CPAP Therapy

How to Improve Your AHI Score Overnight

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.

AHI: Definitions

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.

Final Thoughts

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.

30 Comments

  1. My cpap supplier sends me supplies quarterly, masks, cover for mask, I use full face mask, restaurants med f-30 med, using a chin strap because of mouth breather and can only sleep on my back. Only problem I have is air at times into my stomach which causes gas and possible Bowel problem with floaters, is this possible???

    • Hi Nick, i’m sorry to hear about the problem you are experiencing with your CPAP therapy. It sounds like you are suffering from Aerophagia, which means swallowing too much air.

      I would recommend you speaking with your doctor, as they may make a medical decision to decrease your pressure, or make a recommendation for you to use an auto-titrating machine, if you aren’t already using one.

      Also, you may try to lay in a position which allows your chin to remain above your torso, or try different sleep positions such as, lay on the left side or rotate to the right side. Incline with pillows or lay flat.

      For further questions, or concerns, please feel free to reach us at; 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      We wish you the best!

    • Hey Nick, the article is making suggestions on how to improve your score for all manufacturer’s equipment. If you have specific questions, or concerns, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      Have a great day!

  2. Thomas Lowe Reply

    I’ve been using a res med 10 BiPAP machine for 6 months or so I’ve been averaging over 10 events per night. I’ve tried all the advice on the website. My doctor seems kind of Clueless. How can lessen my events per night?

    • Hey Thomas, i’m sorry to hear that you’re having some problems with your therapy. Have you reviewed your data to confirm that you don’t have a lot of air leaking. If you do notice a high leak rate, you may need to change your cushion, confirm that you have the correct size mask, or switch to a different mask.

      Also, what type of mask are you using (nasal, full face, nasal pillow)? If you are not using a full face mask, there is a possibility that air is leaking from your mouth and causing so many events.

      I would recommend you speaking with your doctor once again, as they are able to interpret your data to confirm if maybe a setting change would benefit you.

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

      We wish you the best!

  3. Dreamstation Auto BiPap with heated humidifier. BiPap setting 9/15. ResMed F20 memory foam full face mask. 2 liter oxygenator.

    I have to wonder if the treatment is based on any kind of medical or scientific findings at all. So far mine has been pure guesswork and poor guesswork at that.

    I see the whole pap industry as a gigantic money grabbing extortion.

  4. I’m totally confused what to do. I’m a side sleeper and do have a dream mapper with humidifier. My ahi has been all over the place. But right now my ahi is around 10-12. I’ve tried all kind of masks and am frustrated. Would the ResMed AirFit™ P10 For Her Nasal Pillow CPAP Mask with work for ne.?

    • Hi Tricia, i’m sorry to hear about the high AHI that you are experiencing. The AirFit P10 would be a great mask to try also, please see the link below of other nasal pillow masks that are good options for side sleepers.

      https://www.cpap.com/cpap-compare-chart/nasal-pillow-cpap-mask/2h7e

      If you purchase your mask from CPAP.com, it is sold with free 30 day returns, so if you don’t like it for any reason, you can return it for a refund, or a different mask. Keep in mind that a valid prescription is required.

      I would encourage you to speak with your doctor about the data you are receiving as well, as its possible that you may need a setting adjustment.

      Please see our cpaptalk.com forum to read what other customers are saying about side sleeping masks.

      http://www.cpaptalk.com/viewtopic/t108956/best-type-of-mask-for-side-sleeper.html

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

      Have a great weekend!

  5. April R Perry Reply

    1. I am a new C-PAP user. I wear my C-PAP for at least 6-7 hours a night, but my CPAP hourly usage is only 2.39. How can I get my hourly usage to reflect my actual time I wear my C-PAP?

    2. Why is there no score for the “mask on/off” on my dashboard?

    • Hi April, i’m sorry that your therapy usage isn’t recording properly. In order for us to assist you, please provide the name of your machine. Also, be sure that your machine is set to the correct time and time zone.

      Please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      Have a great day!

