Acceptable AHI numbers

[Portageegal]

Last night my AHI was 25.6. no leaks. I'm pissed off. Haven't heard anything from the sleep lab and it's been almost three weeks.

[atab]

I have also noticed that my headaches and drowsiness are not directly correlated with my LCD readings. I don't have an oxymeter. May be I will buy one when I feel I can afford it. I just managed to get my ResScan software. Now I see that some of my apneas are long (the number in box) lasting close to 50 secs. I think we can come up with a formula giving more weight for longer apneas to approximate oxygen saturation. Any ideas?

atab.

[El Pap]

In my case, AHI readings at or near zero have been a bad thing -- when I see them I'm almost always tired and groggy the next day. I'm pretty sure those extremely low AHI readings correlate with nights when I don't get enough deep and REM sleep. Most nights I see an AHI a bit over 1, and feel good. On nights that I "sleep in" and get more than 7 hours, my AHI can creep up into the 2-4 range, mostly due to lots of events around dawn, but again I feel rested.

I don't own an oximeter, but I don't think Gerald's guidelines would work for me. I didn't have any significant desaturations even during the diagnostic phase of my original sleep study. And I don't think that there is anything you can buy for home use that would detect the micro arousals that were causing my fragmented sleep.

I try not to overthink my therapy. If my numbers are well under five and I feel good, I'm happy.

[Pugsy]

People without OSA have sleep related issues. Fragmented sleep. Insomnia. Pain that keeps them awake. Limb movement problems. All that comes to my mind at the moment.
These people are going to be tired, have headaches, etc also.

Just because I have OSA doesn't mean I don't have other sleep related issues also... So just because I get a nice OSA number of AHI 2 doesn't mean that I got a good night's sleep and adequate restorative sleep.

I don't obsess over the numbers. They are simply a guideline. Seems like we patients want to have some line in the sand that means we "should" feel the "miracle". Diabetics have the blood sugar levels. So why can't we have a magic number that indicates we made it to that landmark line in the sand? Alas, that is not the case. "Normal" has a wide range in anything related to the human body.

If all we had to fix was the OSA with a mask and a machine, this whole thing would be a walk in the park.

Numbers don't tell the whole story but it is pretty much all we have to work with. Those 40 to 60 second events are going to be hard on the body, even if you only have 3 of them an hour. Most of the time they tend to come within maybe 15 minutes. That is going to hurt the body. Overall number doesn't look so bad but that hour was bad. It will impact how we feel the next day. Not everyone will desat significantly. For those that do, it will explain some of the crappy feelings.

Sure, it is nice to have seen that one night where I had the zero AHI. I know it was a fluke. I didn't experience any miracle feelings the next day. I have other problems sleeping. I wake up often because of pain. I wish that OSA was my only problem. Then those numbers would likely correlate more with how I feel. Best I can say now is that with low AHI I don't get so many morning headaches and I don't have to pee all night long. I still am tired but maybe not quite as much as I was before starting all this.

Use the numbers in conjunction with other aspects of how we feel. Find the numbers that seem to give you the best overall well being feeling. Mine happens to be 1.5 or less. At AHI of 4-5, I feel almost as bad as pre-cpap.
Go figure that one. I compare my numbers to my numbers, not someone else's numbers when judging on how I feel.

[Jason S.]

It seems like the answer to my original post is "there is no one answer". Having low AHI numbers alone may not provide therapy if O2 numbers are low. And low AHI numbers may or may not be associated with feeling good on any particular day. For me, low O2 levels are not an issue, or least not the primary issue for my diagnosed OSA, so I am focusing on AHI.

I guess I'm looking at AHI numbers between 1.0-2.5, which I will take to mean my therapy is certainly at least in the acceptable range.

[Hawthorne]

I think you are doing very well with AHIs like that! That's a very acceptable range! You probably will get some higher than that once in a while (and lower too). Most of us do!

[apnez]

"... low O2 levels are not an issue, or at least not the primary issue for (a) diagnosed OSA..."

The main purpose of the whole exercise is to eliminate obstructions that decrease the 02 level. Good AHI figures is only an indicator that there is lesser obstruction but this doesn't demonstrate that 02 levels are better. We should not focused on intermediary objectives and forget the main goal.

By the way what is an acceptable or good or best 02 level? We never talk about this.

P.S. Portageegal, you have an Autoset machine. There is no reason to have an AHI at level 25 with no leaks! That machine should auto adjust with proper parameters. Even with a vague 8-20 range you should do much better! Give us more details if you need help.

[Jason S.]

... low O2 levels are not an issue, or at least not the primary issue for (a) diagnosed OSA...

The main purpose of the whole exercise is to eliminate obstructions that decrease the 02 level. Good AHI figures is only an indicator that there is lesser obstruction but this doesn't demonstrate that 02 levels are better. We should not focused on intermediary objectives and forget the main goal.

By the way what is an acceptable or good or best 02 level? We never talk about this.

