy. But what if, despite your use of the CPAP machine, you get little to no extra energy? What if all the benefits you once enjoyed from your CPAP machine slowly start to fade away, until one day they’re gone? This scenario sounds like a nightmare, but it’s a situation a lot of people go through, and it’s caused by changing needs that aren’t being met.
Is there anything you can do?
Of course! The first step it becoming in the know and learning how to track your progress and what numbers you should be aiming for to ensure your treatment is working.
What is AHI?
Apnea-Hypopnea Index (AHI) is a score calculated by measuring the number of obstructions, blockages, and hypopneas per hour during the night, and is used to determine the severity of your sleep apnea. Ideally, you want this number to be under five. If your sleep apnea is being effectively treated, in many cases, it will be around one—or even lower.
The Apnea-Hypopnea Index is the most important number you need to know about as you begin your therapy. It’s a measure of how you’re doing and if the therapy is working for you. It measures how many periods of blocked breathing you experience in an hour, as well as the periods of shallow breathing that occur during the same timespan.
Apnea: An apnea is any pause in breathing lasting longer than 10 seconds and is often caused by loose tissues in the throat and sinuses. Sleep apnea is the presence of apneas occurring during sleep. A big part of the AHI computation involves counting the number of these events that occur per hour.
Hypopnea: A hypopnea is abnormally shallow breathing or an unusually low respiratory rate, usually a 40% reduction in flow lasting at least 10 seconds.
Clear Airway Apnea: If you use a DreamStation, you may see this term on your DreamMapper app. A Clear Airway Apnea is an 80% reduction in airflow for at least 10 seconds. While the apnea occurs, the DreamStation will send a few test pulses through the airway to see how you respond. If the pluses result in flow getting through, the airway is considered clear; if the pulses can’t pass, your airway is considered obstructed.
Apnea-Hypopnea Index: Key Numbers
If your CPAP machine comes with an app, you’ll want to check that every morning to see how you did the night before and learn what AHI score was. However, before you jump into the app, it is important to have an understanding of what each number or range of numbers means.
AHI of Under 5: It’s considered normal to have fewer than five events per hour, and if your treatment gets you there, it’s considered successful.
AHI of 5 – 15: This is considered mild sleep apnea. If your therapy isn’t working as well as it should, you’ll wind up in this range. It’s not uncommon for a person using a CPAP regularly to be on the lower end of this scale, but it’s a sign you could be making improvements to your therapy.
AHI of 15 – 30: This is considered moderate sleep apnea. If you’re using CPAP and your therapy has you getting AHI scores this high, you may need to get your settings adjusted or change equipment. Only a doctor will know for sure, so you’ll want to follow up with them soon if you notice your AHI scores in this range.
AHI of 30 or Higher: This is considered severe sleep apnea. If you’re active with your CPAP therapy and you get a score this high, it’s a sign that your therapy isn’t working. You’ll need to see your doctor as soon as possible to figure out what the next steps are.
Tips, Tricks, and Hacks to Lower Your AHI
Getting a low AHI level isn’t always about pressure. While your machine pressure settings are important, indeed, it’s not the biggest factor when it comes to having effective therapy. Often body position, mask fit, and leaks are just as important to your sleep health as your therapy pressure. If you notice your AHI level is increasing, consider making these small changes before switching to a new machine.
When you notice your Sleep Apnea AHI score creeping up, consider trying these three things:
1. Change Your Sleeping Position
If you were using your CPAP machine and noticed an unusually high AHI, you may likely have spent the night on your back. Just by changing your sleep position can effectively start to bring your AHI’s down naturally, without needing to change any of your equipment.
Did you know that sleeping on your back is the worst position for recovering from sleep apnea? When on your back, your AHIs are naturally going to be worse because gravity works to pull your airway closed. By switching your sleeping position to your side, your machine will have to work less to keep your airway open.
2. Replace Your Mask Cushion and Headgear
If your AHI is increasing and you may want to consider when you last changed your cushion and headgear. If it’s been a while, order replacements. Headgear gets stretched out over time and loses its ability to create a good seal. If you replace it along with the cushion, it will be like having a brand new mask for a lot less money!
When you replace the cushion and headgear, you’ll be able to get a better mask seal, cut down on mask leaks, and allow more of the pressurized air to reach your airway. When that happens, your AHIs may be more likely to normalize.
3. Replace Your CPAP Mask
If replacing your CPAP cushion and headgear isn’t successful, you may want to consider doing a full-blown replacement of your entire mask. If you’re replacing a low profile mask, and it’s not working for you, consider going back to a more traditional style. If the mask you’re replacing is a traditional style, consider trying a low-profile mask.
No mask is meant to last forever. (The average lifespan of a mask is just 6 to 12 months!) If the mask you’re replacing is something that gave you problems, you may want to consider a different style from the same manufacturer. There are more options available now than ever before, and you’ll be surprised at what you can come up with.
AHI is one of the most important metrics you need to follow when it comes to treating your sleep apnea. By aiming for a goal of keeping your AHI under 5, you’ll be on the path towards better sleep health. If your AHI is above a five after a night of therapy, you now know what to do. You can change sleeping positions, change your mask cushion and headgear, or change your mask completely. By doing some of these simple tricks, you can lower your AHIs—without spending a lot of money.
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.