ahi slipping

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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zonker
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Re: ahi slipping

Post by zonker » Thu Mar 09, 2017 2:17 pm

49er wrote:
D.H. wrote: 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
thanks, 49er. but it's a waste to tell him(her) that. i really don't think he(she) pays the slightest attention to such things.

i write he(she) because i'm not bothered enough to look to see what d.h. identifies as.....
people say i'm self absorbed.
but that's enough about them.
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zonker
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Re: ahi slipping

Post by zonker » Thu Mar 09, 2017 2:22 pm

Arlene1963 wrote:Zonker, your last sentence in the opening post sums it up for me "I still feel good and rested".

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.
thank you very much! i'm seriously not trying to be bothered by it at all. just wanted a bit of clarification because if there was anything that i could do to improve my sleep, i'd like to try it.

in an effort to NOT chase zero, i don't look at sleepyhead every day. but i do look at it once a week out of curiosity. once, sometime in december i saw that three nights earlier i had indeed
reached zero. but i don't remember being particularly super rested that next morning. i just took as an anomaly and moved on.
people say i'm self absorbed.
but that's enough about them.
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zonker
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Re: ahi slipping

Post by zonker » Thu Mar 09, 2017 2:27 pm

Julie wrote: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.
hi, julie! yeah, that's pretty much the point of my post. how real are these numbers in use to measure our ahi and how it relates to good nights sleep? be aware that at no time have my numbers jumped up to 5. these are slow and steady increases. and it doesn't always trend upwards. sometimes they can even slide back down.

i'm asking all this just to assure myself, in the end, that i'm not doing myself any harm.
people say i'm self absorbed.
but that's enough about them.
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zonker
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Re: ahi slipping

Post by zonker » Fri Mar 10, 2017 5:24 pm

wow, this day kind of slipped away on me. but anyway, i did try setting my a-flex to 2. then i set my bottom pressure to 11. that's up from previous of 10.5. top pressure remains the same at 14.

i slept lightly, more lightly than i normally do. not sure if it was the pressure bump that disrupted sleep or not. will stay with this for a few nights to see if i settle down.

also, i know one night doesn't mean much, but my ahi was 2.85 whereas night before was 3.43.

while i was in sleepyhead, i looked at statistics. i think it's funny how the high ahi numbers jump out at me. yet statistics show for last year i was at an ahi of 2.17, last 6 months at 1.45 and last 30 days at 2.89. that doesn't seem that bad taken in the bigger picture.

in any case, as i've said, not in a panic or anything like that. just want to make sure i'm doing right by my health.
people say i'm self absorbed.
but that's enough about them.
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Re: ahi slipping

Post by Pugsy » Fri Mar 10, 2017 6:30 pm

You made 2 changes...slight increase in pressure and the addition of AFlex set to 2.
Slight changes but changes none the less and it may take a few nights for the body to get used to things.
Sometimes the least little change will upset the body's "norm". I think especially when someone who is a long term cpap veteran makes a change....we've spent a lot longer at one way of doing things than someone new to therapy.

Also remember that in terms of AHI evaluation you have to mentally remove any central/clear airway apnea index if you are evaluating for pressure needs. Centrals we don't try to fix with more pressure from your type of machine...we just have to ignore them like the machine does. Plus it is possible that the clear airway/central event isn't even a "real" central. It's possible that the central is a SWJ central too. Even if it were real we just have to shrug our shoulders because we can't fix centrals with your type of machine.
So if you had 0.5 clear airway index you mentally subtract it from the overall AHI when trying to decide if you want or need more pressure.

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zonker
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Re: ahi slipping

Post by zonker » Sat Mar 11, 2017 12:18 pm

Pugsy wrote:You made 2 changes...slight increase in pressure and the addition of AFlex set to 2.
Slight changes but changes none the less and it may take a few nights for the body to get used to things.
Sometimes the least little change will upset the body's "norm". I think especially when someone who is a long term cpap veteran makes a change....we've spent a lot longer at one way of doing things than someone new to therapy.

