don't worry to much about AHI and AI

[christo]

Hi

Came back from the doctor as a follow-up appointment. I have been on CPAP for 4 months now. I have a mild form of sleep-apnea that does not affect my blood oxygen saturation. In my case he said that I should stop monitoring the AI and AHI numbers for the time being. He gave the following reasons that I understood this way:

1)The AHI and AI numbers the machine outputs are not completely exact and should be taken with a grain of salt. A correct measure of the AHI for instance also takes into account a drop of oxygen in the blood.

2)Sleep is a very evasive thing, the more you think about it, the more it becomes harder to do. Consequently he told me to stop worrying about any numbers related to measuring sleep (e.g AHI, AI and hours of sleep) and just going with how I feel.

He also gave me a few interesting pointers that I want to share

1) Only use your bed for sleep and intimacy
2) Always wake up and get out of bed at the same time every day (even on week-ends)
3) Avoid naps (although if practiced before 6:00 pm for no more than 1 hour, they can be quite healthy)
4) Before going to bed, take a hot bath or a cold drink to decrease body temperature
5) Melatonin can be a good sleep enhancer, take one 3mg tablet at 6:00 pm and then one hour before going to sleep
6) Avoid bright lights, computer screens and TV's after 7:00 pm
7) Try to manage the stresses in your life.

He also told me that the effects from long term sleep deprivation are reversible.

Thanks,
Christo

[Julie]

Hi, you have a very thoughtful and basically good MD, but I would like to just mention something. He told you not to nap, which on the surface sounds like a good idea (if you have insomnia, for instance), but recent studies have shown that for people with OSA taking naps can be really important for your heart, especially if you have trouble, like a lot of us, getting many hours of sleep at a time, regardless of when we go to bed. If you normally do get enough, that's great, and feel free to ignore me , but if you find you're not getting enough hours, then maybe reconsider what he told you. It's a good idea, in fact, if you can manage it, to get some sleep whenever you really feel the need, and always with your machine, of course. Also, Melatonin works for a lot of people (I though it was terrific years ago when I tried it), but not for all (after a while I found it was messing with my life in various ways, long before OSA became a factor BTW. Anyhow, just my 2 c's worth here, but thought I'd mention these things.

[christo]

>but recent studies have shown that for people with OSA taking naps can be really important for your heart,

Yes my MD told me that there is a big caveat to put around the no naps rule mentioning that if practiced before 6:00 pm or 7:00 pm, they can be quite healthy and improve cognitive functions. He made an analogy with having a snack. Just like having a snack right before a meal, ruins the meal; having a nap close to your regular bed-time may make going to sleep difficult.

>Also, Melatonin works for a lot of people (I though it was terrific years ago when I tried it), but not for all (after a >while I found it was messing with my life in various ways,

Yes, he said that every person is different, some people don't produce enough or produce it at odd times during the day, it may help but it's not magic.

What really struck me with the conversation is that a sleep problem should not be treated as a problem. This is counter-intuitive, we are trained that to solve a problem we must think and ponder about it. He mentioned that when it comes to a sleep-problem, the more you think about it, the harder it will become to solve.

Love your 2c
Christo

[Wulfman]

"Worrying" about something is not necessarily the same as "paying attention" to something. It's true that the data gathered from a CPAP machine is based on air flow and can be deceptive at times.....but it IS pretty accurate when you're asleep. Paying attention to things like "leaks" and the rest of the data in a relative context can also go hand-in-hand with "how you feel". If the numbers aren't good, your blood oxygen is probably desaturating. If you're not getting enough sleep, you're not going to feel well rested, either.

Some doctors' advice can/should be taken with a grain of salt, too.

Den

[Gerald]

Christo........

If you are a "sane" person.....intellectually honest....curious.....problem solving....experimental......your doctor's opinion about "not watching your AHI and AI numbers" is what eminates from the south end of a bull.

If....on the other hand....he knows that you're looney......that you are not intellectually honest.........then, what he says is just fine.

