Airsense 11 Central AI Question

[slowmo2000]

Hi all,

A couple months ago, I was diagnosed with very mild sleep apnea via Watchpat and in-clinic study (both with AHIs of ~5.5 and RDIs of 12). Both studies showed essentially no central sleep apnea (~.4). I've been using the Airsense 11 a couple nights now and noticed that both nights it's shown Central apneas around 2. I realize it's a pretty small number but find it odd that the Airsense is finding Central apneas when the studies did not. Any thoughts/ideas as to why this may be happening?

Thanks!

[ChicagoGranny]

They are probably just transition apneas which can easily happen when the user is falling in and out of sleep. Very common. CPAP machines don't know whether you are awake or asleep. In a laboratory sleep study, they would not be scored as central apneas because the EEG would show you were awake.

[Vako]

It's essential to know that the apnea recorded by the machine is not accurate by a long stretch. One should not pay too much attention to it. Only the in-clinic test can determine the exact results as they measure your brainwaves with sticky wires.

Furthermore, a 5.5 AHI is not "very mild," but rather, it is only 0.5 off from what's considered a normal range of 0-5. Honestly, I am not sure why you were prescribed one in the first place as insurance often does not cover it with such a "normal" AHI level.

[ozij]

Hi all,

A couple months ago, I was diagnosed with very mild sleep apnea via Watchpat and in-clinic study (both with AHIs of ~5.5 and RDIs of 12). Both studies showed essentially no central sleep apnea (~.4). I've been using the Airsense 11 a couple nights now and noticed that both nights it's shown Central apneas around 2. I realize it's a pretty small number but find it odd that the Airsense is finding Central apneas when the studies did not. Any thoughts/ideas as to why this may be happening?

Thanks!

APAP machines record any irregularity they see in your breathing.
They do this whether you're awake or asleep.
The tests, on the other hand, discount irregularities that happen when you're awake or semi-awake.

As for your diagnosis: it's the RDI - Respiratory Disturbance Index that justifies it. On the averyage, You're breathing is disturbed 12 time each hour when you're asleep and those breathing disruptions are disrupting your sleep. PAP therapy can help with that, because it's an arousal caused by your disrupted breathing, and not by othre causes. A very good reason to try PAP therapy. Unlike AHI, RDI includes RERA - Respiratory Effort Related Arousals.
https://www.sciencedirect.com/topics/me ... ance-index

[ChicagoGranny]

slowmo2000

Go with ozij's explanation and not Vako's loose comment. It's unclear why Vako is here. She's certainly not trying to help anyone.

[slowmo2000]

Thank you so much for the helpful and thoughtful responses!

[ozij]

You can edit the this thread's heading to add you doubts about the diagnosis

Hi all,

Total newbie here. I posted a question yesterday about my CPAP therapy (just started this week) but am now rethinking my diagnosis. I've pasted below the information I received from my in-clinic visit. I realize my Arousal Index is about double what the "normal" is and my RDI (9.9) puts me in the mild category, but my 02 never really desaturated and my AHI is only 5.6 (only .6 above normal). Finally, there were no obstructive apneas found. Everything was a Hypopnea or a RERA.

I read the AASM manual for diagnosing and it states the following:

The third edition of the International Classification of Sleep Disorders (ICSD-3) defines OSA as a PSG-determined obstructive respiratory disturbance index (RDI) ≥ 5 events/h associated with the typical symptoms of OSA (e.g.,unrefreshing sleep, daytime sleepiness, fatigue or insomnia, awakening with a gasping or choking sensation, loudsnoring, or witnessed apneas), or an obstructive RDI ≥ 15 events/h (even in the absence of symptoms).

While my RDI is above 5, I have very mild daytime sleepiness and not really any of the other symptoms. I'm generally healthy (weight, blood pressure, etc), so I don't think technically I'm diagnosed with sleep apnea based on the definition above.

I guess I'm just questioning whether CPAP therapy is really going to improve my health or make me feel better. I'm much more inclined to try other treatments (side sleeping exclusively, iNap, allergy treatments, etc). My plan is to do a few more nights on CPAP (I'm in my first week) and use the data to see what my breathing, etc looks like. I've been using an 02 ring for many months and don't generally decomp below 90% on most nights. I'll also ask the clinic for my raw sleep study data. Would appreciate any thoughts/inputs from this group.