P.S. Portageegal, you have an Autoset machine. There is no reason to have an AHI at level 25 with no leaks! That machine should auto adjust with proper parameters. Even with a vague 8-20 range you should do much better! Give us more details if you need help.

Hey, that is not what I wrote. I noticed you clipped out the "For me" and "my diagnosed OSA" to make it sound that I was making a general statement that O2 levels are not an issue, when in fact I was referring to my O2 levels not being an issue for me.

Next time you quote me, either quote me in full context, or not at all.

[apnez]

Excuse me Jason S.. You are right. I didn't want to cite you or your case. What I considered as particularly interesting for the sake of the discussion was that particular principle this is why I I extracted it. I should have first removed your name out of the citation. I will do it right now.

[robertmarilyn]

P.S. Portageegal, you have an Autoset machine. There is no reason to have an AHI at level 25 with no leaks! That machine should auto adjust with proper parameters. Even with a vague 8-20 range you should do much better! Give us more details if you need help.

I had lots of nights that were in that range when I started 6 months ago. And what I found (and I had some very good suggestions from forum members that helped guide me with my settings fiddling) was that the autoset doesn't/won't respond to a lot of my events. So for me, even if I had my machine set at a spread of, for instance, 10 - 12, the pressure would pretty much just stay a flat line at 10 while I'd be having all those hypopneas and apneas. (And I understand that this might be what it was designed to do for various reasons but that means having the machine set on autoset may not be in my best interests).

So I started trying settings on the CPAP setting and that helped me to improve my results a lot. Along with other things that are being done...this is an ongoing process for me, as I know it is for a lot of us. So what Pgal may need is to try to hone in on the fixed CPAP setting that will work best for her. I also found that using EPR seems to hinder good readings for me. I seem to do best on a fixed setting with no EPR.

mar

[apnez]

You are right robertmarilyn but Portageegal has to start somewhere. A 25.6 AHI is not "normal" for someone on an Auto set machine. Even improperly adjusted lower figures are to be expected and found as a starting point for future fine tuning. Fine tuning will come later when those lower figures will appear. But we first need more details on her situation to start helping her.

[robertmarilyn]

You are right robertmarilyn but Portageegal has to start somewhere. A 25.6 AHI is not "normal" for someone on an Auto set machine. Even improperly adjusted lower figures are to be expected and found as a starting point for future fine tuning. Fine tuning will come later when those lower figures will appear. But we first need more details on her situation to start helping her.

Oh yes, I understand that...my ex doctor started me out on my autopap with a range of 4-20. Who wants to go to bed and not be able to breath at first? I fine tuned it at first by changing it to 8-17 and then was able to narrow the range based readings over the next several months. I would not want to trade my autopap for a straight cpap ever...because with the autopap I have the both a cpap and apap.
mar

[Portageegal]

I called the lab yesterday and they faxed the info to the DME. They called and are sending out a computer card that will change the pressure range. I didn't bother to tell them that I had changed it long ago. It had been 6-14 and with all of your help I changed it to 9-17. We'll see what the doctor orders.

[mars]

At the risk of sounding like a broken record on the subject, I am more and more convinced that the summary index numbers don't mean too much by themselves. I had another example this morning. I awoke well rested and without an alarm and lay peacefully for 10 or 15 minutes enjoying the quiet, the only dark cloud on the horizon the knowledge that sooner or later I would be poked in the ribs and reminded that it was Monday. When that happened, I checked the LCD on the old ResMed and was shocked to see an AHI of 5.5, which is worse than what I've been used to lately. So I made myself even later to work by downloading my data before I left. More than half my hypopneas were in that last 10 minutes or so before I turned off the machine, forming what looked like a continuous line on the 8-hour ResScan graph. I don't know what it means (any interpretations are welcome), but it wasn't really a sleep disturbance because I wasn't asleep. I don't know if it was because my breaths were slow or shallow or what, but what I was feeling was total relaxation. So I'm not going to let that 5.5 worry me, the way I would if a similar patch hit in the middle of the night, raising the suspicion that I wasn't getting good relief during REM sleep, perhaps, or when on my back.

Hi PST

Today I got myself a new Sleep Doctor, and spent 90 minutes with him covering my overnight sleep study and my progress since then.

One of the things he said was that deep relaxed sleeping (with slowed down breathing) ,can sometimes make the machine think these breaths are hypopneas, and will so report them as such.

Maybe your relaxed awakened state mimicked hypopneas, and the machine could not tell the difference.

So again we have another indication that numbers are not the whole story.

cheers

Mars

[mars]

In my opinion, 5 is acceptable ( and that's according the sleep medicine people). An AHI of 3 or under is good and an AHI 1 or under is great.

What Hawthorne says sounds about right to me.

I started off on cpap pressure 10 with 6.2 AHi, and am now on Apap pressure 10-13 with AHi average over the last 44 days of 2.8. So I am pretty happy about that.

I am having some leak problems, probably because I have a full beard, but it looks like my machine is compensating for that. Even so, I am still looking for an improvement, although my Sleep Doctor thinks I should rest content with what I have.

cheers

Mars