ahi slipping

[zonker]

have a question for the fine folks here. please forgive if this has been addressed before, but i don't remember seeing it.

i've been at this for some years now. whatever it says in the upper left corner, i really don't remember. i know i actually started my treatment shortly after joining the forum.

i'm far too lazy to type out my history, but am happy to answer any questions if you feel you need more info to answer my question.

there are two things i do need to mention, because i feel they are germane. i've learned quite a lot here, but two things are pertinent to my question.

1. ahi under 5.0 is considered treated.

2.we shouldn't chase 0 because it's a bit of a mugs game. one can get so wrapped up in that, when they could put those efforts towards insuring they are feeling good with their sleep.

so what we have here is, well, i don't what to call it. but think of it as 0 on one side, then 5 on the other. if i "get under 5", i'm treated. yay! but am i MORE treated the closer i get to 0? say i'm at 4.5. would i be better off somehow if i were to hit 4? 3.5? and so on and so forth.

i hope that makes sense. due to a change of locale, from sea level to 6000 feet, my AHI has changed upward from around 1.5-2.0 to closer now to that number 5.

i suppose i'm wondering if i should be satisfied with that . i still feel good and treated!

[Pugsy]

What is the primary component of that AHI that has increased?
Is it by chance the Clear Airway/Central index that has increased?

[zonker]

What is the primary component of that AHI that has increased?
Is it by chance the Clear Airway/Central index that has increased?

no the clear airway remains small. over 3, i seem to have a breakdown of mostly obstructive,hypopnea and re. if i'm under 3, mostly re and fl. under 2, re,fl and hypopnea.

bear in mind, if it makes any difference, that i've lowered my lower pressure in the time span i'm talking about. i started getting too much gas with the lower pressure i had, so i had to reduce it in order to sleep.

did i manage to answer your question?

[Pugsy]

did i manage to answer your question?

Seems that way.
And I think you may have answered your question as to why the slightly higher AHI and most likely the cause of the increase in the various obstructive stuff you are seeing.
The lower pressure...it's not doing as good of a job as the slightly higher pressure.

Sometimes we have to make compromises and sometimes accept a little higher AHI because to lower it causes more trouble than the slightly higher AHI might cause.

If it was just more centrals it might be the change in altitude. It's common to have an increase in centrals when we go from lower altitude to higher.

[zonker]

did i manage to answer your question?

Seems that way.
And I think you may have answered your question as to why the slightly higher AHI and most likely the cause of the increase in the various obstructive stuff you are seeing.
The lower pressure...it's not doing as good of a job as the slightly higher pressure.

Sometimes we have to make compromises and sometimes accept a little higher AHI because to lower it causes more trouble than the slightly higher AHI might cause.

If it was just more centrals it might be the change in altitude. It's common to have an increase in centrals when we go from lower altitude to higher.

sooo...all in all, you are saying "it is what it is"(i hate that expression!), i take it? i mean, what you say makes sense and all and is not news to me.

should i take it, then, that i shouldn't worry about the degrees of ahi, but be happy that i'm being treated? and trust me, i AM okay with my current state of affairs. i just wanted to confirm that all is well.

[Pugsy]

Well I suppose if you have a little room to play with between maybe a little more optimal pressure and not causing bad aerophagia issues you could try it. But if you are already real close to the line you may not have any wiggle room. I guess it depends on how much you dropped the pressure along with just how bad the aerophagia symptoms are.

If you are feeling good, sleeping decently and the AHI is in the 3 to 5 range that would probably be acceptable.
It sure would for the doctors but you have to make that final call. Some people just feel better mentally or physically with the AHI lower.

There are ways to try to lower the aerophagia issues at whatever pressures are causing the issues.
Maybe add exhale relief...maybe switch to a bilevel machine.

One thing you might consider because it helps some people is adding a cervical collar which sometimes helps keep the airway less likely to collapse and you might be able to reduce the AHI a bit at current pressures.

All in all if it were me...and I was feeling good and sleeping good then I don't know if I would worry about an AHI of 3 to 5 if getting it lower caused me problems but it's your body and you know how you feel better than anyone else and have to make that decision yourself.

[jtravel]

I found that when lowering My Min Pressure my AHI would creep up with my Apap.
The Reason is at the lower Pressure the Apap must Chase my events by increasing pressure until they go away.
I do better with the higher Min setting but suffer from increased aerophagia symptoms.
Like Pugsy said it's a balancing act and you should use what makes you feel the Best.
I stuck with the Higher pressure as my aerophagia symptoms were not causing me pain.
At the lower min pressure setting my wife said she heard me sometimes gasping but the Apap worked and adjusted to stop it after a few mins.
My sleepyhead data confirmed that as I could see the events at the lower pressure and then the pressure was increased until they went away.