Personally, I don't think you're looney......and I can read between the lines pretty well.

I told a pilot-friend of mine yesterday...that operating a CPAP machine without software....is like flying VFR in broken clouds and fog. He completely understood what I meant. My friend also owns a recording oximeter.......and he thought he wouldn't have to bother with the CPAP software generated reports......that he could get the data he needs from his oximeter. However, he needs both of them....because they look at the sleep apnea problem from two different directions.....pressure variations.....and O2 saturation variations.

Your doctor is comfortable with the average......at least partly looney......customer. The fact that you're here....learning everything you can....as fast as you can....means that you're different....and you don't fit in his standard mold.

Take charge of your own therapy. You can do it.....and it'll be better than what you can buy from him.

Gerald

Gerald

[christo]

I am not really interested in starting a flame war and I am just conveying what has worked for me. Every person is different and every therapy should be curtailed to a person's need.

In my case, according to the machine (ResMed Elite II), my AHI was over 7. However two sleep studies in a sleeping lab told a much different story, the AHI that takes into account the arterial saturation was 0.3 and another measure more relevant to my problem called the (Respiratory effort-related arousals) RERA was 27.2. The lowest arterial saturation level was 94%.

I find the advice of not being two concerned with the AI and AHI numbers of the machine, worked for me. That is
not checking them first thing in the morning when I wake up. This does not mean not taking charge of your therapy or completely ignoring these figures. It meant looking at my sleeping problem in a different light, adopting a new attitude.
Essentially not wanting it to go under 5 too much. It helped me relax and paradoxically, after adopting this new attitude, when looking at the AHI on the machine for the average week, it has decreased to under 5.

I think this advice is particularly relevant for people who suffer a mild form of sleep apnea where the machine tells them they should worry because the AHI is around 6 or 7. Quality sleep is an evasive thing, if you want it too much it will be harder to get.

[DreamStalker]

So are you measuring your O2 at home with an oximeter? ... a one night lab study is hardly representative of your actual condition at home each night.
How is your blood pressure? ... Do you monitor it enough to know (morning before you get out of bed, mid-day, and night right before bed)?
How are your cholesterol levels? ... LDL, HDL, triglicerides?
Are you overweight or obese? ... or within a normal BMI?
Is your heart in good health? ... Have you ever had it checked out by a cardiologist?
Are you diabetic or do you have pre-diabetic symptoms?

If all the above answers are favorable from a health standpoint, then your doctor's advise is fine for addressing "sleep" as your only problem ... otherwise his advice should be taken with a grain of salt

[christo]

>So are you measuring your O2 at home with an oximeter? ... a one night lab study is hardly representative of your actual >condition at home each night.

I am not measuring my O2. I actually had two sleep studies. Both have confirmed a healthy saturation level.

>How is your blood pressure?

Always pretty much within the acceptable 120/80

>Are you overweight or obese? ... or within a normal BMI?

BMI is 24, not overweight or obese, maybe some love-handles here and there.

>is your heart in good health? ... Have you ever had it checked out by a cardiologist?
>Are you diabetic or do you have pre-diabetic symptoms?

My family doctor (who is not my sleep-doctor) has not reported anything out of the normal.

>If all the above answers are favorable from a health standpoint, then your doctor's advise is fine for addressing "sleep" >as your only problem ... otherwise his advice should be taken with a grain of salt

I think this may be a size-able portion of the people who suffer from sleep-apnea and who are otherwise generally healthy. In my case, monitoring the machines AHI and AI needed to be relaxed a little. It was for me excellent advice...

[billbolton]

my problem called the (Respiratory effort-related arousals) RERA

Since you are not suffering from OSA, it would have been useful to state that right up front.

