Switched machine to APAP from Cpap

[river_terror]

Need some advice. I'm new to the process, been on cpap for 3 weeks. In the sleep study I had an AHI of 34. In subsequent study at 12cm Ahi went to 1.2 . Started off pretty rough trying to get use to the mask. Perscription was for 13 cpap. Had trouble adjusting to the pressure and had leaks of .1to .4 with AHI range of 1 to 4 over 2 weeks of time.

For the last few nights I changed to APAP pressure setting of 8 to 13.

Two weeks CPAP pressure 13: AI=0 HI=1.3 AHI=1.3 Leaks=.22
3 days APAP pressure 8-13: AI=.1 HI=1.6 AHI=1.7 Leaks=0

I'm sleeping longer and waking up less under APAP. On the down side, my AI's were at .1, 0, .2 on APAP when they use to be 0 on the CPAP . My question is do you think it's ok to stay with APAP or could it be screwing something else up I'm not aware of? Do you think my pressure settings are ok? DO I need to work on getting the AHI to 0? Any thought would be appreciated, I'd be lost without this forum. As I learn I hope I'll be able to contribute.

[gasp]

Others with more knowledge will probably reply, however here's my two cents.

First of all, I'm a fan of using the body to tell if it's getting good therapy. If you more well rested and feel better, then given the numbers are still really good I'd leave it on APAP.

Secondly, it would take more data comparisons to draw the conclusion that APAP results in higher numbers (IMHO). Just normal variation between nights can cause a small data variation.

By the way, what exhalation relief setting did you choose, 1, 2, or 3?

[Wulfman]

It's YOUR therapy......and only YOU will know the answers to your questions.
AHIs will (probably) be higher with an APAP because there have to be "events" that cause it to change pressures. Some of those events will be apneas and hypopneas.

However, your numbers on APAP look very good. Hopefully, the pressure changes won't disturb your sleep.


Den

[rjjayrt]

Numbers were ok with both methods. Guess it depends on how you feel, use which ever you feel better with.

[LinkC]

I second the posts immediately above. Those numbers are ALL good. And also well within the range of normal variation. For all intents and purposes, they are identical. Go with what is more comfortable and makes you feel better.

[jmelby]

Your AHI on APAP is still very low and your days of sample are not really enough to make a good statistically significant sample. I'd say do what makes you comfortable and as long as you feel it is effective (with whatever daytime symptoms you may have had), you are doing well. If you think you could get your AHI lower with more pressure, try increasing the lower end of the range from 8 to maybe 9 or 10. I've been doing my own experimenting with that, but still get AHI around 2 - 6.

[el_zorro]

I think your numbers are really good for both. The only problem I see with increasing your minimum is that the autoset doesnt have a separate setting for ramp and minimum apap (at least I cant seem to figure out how to do it.) 9 or 10 is sort of high for a ramp start if that matters to you. I have am a CPAP=11 myself and when I use the APAP I have been using 8-11. My AHI has been 1.4 or less on CPAP and 3.4 on APAP. I think I might bump mine up to 12 for the max just to see if it lowers my AHI.

[SleepingUgly]

What I understood from my sleep doc is that we don't know whether there is a meaningful difference between an AHI or 1 or 4.

I thought I read somewhere that an AHI cutoff of 5 was reached arbitrarily. That one big wig in sleep wanted a cutoff of X, another wanted Y, and they compromised on 5. I wish I could find where I read that again... possibly here, not sure.

OK, here is the part where I'm purely guessing: Like most things in life, there is a continuum that ranges from normal to abnormal (at the far ends, we're pretty sure what we're dealing with). Yet for a variety of reasons, such as facilitating communication between professionals and billing insurance, we artificially categorize what are really continuous constructs. We artificially say that an AHI over 5 is a disorder, under 5 is normal. Is there a clinically significant difference between an AHI or 5 and 7? 5 and 3? 5 and 1? (My doctor would say we don't know). Meanwhile, there is huge variability from night to night, in scoring from one tech to another, and from machine to machine and mask to mask. And there is measurement error. When we use numbers, it makes it seem so absolute and so certain, but maybe we should use confidence interval that shows our uncertainty (e.g., "My AHI last night was 4.4 + or - 10, and the odds that tonight will be the same are less than a snowball's chance in hell...).

I hate the ambiguity myself. But what I'm gathering is that once you're in the so-called "normal" range (arbitrarily set at 5), we don't know that there is a difference (more normal?), and a week at a time is the smallest interval that should be examined. That said, I just can't help myself... I'm off to check my daily details...

[LinkC]

No matter where the line is drawn between effective therapy and not, one parameter is clear. The fewer apnea events, the better better off your body is. The long-term effects are cumulative. Thus, ANY event you can prevent is one less O2 desat, one less shot of adrenalin, one step closer to stroke, etc.

My PSG showed AHI=96 untreated. Is 5 better? Heck yes. Is 1 better than that? Yup. Is .7?

Will you live longer with a 2 than a 10. Maybe. Maybe not. The odds would seem better, tho.

The bottom line is, strive for 0.0.; but take what you can get.

[river_terror]

Thanks for everyones feedback. I guess I'll stick with the APAP since I've been sleeping better and not waking up with leaks.