Just wanted to share another little quirk that I have found relating to myself that might ring a bell with someone else.
We hear about AHI less than 5 being the gold standard for therapy results and I just imagine that for many people it is quite sufficient but if you happen to be one of those people who continually get AHI's in 4-5 ranges and still have headaches, other symptoms, or do not notice any improvement, you may need a smaller goal.
Short history for newbies not aware of my previous posts. I am a newbie myself. Initial sleep study showed 11 events per hour in non-REM sleep and 53 events per hour in REM sleep. Oxygen level went down to 73% and averaged in the mid 80%. My initial recommended pressure setting was 8 cm. I am much worse in REM sleep and this is quite common, not a rarity at all. Our muscles relax more in REM sleep so stand to reason the airway muscles also relax and obstruct more. I will not see the full sleep study results and get copies till mid August.
I have changed my original prescribed pressure of 8 cm CPAP (giving me AHI's in the 8-9 range) to APAP 10 min/20 max and it has been this way for a little over 3 weeks. I have had a handful of nights were my AHI was below 3 and with those results I am headache free and feel much better the next day. I have had even smaller handful of nights less than 1 AHI and I feel remarkable on those days. The majority of my nights look like this graph below. In the 4-5 AHI range and again I woke up this morning with my usual sleep apnea headache that goes away in an hour or so.
I tend to have little "clusters" of apnea events and they appear within a time frame where my sleep cycle is likely in REM. Always majority being AI's and much fewer Hyponeas. I don't have an oximeter to judge oxygen desats during these clusters but I would bet money that I desat significantly, hence the headaches. Ozij and I have discussed finding a minimum pressure where I prevent these "clusters". The machine can't seem to respond quick enough to prevent at the 10 cm setting. So last night I increased the minimum pressure to 11cm and will leave it that way for a few days to how things go. If this trend continues I will likely have to increase it a bit more. I don't use the ramp and CFlex is off. The pressure variations during the night do not affect my sleep at all. I never notice them. I don't have any history of centrals and since the machine won't go higher than is needed, I am quite happy with the 20 maximum because when I initially had it at 12 cm, I was maxing out often and allowing too many events. I slept very well last night and didn't have to get up to pee. So while last night's result is good, it could be better because I still had the usual headache today. I have found that along with the headache comes the GERD symptoms during the day. No headache days have given me zero GERD symptoms.
Results below is with using my Swift LT for her nasal pillows and a sweatband used as a chin strap. Leaks are very minimal and snores also minimal so I don't think my pressure increases were chasing ghost events. I do believe they were real. This is why the software is priceless to me. If I didn't have it I would be sitting here wondering why I still had symptoms despite the attained < 5 AHI.
So... while we look at numbers we also have to look at how we feel. I wish I felt remarkably better with this AHI but I don't. I am going to need a lower AHI.
So... for those of you that attain the < 5 AHI and feel much better, that is wonderful. Count your blessings.
For those of you that don't feel so hot, haven't noticed any change with decent AHI's, you need to first evaluate your leak rate. You really need the software to see what happened. And yes, the overall leak rate can give a false sense of being good. One large leak might allow enough events to make you feel like crap but the overall average might not be so bad because you had enough "good" rate hours to offset the large leak. I have seen this very thing often with my own data. Last night's data just happens to have a nice flat leak rate.
Here is last night's data. Almost 6 hours of therapy. Pretty good since I took a Sudafed last night to help with nasal congestion and it does tend to wire me up.
|Machine: PR System One REMStar 60 Series BiPAP autoSV Advanced|
|Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear|
|Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube|
|Additional Comments: Backup machine S9 Adapt|