Do you get to point where you just accept a high AHI?

[detcord]

Hello all and Happy New Year. I have been on APAP since April 2010, and adjusted immediately to the machine. Because of insurance co policies, I had an in home test, and no formal titration. I was sent home with my machine, a PR System One APAP, set wide open. My 95% setting settled at 18, and I have set my machine from 16.5 to 20. I current use a Mirage Quattro, although have used an Ultra Mirage II nasal mask and the Swift FX. I do have the software and daily monitor my sleep waveform, and data. I sleep a good 8 hrs at night, and wake up OK. I feel generally good during the day especially if busy. If stuck at the office behind the computer or at home, I still get somewhat sleepy at times. My AHI was 59.5 at my test, so I know that the therapy is working, but my AHI right now stays between 5 and 7, with very occasional dips into the 4's. I try to maintain the same sleep hygiene patterns, so don't know why the changes. My leaks are OK according to my data as well. Should I just accept that this is what I will have from therapy, or should I still work to achieve lower AHI's. At this point I really don't know what else to try.

[chunkyfrog]

I have to think not, but I will defer to others smarter than me.
In the meantime, hang in there.
Be ready to pony up with more info--if asked. It could help.
Let us help you through this.

[Gerald]

There are those who don't agree with me, but I believe that an AHI score of 2.5 or below should be your goal.

The medical business says that anything below an AHI of 5.0 is "OK", but my experience has found that this opinion is not valid.

There are a couple of things you can do: Purchase the Encore Viewer software that works with your CPAP machine so that you can generate reports that'll help you see where you can improve.

Also, you can purchase a recording oximeter that'll act as a "cross-check" to determine the effectiveness of your CPAP therapy. Sleep Apnea is simply "suffocation"......a lowering of the O2 levels in your bloodstream. The oximeter will help you see when your O2 levels are dipping below 93%....and that'll give you clues as to what you can do to improve. The oximeter I use has good software that generates very useful charts. Here's the link to the oximeter. http://www.turnermedical.com/SPO_PulseO ... imeter.htm

Using both CPAP software....and Oximeter software will give you a depth of understanding that is unobtainable except by having a "sleep center sleep test". By running your own sleep test....in your own bed....every night for a few weeks...you'll improve your AHI score more easily than you suspect.

[mayondair]

I agree with Gerald, I felt better after getting my ahi below 2 or 3 most nights, it did take a bit of tweaking. Your pressure is certainly high, maybe an auto bi pap trial? Just a thought. Pulse ox sounds like a very good idea, I don't think I'd accept a routinely high AHI

[robysue]

I do have the software and daily monitor my sleep waveform, and data. I sleep a good 8 hrs at night, and wake up OK. I feel generally good during the day especially if busy. If stuck at the office behind the computer or at home, I still get somewhat sleepy at times. My AHI was 59.5 at my test, so I know that the therapy is working, but my AHI right now stays between 5 and 7, with very occasional dips into the 4's. I try to maintain the same sleep hygiene patterns, so don't know why the changes. My leaks are OK according to my data as well. Should I just accept that this is what I will have from therapy, or should I still work to achieve lower AHI's. At this point I really don't know what else to try.

You say you have the software and you have data and monitor the wave form every day. But the data from your machine is only part of the story: Now you need to start analyzing it. You may need to keep a "sleep journal" that also keeps track of the basic things going on in your daily life that could affect the quality of your sleep each night. These include a number of lifestyle variables as well as the sleep hygeine stuff.

So what does your data tell you? Have you started analyzing to figure out what's different on the days when your AHI is better than normal? And what's different on the days when your AHI is worse than normal?

On an average day are you having mostly short or long events? Or does it seem really random?

Do your events typically occur in nasty clusters? Are there some relatively long event-free stretches each night?

Can you tell if there's something different about the occasional nights that are better with the AHI's below 4? Such as an earlier supper? Or maybe no alcohol at dinner? Or maybe no late night caffeine? Anything remarkably different about the nights where your AHI is closer to 7? Bad hay fever? Bad head cold? Bad day at the office?

And if you haven't spoken with your sleep doctor since last spring, you might also want to call his/her office and let them know that your AHI numbers are still running pretty consistently above 5 and see if they have any concerns about the situation and any suggestions for you to try.

[jules]

Did your home study separate centrals from non-centrals? Does your current software do same?

Some will never get an AHI that is super low because of residual centrals that are not being treated with a standard machine.

Get a copy of the home study, read it and start asking questions both here and to your medical providers.

[KimberlyM]

Did your home study separate centrals from non-centrals? Does your current software do same?

Some will never get an AHI that is super low because of residual centrals that are not being treated with a standard machine.

Get a copy of the home study, read it and start asking questions both here and to your medical providers.

That is my situation. I always have an AHI of around 5 or 6 per hour, but it is because most of them are sleep onset centrals.

[dtsm]

I'm only familiar with ResMed models and until the S9 version was released, the proverbial wisdom says that Hi are overstated and should be cut in half when determining the 'real total Ahi'. So, if you're Hi were 6 and ai were 2, your total ahi would be (6/2=3) + 2 = 5. With my ResMed S8, on apap, my Ahi fluctuates between >2<5 but have been able to maintain my Ai at the 1 level. Plus I sleep through the night, and feel infinitely better since I started therapy. In fact my first year anniversary is coming up in a week!

In your case, does the software distinguish btw hi and ai? Also, Gerald's suggestion on the oximeter is the same he gave me when I first started, and a good one.

Bottom line, if you're in the range, feeling good and your oximeter readings confirm solid >95%, you're in the zone!

Happy new year.

[Goofproof]

I shoot for under AHI 2.0, and get it. You need the Software, and keep your avg leak rate under 40 LPM,(I use 35 to 38 @ 15CM) as my guide, if I had a mask that didn't meet those specs, I'd trash it. With a FF mask I can do even better, but for the most part I use a nasal mask. Some masks out there have a leak rate that is too high to buy, in my oppinion, so I don't. Jim

[rested gal]

I do have the software and daily monitor my sleep waveform, and data. I sleep a good 8 hrs at night, and wake up OK. I feel generally good during the day especially if busy. If stuck at the office behind the computer or at home, I still get somewhat sleepy at times.

----


My AHI was 59.5 at my test, so I know that the therapy is working, but my AHI right now stays between 5 and 7, with very occasional dips into the 4's. I try to maintain the same sleep hygiene patterns, so don't know why the changes. My leaks are OK according to my data as well. Should I just accept that this is what I will have from therapy, or should I still work to achieve lower AHI's. At this point I really don't know what else to try.

If you generally feel good, I wouldn't worry about trying to lower the AHI. A lower AHI might, or might not, make a difference in getting somewhat sleepy sometimes during the day.

Gerald's suggestion is a good one -- using an oximeter to check to be sure your therapy is keeping your O2 levels up nicely at night.
If it is, then I'd be satisfied with your usual AHI. Could be some perfectly normal sleep onset centrals, or occasional centrals when you turn over in your sleep, that are adding a little to the AHI. Main thing, imho, is that you "generally feel good during the day." That, to me, says your therapy is going well enough to be satisfied with the AHI the software is reporting.

[Cuda]

Never settle until you know for a fact you have done everything that can be done.