Chances are that if you haven't followed up with your doctor in years, or at all, about your CPAP therapy, something isn't quite right in CPAP-Ville. PAP treatment is as much an art as a science, and it requires continuous monitoring and attention, preferably between you and your physician. That said, I'm finding that doctor follow-up is more the exception than the rule. So you the patient must take the initiative. If you haven't seen your doctor in awhile, make an appointment, and start off with these 3 questions:

1. What is my AHI?
AHI stands for "Apnea-Hypopnea Index," and is a measure of the total number of times you stop breathing or have shallow breathing during sleep divided by the total number of hours you were asleep. An AHI of greater than 5 means you are not breathing normally. An AHI of greater than 5 but less than 15 is deemed "mild" sleep apnea; an AHI greater than 15 but less than 30 indicates "moderate" sleep apnea and an AHI of greater than 30 indicates "severe" sleep apnea. So you should of course shoot for an AHI of below 5, which is not always possible, but certainly a worthy goal. If you have an AHI above 5, ask your doctor how he plans to get it down closer to 5.

2. What is my leak rate?
The positive airway pressure your machine provides doesn't do you much good if it's leaking out of your mask and not getting into the airway to do the job it's supposed to: to act as a splint keeping the airway open so you can breathe properly. With this in mind, most machines have been designed to measure the rate at which your mask is leaking. Some mask leak is normal; too much is counter-productive --- the proper mask leak rate varies with your pressure settings and the specific type of mask you own. That said, on all the masks I've had (and I've had many), if the leak rate was above 40, I had a problem. When you ask your doctor what your leak rate is, if it's above 40, ask him what he's planning to do to help you reduce the leakage.

3. Is my pressure appropriate?
The pressure on your machine was prescribed by your doctor when you first had your sleep study done. The sleep study is just one night's worth of data, though, and not a very typical night at that since you were in a strange bed hooked up to a bunch of wire and monitors. How you sleep and use your machine night after night from the comfort of your own bed can therefore be a much better indicator of what your pressure settings should be. Most machines are smart enough to record pressure data. Ask your doctor whether he thinks your pressure settings need to be adjusted based on that data.

Bottom Line
See your physician if it's been awhile and ask these 3 basic questions. If your physician can’t answer these questions, that means one of two things: (i) you’ve got the wrong machine, or (ii) you've got the wrong physician. Either way, something needs to change. You've got the wrong machine if your machine doesn't track this data. How else are you supposed to know how well your treatment is working? You won't --- it's like flying blind. And if you have a good machine, but your physician just isn't knowledgeable enough about the reports it generates to give you the answers, RUN, don't walk, to another physician. There are plenty of docs out there who can give you these answers, and it's pretty basic stuff that you should demand.