Also remember that in terms of AHI evaluation you have to mentally remove any central/clear airway apnea index if you are evaluating for pressure needs. Centrals we don't try to fix with more pressure from your type of machine...we just have to ignore them like the machine does. Plus it is possible that the clear airway/central event isn't even a "real" central. It's possible that the central is a SWJ central too. Even if it were real we just have to shrug our shoulders because we can't fix centrals with your type of machine.
So if you had 0.5 clear airway index you mentally subtract it from the overall AHI when trying to decide if you want or need more pressure.
slept much better last night. am going to leave the settings as they are. come friday, i'll look at my numbers. thank you much for reminding me of the a-flex settings. that may just be the key.

as to the rest, i know you are speaking for the benefit of others reading. for me, i'm just as bewildered by the makeup of ahi as i was at the very beginning. i don't give it much thought until my sleep quality degrades.

it IS a bit easier as a veteran to make changes. when i first started, i was just floundering about, trying to figure out WHY i couldn't get used to it!
people say i'm self absorbed.
but that's enough about them.
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Re: ahi slipping

Post by Pugsy » Sat Mar 11, 2017 7:32 pm

Short version.
Centrals vs the obstructive stuff (OAs & Hyponeas). When to change the pressure or leave them alone.

cpap/apap can't fix centrals so when someone is looking at their AHI and they see mainly centrals...increasing the pressure isn't going to fix them and might make them worse.

Now if the AHI is mainly the obstructive stuff (like yours was) then more pressure will likely reduce the obstructive stuff.

I mention this because I have seen people go crazy increasing the pressure trying to fix a high AHI and more pressure wasn't helping...come to find out they were having mainly centrals.

The knee jerk reaction to a high AHI is "more pressure" but people need to look at those event categories before that blindly go increasing the pressure because they may be trying to fix something with more pressure that simply can't be fixed with more pressure from a cpap/apap machine.
I always tell people to make sure what you are wanting to fix with more pressure is fixable with more pressure.

That little bit of exhale relief using AFlex probably allows you to use a wee bit more minimum pressure without increasing the aerophagia issues. Sometimes there a fine line between this pressure doesn't cause a problem and the next step up in increments will. Adding in a little exhale relief will often let a person use a little more past that line where the pressure causes a problem.
Certainly worth giving it a try and if it works...it's free and easy to do. Can't get much better than that.

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Re: ahi slipping

Post by D.H. » Sun Mar 12, 2017 10:04 am

49er wrote:
D.H. wrote: 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
Sorry, zero is the ideal. If somebody wants to chase zero obsessively, that's wrong. However,if one chooses to be obsessive (or can't help it), don't blame my postings.

Note that in most areas of medicine, you can overshoot the target and cause damage to the patient. For instance, if one needs to lower his(her) blood pressure, one has to be careful not to let it fall too low (and certainly nowhere near 0). Same with Diabetes. When one takes medicine to lower his(her) blood sugar, care must be taken not to allow it to go too low.

In the case of lowering the AHI, it is safe (and ideal) to hit zero! This is not possible for most, but the lower the better! You cannot overshoot zero!

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zonker
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Re: ahi slipping

Post by zonker » Fri Mar 17, 2017 8:15 pm

Pugsy wrote:Short version.
Centrals vs the obstructive stuff (OAs & Hyponeas). When to change the pressure or leave them alone.

cpap/apap can't fix centrals so when someone is looking at their AHI and they see mainly centrals...increasing the pressure isn't going to fix them and might make them worse.

Now if the AHI is mainly the obstructive stuff (like yours was) then more pressure will likely reduce the obstructive stuff.

I mention this because I have seen people go crazy increasing the pressure trying to fix a high AHI and more pressure wasn't helping...come to find out they were having mainly centrals.

The knee jerk reaction to a high AHI is "more pressure" but people need to look at those event categories before that blindly go increasing the pressure because they may be trying to fix something with more pressure that simply can't be fixed with more pressure from a cpap/apap machine.
I always tell people to make sure what you are wanting to fix with more pressure is fixable with more pressure.

That little bit of exhale relief using AFlex probably allows you to use a wee bit more minimum pressure without increasing the aerophagia issues. Sometimes there a fine line between this pressure doesn't cause a problem and the next step up in increments will. Adding in a little exhale relief will often let a person use a little more past that line where the pressure causes a problem.
Certainly worth giving it a try and if it works...it's free and easy to do. Can't get much better than that.
pugsy, thank you SO much! just that little bit of exhale relief has turned the trick. just checked my sleepyhead dats this morning and for the last 7 days, highest ahi was 2.60 and the lowest was 1.07. and i feel terrific!

ca didn't rear it's ugly head. i would either get fl or re. in most cases the oa was extremely low.

i will continue on this course and MAYBE bump that lower pressure up a bit more. this past week, i'd bumped from 10.5 to 11. so i just want to see what 11.5 will do. if it's back to burping, i'll cheerfully go back down to 11 again!

again, thanks for the advice!
people say i'm self absorbed.
but that's enough about them.
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Re: ahi slipping

Post by Goofproof » Fri Mar 17, 2017 10:18 pm

You might try raising the head of your bed 4 to 6 inches! Also diet 4 to 6 hours before bed can cause more problems also med's can help. Jim
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