Understanding AHI Confusion

[SoarHigher]

Just checking my semi- newbie knowledge with experts. I had a bad recorded night last night and with deep sleep thought my AHI and apneas would be OK, however the AHI reading 4.5 wasn't bad but I had unusually high OA of 14 and total Hypopneas of 19 with 98% mask leakage. My question is: Did the machine treat these high obstructions and allow me to breathe with an open airway, or does this mean that 14 and 19 respectfully were untreated and oxygen was not getting through that many times during the night? I understand the recording is made if there is 10 seconds or more with compromised airway open. For some reason my mind went confused on this even after 5 weeks of doing this. I usually am below 5 AHI but this was the worst night with the recordings in 5 weeks for me, and I actually thought I had slept well.
Thank you for your thoughts on this or anything related.
PS: My Dream station auto is set at 7 - 10, with full face Resmed AirFit F10 + heated humidifier

[palerider]

Just checking my semi- newbie knowledge with experts. I had a bad recorded night last night and with deep sleep thought my AHI and apneas would be OK, however the AHI reading 4.5 wasn't bad but I had unusually high OA of 14 and total Hypopneas of 19 with 98% mask leakage. My question is: Did the machine treat these high obstructions and allow me to breathe with an open airway, or does this mean that 14 and 19 respectfully were untreated and oxygen was not getting through that many times during the night? r

an ahi of 4.5 is pretty crap, in my book.

as to your question, what's logged is what happened, the machine can't log prevented apneas and hypos, because there's no way to know you would have had one, but didn't. does that make sense?

[SoarHigher]

I understand the recording info but were they treated by the machine satisfactorily or no?
Thanks for your response.

[ChicagoGranny]

were they treated by the machine satisfactorily or no?

They were treated, but not successfully.

[Pugsy]

If an apnea event is recorded/flagged then it means it slipped past the defenses. The machine does it's best job in preventing...not in trying to fix something after it has happened. It can't/won't give a person a burst of pressure to blow past the obstruction. It sits patiently waiting for the obstruction to go away and then depending on the machine's settings it may learn something so that it can do a better job should the same situation happen again.

It doesn't "treat" an apnea event that slips past the defenses. Now it will try to prevent further apnea events slipping past the defenses but once an apnea event happens (comes and goes) it done and over with unless someone is using auto adjusting pressures and if they are then the machine will learn from those apnea events and in conjunction with other signs of airway collapse it may try to increase the pressure in an effort to prevent those apnea events from happening again.

[SoarHigher]

So Pugsy, if my auto cpap machine dream station is set at 10.5 max and the 90% is bumping up against that pressure once in awhile but not every night, where should it be generally set to allow better coverage of the events? I increased my settings from 9 to 10.5 and it just seemed as though it continues to want to rise and I get more leaks which are affecting the AHI and my sleep as well. 10 or under I sleep and with less leaks and for the first 3 weeks of my therapy, I had better results all the way. I read your postings for everyone to read and saw that sometimes how you feel is more important than the AHI score but I am concerned about the rising Obstructions and Hypos and whether I am getting enough oxygen through the night. I do not have the ramp feature nor the flex feature set to run on my machine. I see the Dr in about 3 weeks so he might opt for another sleep study if it continues.
Thanks for the clear info.

[Pugsy]

In most situations it is the minimum pressure that is doing the job of "preventing" not the maximum.
If it were the maximum then people could set it at 4 min and 20 max and everything would be all hunky dory for everyone but it doesn't work that way.

The minimum pressure must be close enough to where the machine needs to go and get there in a timely manner in order to prevent the airway from collapsing and it can't get there in the blink of an eye. Instead the machine's use an algorithm based on apnea events, snores and flow limitations to help it decide where it needs to go and how fast it needs to get there. We have to help it out with the minimum so that how fast it decides to go is a doable effort.

Sometimes using more minimum can create more problems (comfort, aerophagia, leaks, etc) than the maybe a little bit higher than we want to see AHI is causing so we have to make a compromise.
Without seeing your reports it's difficult to make any specific ideas. If it's hitting the maximum...we need to look to see how often it hits the maximum and how long does it stay up there and are those events you see flagged happening when the maximum is being hit or are those events being flagged at some other time.
If the maximum is being hit and pegged out for quite a bit of the night then more maximum might help but if those events are happening at other times when the pressure is less than the maximum then more maximum isn't going to help. That's where more minimum becomes really important.
More maximum also will increase the chance of aerophagia, comfort, and leak issues.
Nothing is ever totally free. We have to pay for everything in one way or another.

If you are seeing clusters of events at the same time the max is being hit...then by all means open up the max and see if it helps or not. But if you are seeing clusters of events unrelated to the time frame where the maximum is being hit then more minimum is what is needed.
Up to you if you decide the AHI reduction is worth whatever you have to pay to get it done.
Given a choice between sleeping great and feeling good with an AHI of 4.0 and having an AHI of 1.0 and sleeping poorly because of leaks or comfort and thus I feel like crap during the day...I will take 4.0 any day of the week.

[SoarHigher]

Pugsy, Thanks for your time in answering this basic question without the graphs. . . and thanks for your clear explanation of what is going on. I am still working on figuring out the sleepyhead software and inputting my data from the machine to sleepyhead. I see there are a lot of posts about sleephead and how to interpret so I have hit the "Mother Load." I live in Texas but was born in Missouri, your "Show Me" State, and taught school in the Ozarks for many years so guess I still am a visual learner and have "to be shown." Have a great day.

[englandsf]

With 98% leakage would the data have any meaning any way?

[Pugsy]

To post the images of your reports you first need to master screen shots.
Then you have to master uploading the images to some place where we can see them.
For right now don't worry about mastering the organization of the graphs part.
Too bad you aren't still in the Ozarks...I could come over and show you how it's done and I do understand that sometimes it's easier to learn if we see the process done right in front of us. I am the same way.

But you can still evaluate your own graphs...look at the pressure graphs and the events graph and if you are seeing clusters of events then look at the same time frame on the pressure graph and if you see the maximum being maxed out...then increase the maximum.
If you don't see it being maxed out then try a small increase in the minimum. Sometimes just a tiny increase will make a big overall difference.

[palerider]

I understand the recording info but were they treated by the machine satisfactorily or no?
Thanks for your response.

machines don't treat apneas, they attempt to prevent them. if they prevent them, there's nothing to log, if they don't get prevented, then they're logged.

[Pugsy]

With 98% leakage would the data have any meaning any way?

I am pretty sure that 98% number means 98% if the time no large leaks and only 2 % of the time in large leak.

What is being reported and the manner it is being reported sounds like either DreamMapper report or the data on the LCD of a Respironics machine.

Mask fit from the DreamStation machine reports is % of good and not % of bad.
Leaks aren't an issue in this situation. 2% of a night in large leak isn't a big deal.