[Pugsy]

Are you using auto mode or fixed pressure mode?
What is your Flex relief setting?

We could maybe do some little tweaks to make the aerophagia less annoying if you want to try but it's not urgent that you do anything since you are feeling good.

[D.H.]

Your PR System One REMStar 60 Series Auto has automatic altitude adjustment. That is, it should deliver the same pressure at 6000 ft as it does at sea level (at the same setting). However, the motor had to blow harder to do that. There are other things that happen at different altitudes, and they do affect your treatment.


Also, I would assume that you're sleeping in a different bed in a different house, etc. That could have a bearing on this too.


You're correct that zero is not realistic, but you want to get as close to it as possible. I get upset whenever I go above 1.

[49er]

You're correct that zero is not realistic, but you want to get as close to it as possible. I get upset whenever I go above 1.

Big fat sigh! Once again you are providing incorrect information as someone is considered to be technically treated with an AHI below 5.

It is true that many people feel better with a sub 1 AHI but that does not apply to everyone. As a result, you are going to create unnecessary anxiety with people who are doing fine with their sleep but then see your statement and incorrectly think it should be close to zero.

What is frustrating DH is many people have complained about your inaccurate statements but you don't seem to be listening. That needs to change.

49er

[Arlene1963]

Zonker, your last sentence in the opening post sums it up for me "I still feel good and treated".

I'm reading a very interesting book at the moment called 'Overdiagnosis : making people sick in the pursuit of health". written by Dr H. Gilbert Welch. He discusses the current aggressive overdiagnosis and treatment of conditions, most especially when the patient feels perfectly healthy and well. It is as if we are being told that we can't trust our bodies anymore, creating anxiety and a "patient" mentality that leads to a great deal of unnecessary concern.

I think the pursuit of the lowest AHI is less important than how you feel in real life, i.e. if you are sleeping well and feeling rested, as you say ....not what a machine tells you each morning.

Now if you came here saying you feel like crap that is a different story, or if your AHI is routinely well over 5, but since this is not the case, relax and enjoy your life would be my suggestion.

[ajack]

Hi, my first post. As a new guy to apnea, I don't know how realistic it is to promote an AHI under 2, when 5 is normal and "An AHI of less than 10 is not likely to be associated with clinical problems."
http://www.britishsnoring.co.uk/sleep_a ... apnoea.php

[Julie]

Five is 'normal' if you think in the somewhat arbitrary terms doctors do... they had to come up with some figure to say that below it patients weren't considered to need Cpap and above it they might be. But the majority of people here, while not being neurotic about chasing zero, do find they feel best at under (and often well under) at least 3, if not 2, so for us calling 5 normal is a bit misleading. I know if I suddenly saw my numbers 'jump' to 5 from their normals of 1 to 2+ (depending on the week or month) I'd be a bit concerned as to why it happened, and unless I felt perfect (and software agreed) at 4-5 I'd try to get it lower again.

[Pugsy]

Here's the deal with zonker that people are missing...the aerophagia monster has raised its ugly head.
Those of you who haven't had the pleasure of meeting that little guy and only have to deal with the relative ease of getting those nice sub 2 AHI numbers with a little more pressure don't have a clue just how much of a problem that little monster can cause.

He can be really nasty to some people. He can create problems much greater than what an AHI of 3 to 5 will cause (and BTW some of that AHI could be false positives from SWJ flags).

In some situations we simply have to decide to make a compromise....nice low numbers on paper and feeling quite ill during the day or feeling good and sleeping good with may not quite so low numbers.

What is the primary goal? Is it a good math score or feeling good and sleeping well with OSA acceptably treated?
Yeah..in a perfect world we would get both but it isn't a perfect world.
A nice low sub 2.0 AHI doesn't guarantee squat except maybe a pat on the back for a good math score.
It's meaningless if you feel like total crap during the day getting it.

[zonker]

Are you using auto mode or fixed pressure mode?
What is your Flex relief setting?

We could maybe do some little tweaks to make the aerophagia less annoying if you want to try but it's not urgent that you do anything since you are feeling good.

i snuck in here last night before going to bed, but didn't respond. when i read your question about flex relief, i said to myself "oh".

i said that because, back when i first started my treatment i used epr on that particular machine. and i hated it. seemed to do the opposite for me of what it was intended to do. so i quit using it.

but i got to thinking that there were a LOT of things i hated about the machine and the mask and so on, when i first started . i got over them. maybe it was time to try it again.

when i examined my settings, i found a-flex set at 1 as i never did find a way to turn it off. so i decided last night to set it to 3. yikes! no, that wasn't good and it kept my awake for a couple of hours from the feeling of pressure i was getting. i then set it 2 and slept reasonably "normal".

now, i didn't bump my pressure last night. i'll try that tonight to see how it goes. will report back tomorrow....