Stage N1 Sleep (min, % of TST): 62 minutes, 17.8%
Stage N2 Sleep (min, % of TST): 241 minutes, 68.7%
Stage N3 Sleep (min, % of TST): 00 minutes, 0.0%
Stage R Sleep (min, % of TST): 47 minutes, 13.5%
Supine Sleep: 154 minutes
Arousal Index: 26.5

RESPIRATORY ANALYSIS: (Index = Avg # of events per hour)
Apnea/Hypopnea Index (AHI): 5.6
AHI w/ 4% criteria: 0.9
NREM AHI: 4.5
REM AHI: 12.6
Non-Supine AHI: 2.4
Supine AHI: 9.7

Respiratory Disturbance Index (RDI): 9.9
NREM RDI: 8.9
REM RDI: 16.4

Apneas (#, index): 1, 0.2
Obstructive Apneas (#, index): 0, 0.0
Mixed Apneas (#, index): 0, 0.0
Central Apneas (#, index): 1, 0.2
Hypopneas (#, index): 32, 5.5
RERAs (#, index): 25, 4.3

Mean Wake SpO2: 98.0%
Mean Sleep SpO2: 97.0%
Minimum Sleep SpO2: 93.0%
Sleep Time with SpO2 < 88% (min, % of TST): 0.0, 0.0%

Cheyne Stokes breathing: No
Snoring: Yes

CARDIAC ANALYSIS:
Mean Awake HR: 52 bpm
Mean Sleep HR: 51 bpm
Highest Sleep HR: 70 bpm

Reasons to treat your sleep apnea with CPAP marked in red. REM = Rapid Eye movement and important stage of sleep. I doubt you have worse allergies when you're dreaming, and I doubt side sleeping will solve the problem, though that's a bit more likely.

[slowmo2000]

Appreciate the response and help! Apologies if it seems like I was dismissing your earlier answer.

I guess what I'm confused by is the lack of measured obstructive apenas and o2 desaturation. Said another way, I understand that reras and hypopneas may be creating some sleep fragmentation but the reality is the everyone has these (obviously not the same degree) and I'm not sure my symptoms are aligned with the need for treatment.

Ultimately, I'll go back to my doctor to discuss all of this but I do get the sense that I'm putting a lot more thought into this than the doctor I'm working with.

[ChicagoGranny]

I do get the sense that I'm putting a lot more thought into this than the doctor I'm working with.

He has hundreds of patients to think about. You only have one. That's one of the reasons it's good to DIY using tools like OSCAR and this forum.

[zonker]

Ultimately, I'll go back to my doctor to discuss all of this but I do get the sense that I'm putting a lot more thought into this than the doctor I'm working with.

we all are, my friend, we all are!

your doctor, sadly, is pretty much the norm.

[ozij]

I guess what I'm confused by is the lack of measured obstructive apenas and o2 desaturation. Said another way, I understand that reras and hypopneas may be creating some sleep fragmentation but the reality is the everyone has these (obviously not the same degree) and I'm not sure my symptoms are aligned with the need for treatment.

Ultimately, I'll go back to my doctor to discuss all of this but I do get the sense that I'm putting a lot more thought into this than the doctor I'm working with.

What you're really saying is:
I prefer to treat the issues that sent me to a sleep test in the first place with any means but a CPAP. " I'm not sure my symptoms are aligned with the need for treatment."
I only want to focus on desaturation and measured obstructive apneas, all else is irrelevant " I'm confused by is the lack of measured obstructive apenas and o2 desaturation"
I don't care about breathing problems disrupting my REM sleep, because "the reality is the everyone has these (obviously not the same degree)"
Whether your statement about "reality" is true or not, you decision that there is no need for treatment because the disruptions (as you understand them) are prevalent is the equivalent of reading the following "Fast Facts about Diabetes" and deciding not to treat it because it's so prevalent.
https://www.cdc.gov/diabetes/data/stati ... index.html
And my doctor won't convince me either, because I do get the sense that I'm putting a lot more thought into this than the doctor I'm working with

You don't need our help. You don't need to waste your time with a doctor who is not giving enough thought to your problems. You do need to dig far deeper into available info on sleep and its stages, the effects of sleep fragmentation on health and daily living.

And maybe you have to ask yourself why you want to look for another solution so badly.

Whatever it is - it's a lot of work you have to on your own.
Do whatever you have to do to treat whatever it is that sent you for a sleep study in the first place.

[kteague]

I wouldn't want to use cpap if it wasn't needed, so I understand you wanting to know if other measures could help enough to not need the machine. It's hard to know the answer to that without being tested while side sleeping exclusively. Short of that, it's a serious decision to make on a maybe. Your arousals while in REM would concern me. I can testify to the consequences of chronically disrupted sleep. At the very least, a properly adjusted cpap will address your snoring. My snoring was so bad I'd use pap just for the sake of others in the home. Do consider that one night in a study may not be fully representative of your usual sleep when you are at home and sleeping comfortably. What if some nights your numbers are worse? If you were my family member, I would hope you'd continue with treatment for a few months while you are sorting through things. At least then you'd be making decisions with a more rested mind. Sorry to not be of much help. You aren't likely to find many, if any, here who will co-sign not utilizing the treatment. Even if not forever, you know there is some benefit so why not see where this can take you. You might be pleasantly surprised.

