Should the goal be a low AHI, or to feel good?

[LoQ]

She then used the SD card and did a download and from that information said I should be feeling "normal".

One thing that is clear -- she is an idiot, just as you said. If you should be feeling better, why don't you? Her answer sounds like she is trying to imply that the problem is psychological. Perhaps she doesn't want to deal with a patient whose problem is beyond her ability to understand, much less solve, so it is convenient for her to put up a wall.

I believe that you have a genuine problem. I think you need to continue CPAP therapy. It may be that you will feel better only after several months of treatment. It may be that there are still things you need to discover to make it all work for you. All I can tell you at this point is that you have my complete empathy, and hang in there. I am so sorry you are not feeling better yet.

[dreamyenner]

For what it's worth, I refused the Ambien my sleep study doc wanted me to take before my titration study; I personally don't trust heavy duty drugs like that which can have such powerful side effects in some people. I took valerian for the study instead. (Had previously & occasionally taken melatonin @ around .25mg, if I remember right, but that still made me feel sedated the next day.) I had learned of these two natural sleep aids from Andrew Weil, the integrative medicine doctor: http://www.drweil.com/drw/u/ART02004/insomnia

Try searching "taper Ambien"; here's one: http://www.talkaboutsleep.com/message-b ... p?p=130506

[M.D.Hosehead]

"Sleep architecture showed a sleep efficiency of 85.3% with total sleep time of 5 hours and 36 minutes. 16.8% of the total sleep time was spent in REM sleep, but no slow wave sleep was seen

It's not a mystery why you feel like crap; you don't get enough sleep, especially deep, slow wave sleep. The mystery is why O2 makes you feel better. It's no surprise that it's beyond the competence of an RT to figure out such an unusual picture.

Maybe an experienced pulmonologist-sleep doc could help. It's certainly better to have a doc on board.

But suppose no medical doctor can offer an explanation, you're still left with your original question (is the goal low AHI or symptom relief). I agree with LoQ that your own sense of whether you feel healthy or not is a valid indicator; I would use the O2. There's an aphorism "Treat the patient, not the lab value." I think that applies in your case.

Possibly, if you get along with O2 while you must, you may learn about some new science that offers an explanation down the road.

[ldj325]

But it seems that the key issue is not AHI levels, per se, but oxygenation levels that are important. The only importance of AHI is that it tends to be some indication of oxygenation levels.

The real issue is how much oxygen my body is receiving

Au contraire, mon ami. There can be lots of sleep disruptions that prevent you from having restorative REM sleep but which do not affect your oxygen levels. That can leave you feeling exhausted every day. I suspect that possibly some people's bodies sense a reduction in oxygen before the SpO2 is lowered, and that causes a responsive stir to eliminate the reduction. THAT kind of arousal keeps oxygen levels good but causes sleep disruption, preventing restorative sleep.

This may be frh's problem. His system may be very sensitive to small changes in oxygen level that are small enough to not register as a "dangerous" reduction in oxygen (according to medical texts) but that cause an arousal preventing good sleep. Adding oxygen to the system may be working for him because it reduces his "sensitivity" by raising the bar for arousal. I hope that makes sense.

And what about PLM? People who have that can be VERY fatigued because their sleep was not restorative, yet it has nothing to do with their oxygen levels.

Point taken about deeper stages of sleep and unclarity of how that relates to oxygen. I was more relating to what was being posted here. Your post also brings up one of the fallacies of going by the numbers. Somewhere in the past someone(s) decided that the criteria number-wise for apneas and hypopneas and then further decided on averages that they considered acceptable for the general population. Maybe those numbers are statically pretty good for the population, but they can be far off from being optimal for an individual. I suspect for all of us that our true optimal range is much smaller than the generally accepted numbers. Case in point (and I suspect this is still on the "gross" level), an AHI of 5 or below is considered normal. But I (and probably many of us) sure feel a lot different when I've had a night of AHI below 1 than a night of around 5.

It is OT but this principle is a major factor in lab blood work values/ranges.

As for me, I've more and more started getting into the "guts" of my ResScan 3.11 data to try to spot some of these factors, frequent 6 second "apneas" being one example of something that goes unreported/unflagged but might have significance if there are enough of them.

[SleepingUgly]

Which version of Ambien are you on, immediate release or the CR? How many mgs do you take? Did you have the daytime sleepiness before you were Ambien?

Did you have the Nissen?

[frh]

Which version of Ambien are you on, immediate release or the CR? How many mgs do you take? Did you have the daytime sleepiness before you were Ambien?

Did you have the Nissen?

1. Regular 10 mg. I'm in the hospital and can't type an adequate answer on my pda right now. 3. Yes.

[SleepingUgly]

When did you go on Ambien relative to when you started CPAP? Have you been off the Ambien and did it make any difference in how you felt during the daytime? (after a few days of washout)

You can respond when you're out of the hospital--I hope the procedure went well and you aren't in too much pain.