AHI and Symptoms

[JTB1987]

Not letting me take off the chart Pugsy! Thanks for the pointers though. How do I go about upping the minimum pressure on the DreamStation Auto?

[Pugsy]

Have no idea why the pie chart won't leave but I have heard of that happening. Don't worry about it.
Next time you post an image (don't bother redoing this one) don't scroll down so far on the left side.
We still can't see your machine and settings but I can see the sleep session stuff which I don't need.
I don't care about the bottom of the statistics side or the sleep session information but I do care about machine model and settings.
But no need to redo this image. I saw on the summary overview what your settings were...4 min and 20 max. The default settings from the factory.

Go here and request a copy of the clinical/provider manual for your machine
http://www.apneaboard.com/adjust-cpap-p ... tup-manual
In that manual it will explain how to get to the ultra secret part of your machine where you can change things.
Do go ahead and get the manual instead of just reading up on how to get to the setup menu area. There's some really useful stuff in that manual that isn't in the typical user manual.

[JTB1987]

Thanks Pugsy.
My machine is the DreamStation Auto and it was set between 4-20. Last night I adjusted it on your advice to min 5. I got a worse AHI of 4.3 although symptom wise probably not as bad as yesterday when it was lower!

[Pugsy]

So what category of flagged events was "worse"?
Any pattern to the increase? When were they flagged?
Did you change sleeping position that you know of? Maybe be on your back more??
Maybe sleep more soundly and get more REM where people often will have an increase in apnea events?
Maybe have more awakenings and thus an increased chance of Sleep/Wake/Junk event flags which don't count?
AHI numbers alone don't really tell us much of anything.

[JTB1987]

I’ll plug my SD card in later and share it with you if that’s ok? I slept with foam noodles inserted into the back of my t shirt - would suggest less time therefore on my back? I know supine position is a huge culprit for most apnea sufferers.. I probably also had deeper sleep to compensate for yesterday’s miserable symptoms!

What sort of apnea and symptoms do you have? What have you found most useful to feel better? And what impact do you think those pressure increased pressure will have?

I appreciate your kind concern. It’s a strange old thing to have at this age, high moderate apnea, and to think of the toll its potentially had on my brain and body since most likely a young age is quite worrying!

[JTB1987]

[JTB1987]

If you zoom out you can see the full image.

I am not sure where I would find answers to your questions, I am seeing a specialist in a few months but happy to learn something new now!

[Pugsy]

My OSA is the plain jane garden variety OSA except it is worse in REM sleep.
Sleep study in a lab showed maybe 12 AHI in non REM sleep but 53 in REM but wasn't getting much REM because when I would slip into REM the apnea events would come on fast and furious and I would wake up or have an arousal and have to start all over in the sleep cycle.
BUT I must have been having some fairly long in terms of duration of events when in non REM sleep because despite the AHI in non REM being rather "mild" my oxygen levels were dropping to 73% which is quite low.
My main symptoms...killer headaches in the AM which was from the low oxygen stuff....nocturia because of the abundance of the stress hormone ANP
Atrial natriuretic peptide which the heart dumps out into the blood stream when an apnea event happens and the heart is stressed and this hormone causes the kidneys to go into overdrive and large amounts of urine get produced when the kidneys go into over drive.

I also snored something awful. I would wake with massive sore throat from the snoring and would often wake myself up with the snoring but mainly the snoring disturbed hubby's sleep. I blissfully slept through the biggest part of my snoring but hubby said the windows would rattle.
BTW I was a tiny person...5 ft tall and maybe 110 lbs with a long skinny neck. Certainly not what most people picture when they think of someone with OSA. I never had any sleep apnea symptoms until I hit menopause so I thank good old Mother Nature for giving me OSA. Everything starts to sag and go south with menopause...the boobs, the belly and the airway tissues.

I also had the typical "no energy" thing and would want to take a nap at 9 AM after getting up at 7 AM...and often would nod off.
With effective cpap therapy the snoring pretty much went away so hubby sleeps better...the morning killer headaches went away because oxygen levels were stable and the nocturia totally went away (that alone would make me want to use cpap because waking up to pee 3 or 4 times a night really messes with sleep quality) once I had my therapy optimized. It did take a little bit of time to get the therapy optimal because in the lab titration sleep study I still didn't get much sleep which meant very little REM where my OSA was worse.
My pressure needs in REM can be significantly higher than in non REM.