[slowmo2000]

Thanks Ozij. Let me try to provide more context/thoughts

I guess what I'm confused by is the lack of measured obstructive apenas and o2 desaturation. Said another way, I understand that reras and hypopneas may be creating some sleep fragmentation but the reality is the everyone has these (obviously not the same degree) and I'm not sure my symptoms are aligned with the need for treatment.

Ultimately, I'll go back to my doctor to discuss all of this but I do get the sense that I'm putting a lot more thought into this than the doctor I'm working with.

What you're really saying is:
I prefer to treat the issues that sent me to a sleep test in the first place with any means but a CPAP. " I'm not sure my symptoms are aligned with the need for treatment."

I initially did an in-home watchpat study (didn't engage a doctor) out of curiosity to see if I have any sleep issues. I've used an Oura ring and Fitbit for many years to track my sleep and was curious to see what it would come back with. My average sleeps scores on Oura have been above 80 for over three years so I assumed the study would come back with no issues. When it did, I was really surprised and engaged a sleep doctor.

My goal is to use the most minimally invasive way of treating my sleep issues. I've continued to use my CPAP and have adjusted really nicely - AHI's are down and I don't really notice the CPAP while sleeping. My subjective sense is that the quality of sleep I'm getting is quite good (I feel great), though I do notice I'm sleeping less (~7 hours real-time and about 6 hours on Oura/Fitibit with lower sleep scores [75]), but I feel pretty good so I'm not that concerned about the Oura scores.

I'm going to try a few different ways to treat my apnea and will go with the treatment that I find is the best fit for me, which may end up being CPAP. I plan to test the iNAP (once adjusted) with watchpat to see what my AHI/RDIs are. I realize this isn't the same as daily numbers from a CPAP machine but I may end up doing a few studies just to make sure efficacy is there.

I only want to focus on desaturation and measured obstructive apneas, all else is irrelevant " I'm confused by is the lack of measured obstructive apenas and o2 desaturation"

The "all else" has never sufficiently explained to me. Would love details - perhaps you previously shared in that study link and I missed it?

I don't care about breathing problems disrupting my REM sleep, because "the reality is the everyone has these (obviously not the same degree)"

I absolutely do care about breathing problems - that's why I did the watchpat, in-clinic study, and am figuring out the best therapy for me Again, the reality is no-one has completely stable breathing at night and there's a point at which breathing issues are clinically significant. There are standards that the medical establishment has created and I'm not saying they're wrong but if you look at the strict definitions of those standards, I'm right on the border of diagnosis (I know you previously highlighted my REM numbers but I don't believe REM numbers are what's used by the medical establishment to diagnose patients).

Whether your statement about "reality" is true or not, you decision that there is no need for treatment because the disruptions (as you understand them) are prevalent is the equivalent of reading the following "Fast Facts about Diabetes" and deciding not to treat it because it's so prevalent.
https://www.cdc.gov/diabetes/data/stati ... index.html

Thank you for sharing this! Very helpful context.

And my doctor won't convince me either, because I do get the sense that I'm putting a lot more thought into this than the doctor I'm working with

I make decisions based on explanations. Unfortunately, my doctor is super busy. I didn't mean throw a jab about the thought he's put into my situation - I guess I just wish he had a bit more time talk me through all of this.

You don't need our help. You don't need to waste your time with a doctor who is not giving enough thought to your problems. You do need to dig far deeper into available info on sleep and its stages, the effects of sleep fragmentation on health and daily living.

I would love to do this. Can you provide details.

And maybe you have to ask yourself why you want to look for another solution so badly.

Whatever it is - it's a lot of work you have to on your own.
Do whatever you have to do to treat whatever it is that sent you for a sleep study in the first place.

I'm very early in this journey and appreciate the help of this forum and members like you.

[chunkyfrog]

slowmo2000

Go with ozij's explanation and not Vako's loose comment. It's unclear why Vako is here. She's certainly not trying to help anyone.

Indeed.
Ozij has been on the forum since 2005--Vako just a WEEK!
Experience makes a huge difference.

[ozij]

You don't need our help. You don't need to waste your time with a doctor who is not giving enough thought to your problems. You do need to dig far deeper into available info on sleep and its stages, the effects of sleep fragmentation on health and daily living.

I would love to do this. Can you provide details.

It's called SDB, Sleep Disordered Breathing.

Use scholar.google.com for details.