• A RERA (Respiratory effort-related arousal) is defined as an arousal from sleep that follows a 10 second or longer sequence of breaths that are characterized by increasing respiratory effort, but which does not meet criteria for an apnea or hypopnea. Snoring, though usually associated with this condition need not be present. Respiratory effort is measured via esophageal pressure monitoring. Where esophageal pressure is being monitored the pattern is one of progressively more negative pressure terminated by a sudden change to a less negative level and an arousal. An alternative to esophageal pressure monitoring is the use of nasal pressure signal with progressive inspiratory flattening followed by an arousal. RERAs have the same implications for sleep fragmentation and consequent daytime sleepiness as do apneas and hypopneas. Some patients who have symptoms suggestive of OSA have few apneas or hypopneas on polysomnography, but frequent respiratory effort related arousals to which their clinical presentation can be related. This condition has been termed Upper Airway Resistance Syndrome

[christo]

>Since you are not suffering from OSA, it would have been useful to state that right up front.

As I mentioned in my original post, I suffer from a mild form of sleep apnea that does not affect my blood saturation level. The exact term is Upper Airway Resistance Syndrome and it's bad. It requires a CPAP. If I don't sleep with CPAP, I just can't function or concentrate. After a while it will affect your heart condition and it is the same as being sleep deprived for days or years. Like being permanently mildly drunk. I remember being in a meeting at work and wondering to myself "why am I not understanding anything these people say".

I would guess it is also under-diagnosed or misdiagnosed. One doctor to whom I clearly stated I had sleeping problems prescribed me anti-depressant!!! I had to really fight to get to a sleeping lab. This is probably a significant size of cpap users, worried by a machine that tells them that the AHI is over 5 and wondering why the sleep study tells them differently. If there is a mistake somewhere... I also had to take the initiative of getting my sleep lab report.

[OldLincoln]

If you do not take sleep meds and are groggy on the mornings you don't use CPAP, there is a fair chance that you are slipping lower in O2 than you think. Studies only measure a point in time and that is in an odd setting. I know for me my body does not really relax and goes into combat sleep mode where part of me is on guard.

I agree some can fixate on numbers and others let their body determine success by how they feel. However I do suggest you get (rent?) a recording oximeter and use it to confirm your belief that your O2 levels are OK. Your statement of "Like being permanently mildly drunk" sure sounds like O2 issues (that's what being drunk is about), so I really suggest you check it out.

I really hope your condition is as you believe because it should be much easier to live with than the more serious OSA mostly discussed here.

[christo]

>However I do suggest you get (rent?) a recording oximeter and use it to confirm your belief that your O2 levels are OK.

That's one thing I was wondering, however the sleep doctor did not think it was necessary. But I will certainly check this on my own. Not sure if I should test O2 levels with or without the CPAP.

[DreamStalker]

>However I do suggest you get (rent?) a recording oximeter and use it to confirm your belief that your O2 levels are OK.

That's one thing I was wondering, however the sleep doctor did not think it was necessary. But I will certainly check this on my own. Not sure if I should test O2 levels with or without the CPAP.

Well if you feel comfortable and secure trusting your doc "completely" with your life (not necessarily a bad thing if you have a good doc), by all means listen to your doc instead of us. Most of us are on this forum for a reason ... our docs failed us in one way or another (trust or adequate treatment/advice or some other thing). No need to ask us for advice or comments if you insist on completely trusting your doc.

May you decide to check you O2 levels ... do so under normal or typical sleeping conditions for you for at least a week and perhaps even with and without CPAP (a week for each).

[Goofproof]

I think I'd wear high top boots when I visited that Doctor, and nose plugs. So basically you don't have Sleep Apnea, and you just like giving him money for advice. Jim

[oh_possum]

It sounds to me like your Doc is coaching you to improve sleep quality and delayed onset. It reminds me of some of the ideas from Sound Sleep, Sound Mind by Dr. Krakow. I think your attitude of monitoring your progress without stressing and without checking numbers every morning is probably exactly what your Doc had in mind. I think he/she is right that for many, the less you think about sleep while you are in the bedroom, the better your sleep will be.