  6. I have the airsense 10 autoset by resmed. It has the water tank (humidifier). My question is related to the water tank but I wanted to mention that I sleep on average 6 to 7 hours a night and my events per hour range between 0.1 to 0.8 and sometimes 0. Question. What does it mean when I fill my tank with water at max level and wake 6 hours later with no water in tank? Should I be concerned?

    • Hi Lady, my apologies for the delayed response. What setting do you have your humidity on? Is your humidity set to manual or auto? If auto, please change to manual and you should try the setting at 4, or 5 to begin. If more humidity is required, you can increase to your comfort.

      Are you receiving a smiley face for humidity? If so, no need for concern since this indicates your humidifier is working as it should.

      For further questions, or concerns, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      Have a great day!

  7. Two months later, 3 visits to the doctor and 1 visit to my supplier and what a trip. I have been using a BiPap for 11 months. One month was while I was in ICU so I don’t know much about that. I know I had 70 on my sleep lab. My doctor’s response to my jump to AHI between 15 and 21…it’s better than 70 and what do I think we should do. Well, let me check with Dr. Google and I’ all get right back with you on that, doc.

    It is just a cash cow business.

    • Hi Mary, I’m glad to hear with the use of your BiPAP, you managed to decrease your number of AHI’s. Even though there has been a significant decrease in the number of AHI’s you have, 15-21 still indicates Moderate Sleep Apnea.

      I would recommend you speaking with your doctor once again, to see if he/she can review your sleep therapy data. They may make a decision to increase your pressure settings.

      If you aren’t receiving the care you need from your current physician, you may consider switching your doctor/sleep specialist. If you ever have any questions, or concerns, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      We wish you continued improvement in your CPAP therapy!

  8. I have been on cpap over 10 years I have the dream station with humidifier my reservoir also is empty at the end of the night which it wasn’t before my humidifier says adapted flex 3 ahi up and down what could be wrong

    • Hi Janie, when your humidifier is in adaptive mode, it means the temperature of your heated plate is changing to match the temperature in the room. If the room is cooler, it means the heat plate temperature is increasing and in turn, using more water. My suggestion would be for you to change the setting from adaptive to fixed to see if this resolves your concerns.

      For further questions or concerns, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      Have a great day!

  9. I been using cpap for 14 years with great numbers, always in the 2 range. Lately, and all of a sudden, my rate jumped to the teens and even into the 20’s. This is mostly hypopneas. I tried tinkering with the pressure, the humidity, added a humidifier, to my bedroom, changed my cushion and headgear; but can’t seem to get it back to where it was. I only use a ResMed S8 as I found my S9 and S10 used up the water by the middle of the night. The water chamber in the S8 is larger. I wear a F&P Flexifit for petite faces and have used this for 13 years and my recommended pressure was 12 and I don’t use the EPR option. My question is this: Should I increase or decrease my pressure, increase or decrease the humidity? I presently put it at 14 and the humidity at 2.5. FYT, my weight has not changed and I use a nasal mask and am a side sleeper. My leak rate averages around 40.

    • Hi Maria, i’m sorry that you’re having some problems with your increased number of Apneas. We always recommend you speak with your doctor before you adjust your pressure setting. Your doctor, can review all of your therapy data and make a determination on if you would benefit from a setting adjustment. You can however, make comfort setting adjustments to see if that helps.

      Also, your leak rate of 40 is pretty high. This may be the cause of the increase in your Apneas. I understand you’ve changed your cushion and headgear, which is great! Keep in mind you should change your cushion ever 3 months and your entire mask every 6 months. Have you changed your hose within the last 6-12 months? If not, please do so. Also, please make sure you have changed your disposable filter within the last 30 days.

      Otherwise, please continue to follow-up with your doctor regarding your pressure setting as it may need to be increased.

      If you would like to speak with us further, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      Have a great weekend!

  10. Charlotte Trexler Reply

    I use a nose cushion and just replaced it and my hose because my AHI started to creep into the 5-15 range. It is still above 5, if I’m sleeping with my mouth open, would that affect my AHI?

    • Hi Charlotte,
      If you sleep with your mouth open while using nasal pillow mask, yes, this will affect your AHI. This is because the pressure you’re receiving is entering through your nose and coming back out through your mouth. This means, you aren’t receiving the treatment you need.