Sleeping on my back never seemed to be much of a deal breaker. I did some experiments where I built a wall to force me to stay on my side to see if my pressure needs changed during REM but they didn't seem to. I would still see the same higher pressures in probable REM no matter what position I slept in. So I abandoned any attempts at trying to stay off my back because it didn't seem to matter and REM we can't control anyway so I just decided to let the machine sort out the pressure needs....and I use less pressure for the bulk of the night and let the machine auto adjust upwards as it senses the need during REM.

If a person has an auto adjusting machine and they want to try to stay off their back because there's a significant pressure needs difference and those higher pressures cause a problem then by all means try to stay off ones back but otherwise I just say sleep in whatever position you sleep the best in and let the machine sort it out. That's why we have auto adjusting machines anyway.

Getting good solid sleep and feeling decent during the day has always been my primary goal because nothing else matters if we don't sleep or feel decent. Nice low AHI numbers all by themselves don't mean squat if we still feel like crap because our sleep quality is crap for some reason or other.
So while I watch AHI numbers I don't put all my evaluation of my therapy in the AHI basket. Some of my best days in terms of how I felt early on in my therapy followed nights where my AHI was 10. Go figure that one. Made no logical sense but it happened.
Now those nights with AHI of 10 were rare so I didn't worry about them and as time went by they became even more rare and now after over 8 years a bad AHI night for me is 4 to 5 AHI. Usually some sort of cluster and probably in REM. Funny thing though...I can't really tell any difference in terms of how I feel with an AHI of 4 or 5...or an AHI of 0.0. Now some people can tell a marked difference in how they feel with the AHI variations but I never have been able to.

Now I am 65...and been on the cpap machine since May of 2009....so I am a bit older and with age comes the other stuff that Mother Nature wants to bestow on us and one of those "gifts" happens to be some pretty bad arthritis mainly in parts of my body that were damaged in a bad car wreck some years ago. With the arthritis comes the usual pain and discomfort which also affects sleep quality a lot at times. So my sleep quality isn't always as good as I would like because of poor sleep from the pain so I don't always feel the best during the day. It's not related to sleep apnea though.
As much as I would like for cpap to fix my poor sleep from pain...it can't do that because the cpap machine only fixes the sleep apnea related problems.
So while my killer headaches are gone and my nocturia is gone...my sleep quality isn't always optimal but not because of the cpap/sleep apnea side of things. To add insult to injury I now seem to have developed some insomnia issues that I have never had in the past. I can go to sleep just fine but wake earlier than I want more times than normal and often can't get back to sleep. Sleep maintenance insomnia....that's how come I was up so early this morning. Woke up early and couldn't go back to sleep and it wasn't from pain either. This is a fairly new problem for me and I think most likely related to my mom and her recent breast cancer diagnosis...so stress is most likely the major cause. Fixing stress related issues is always a work in progress and sometimes I win the battle and sometimes the stress wins.

My OSA is optimally treated so that side of my life and symptoms is well managed. On the nights where I only sleep 4 to 6 hours I can pretty much guarantee that I will feel like crap during the day. I simply need 7 to 8 hours of decent sleep to feel my best. If I don't get it my butt drags around all day. Any outlier weird bad AHI nights I ignore because sometimes crap happens that we can't explain or prevent and unless it happens often there is no urgent need to worry about them anyway.

So there you have a bit of my history and why I look at things the way I look at them.
AHI...is just a number that may or may not mean much.
These machines can give us falsely elevated AHI numbers when we don't sleep so great because these machines will often flag awake breathing irregularities by mistake. Our awake/semi awake breathing is much more irregular than our asleep breathing and these machines only measure breathing air flow stuff....so the AHI by itself doesn't always mean much if someone didn't sleep all that well. It's possible that some of the events are what we call SWJ or Sleep/Wake/Junk and awake breathing flagged events don't count in terms of OSA therapy evaluation. Often the false flags are centrals/Clear Airway apnea events but they can also be OAs and hyponeas.