      If your mouth falls open during the night, please consider using a chinstrap in conjunction with your nose cushion, or you should switch to a full face mask.

      For further questions/concerns, or if you would like assistance with selecting a different mask, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      Have a wonderful, safe weekend!

  11. I’ve been using the DreamStation BiPAP for about a month or more now,and ahi has stayed between 2.9-4. The last 3 nights though have been horrible. I wake up after about 3 hrs of sleep every night,and takes about an hr to fall back asleep. I get headaches then in the same spot on left top of head,as well as upon waking. My ahi by morning(per Dreammapper app) has been 6.9-8.7 the last 3 nights. My mask doesn’t leak, humidifier is set to 2-3 every night(without using any water it seems),and my breathing seems a little shallow. I’m at a loss for words on why my ahi is creeping up. I use the AirFit F20 full face mask. Any advice would be beneficial.. thank you!

    • Hi Gabe, i’m very sorry for the delayed response. To confirm what’s causing your AHI, to increase, your doctor would need to review a complete detail of your therapy data.

      You may need a setting adjustment, but it could be that changing some of your comfort settings, would help to lower your AHI.

      Also, you mentioned your humidifier, doesn’t seem to be using any water. What setting is your humidifier on? Is it set to auto, or manual? If in auto, please change to manual and increase the humidity setting to see if this helps.

      We are happy to assist you via phone with troubleshooting, or your comfort setting adjustments. Please feel free to reach us at: 1-800-356-5221.

      We hope to hear from you soon!

  12. I am new to CPAP resmed machine. Sleep test # of 14. 3 months later my # is between 11.6 to 12. Should I be able to achieve around 7 ?

    • Hey Weldon, welcome to the CPAP Family! Most folks, will continue to see a decline in their AHI’s as time passes. Yes, with continued and consistent use of your CPAP machine, it is possible for you to lower your AHI’s to 7, or even less.

      For further questions, or concerns, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      Have a great day!

  13. David Clark Reply

    My sleep apnea numbers have quadrupled in the last month. My average was. 07 for years, now it’s in the 6 to 7.5 range. Due to a shoulder injury, I try to sleep on my left side.
    I’m seriously concerned about this, as I’ve been on CPAP for 11 years.
    Any advice would be appreciated, especially during the Covid 19 pandemic.

    • Hi David,
      I’m sorry to hear about the increase in your AHI. Have you confirmed what your leak rate is? If you have a high leak rate (usually, more 24L/m is considered high), this could be cause for the increase.

      Also, have you recently started taking a different medication? If so, this could be reason enough to raise your AHI.

      I would suggest you speaking with your doctor as he/she, will be able to review your therapy data in detail to determine the reason for the AHI increase. If you haven’t had a sleep study within the last 5-7 years, your doctor, may suggest you having one to confirm if a setting adjustment is needed.

      For further questions, or concerns, please reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      Best Wishes!

  14. I have the air sense 10 and it works great. My problem is I have been using nasal pillows with a chin strap for years. Since getting this machine my air show severe leakage while using the nasal pillow set up, breathing through my mouth but my ahi are always low. I have talked to my supplier multiple times and tried may mask. The res med f30 works good and air leakage is very low but ahi when using this mask goes way up. Full face mask has sever leakage unless tighten so much it’s uncomfortable. My question is it better for your health to have low ahi with sever leakage or is it better to have low leakage with high ahi. Getting pretty frustrated trying to resolve both.

    • Hi Doug,
      I can certainly understand your frustration. Both low leakage and AHI are important. What is your leak rate while using the nasal pillow mask? Is it under 24L/m? If so, in most cases this is considered acceptable. If higher, I would recommend you try using a different size cushion, or even try a different mask, or chinstrap.

      The goal is to get and keep your AHI under 5. If you are receiving an AHI over 5, while using the F30, you should try a different mask. I would also encourage you to speak with your doctor about your hardships with getting ahi and leak rate at, or below what is considered normal.

      If you would like to speak with us in depth about your concerns, please give us a call at: 1-800-356-5221 and we’ll be happy to provide you with suggestions and recommendations to help improve your CPAP therapy experience.

      We wish you the best!

Reply To Nick Cancel Reply