So I always try to look at the whole picture instead of just one little corner of the picture when evaluating therapy. AHI is just one little corner of a very big picture. Seems like we humans really need some sort of "good" number for evaluating anything though. It's how our medical system tells us something is wrong or not. We use it all the time for various things like thyroid function or diabetes management. So people target the AHI number like they do a blood glucose number as the primary measurement tool for evaluating cpap therapy and while it is important it isn't the end all goal and we have to realize that sometimes the AHI might be high due to awake event flags and not get all in a panic when the AHI isn't what we feel we need to see for validation of effective therapy.

I am NOT saying to ignore the AHI...make no mistake about that but what I am saying is that we have to be able to look at the big picture and realize that the AHI isn't always 100% accurate due to the chance of SWJ messing with the numbers.
This is especially true for newbies to this cpap therapy stuff. Lets face it...sleeping with the alien stuck on our face blowing air up our nose isn't the most natural and comfortable thing to be doing and sleep quality can and will be impacted just from the alien. I think it was probably 3 months before my brain stopped waking me up several times in the night just to tell me "hey dude, do you know there is an alien on your face"
No pain with the mask or problems with the pressure or anything like that...just the brain telling me that there was something alien going on in my normal routine. With time the brain comes to accept its new best friend and won't wake us up just to say "hey dude...did you know".

When we do experiments and change something in our routine it is best to make only one change at a time if at all possible. When we make more than one change we don't know which change might have caused a different result. You made a very minor change in the pressure last night. It's such a minor change that I really didn't expect any change in anything and then you added the stuff to try to keep you off your back...so you made 2 changes last night and your AHI is a little "worse".
We have no idea if the AHI would have been "worse" anyway because of the fact we simply don't sleep the same each night or if the change in pressure had anything to do with it or the fact that you added the attempt to stay off your back into the experiment. Looks like maybe the category of events that increased was hyponea. Not sure what to make of that at this point. There doesn't seem to be any pattern that we can see unless maybe a REM sleep pattern. Do you know if your OSA is worse in REM or not?

Maybe this is nothing more than an indication of more sleep which means greater chance of more REM....it's not impossible.
Unfortunately there is no way to know for sure. We can suppose a bit and make educated guesses based on known history ....like I can with my known REM dependent OSA. We can zoom in on events and get an idea or not if they are SWJ flagged events but that takes time, work and education and even then not always a clear cut answer can be seen.

My personal thoughts about the trying to avoid supine sleeping because it "might" make OSA worse...I wouldn't do it unless there was a proven need to do it. Like if your pressure needs were so markedly different when on your back that it was just more comfortable to try to stay on your side.
I know one person who needs pressures of 18 when on their back and only 9 when on their side....I don't blame them for wanting to stay off their back but I don't see that big of a difference in your reports and if you are like me and REM is the bigger culprit it isn't going to matter what you do on your back...the machine is going to have to do whatever it needs to do anyway so why risk messing with sleep quality by adding something that could affect comfort (like something on your back). Sleep in whatever position you sleep the best in and let the machine sort it out. That's why we use the machine in the first place.
Staying off one's back is more for when someone is not using cpap therapy at all or if the pressure needs when supine are so high that they create a problem. If the airway is optimally held open and the collapses prevented in the first place who cares what position a person sleeps in...because the collapse is prevented anyway. They won't happen.
Your choice whether you want to continue with the avoiding supine sleeping position but if it were me I would postpone that experiment until a later date or indefinitely. At this point I don't see any reason to try to stay off your back and instead would just let the machine sort it out.

I didn't really expect that minor change from 4 to 5 cm minimum to do anything really. It's not that big of a change and to be honest there was no urgent need to change anything. I was thinking mainly of comfort and the fact that for some people that 4 cm mark can be a bit uncomfortable in terms of air movement. We won't suffocate with such little movement but it can sure feel like we are and for some people they say they are more comfortable at a bit higher pressure and more comfort equals better sleep for a lot of people. Let's face it if we aren't comfortable we can't go to sleep or stay asleep so easy....and remember primary goal...good solid sleep because without good solid sleep nothing else matters much does it?