Why AHI?

[Mike6977]

.

Post utterly revamped and EDITED FOR CLARITY

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1. IMHO, AHI <5 = great result" is a lazy medical metric.

2. IMHO, Obstructive, central and hypopnea = clinical event of 10> seconds" is rather arbitrary.

Do you agree with the above . . . and what would you propose we use in it's place?


Mike

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Sept 23 DETAILED:

All times deliberately off by 12 hrs: If the time below reads 6 p.m., it was, in fact 6 a.m.




Sept 24 DETAILED:

All times deliberately off by 12 hrs: If the time below reads 6 p.m., it was, in fact 6 a.m.



Sept 24 STAT:



Sept 19 to 24 STAT:




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By AHI standards, I "seem" to be doing quite well.

But look how much sleep I average per night.

It's been this way for the past month or so.



.

[rocklin]

Take my body, Mike6977, just let me keep my avatar.

roc

[BlackSpinner]

Take my body, Mike6977, just let me keep my avatar.

roc

He had it before you and unless that is a picture of you, you don't own it anyway. Get a bit more creative.

[Mike6977]

He had it before you and unless that is a picture of you . . . Get a bit more creative.

Hi BlackSpinner!


Thanks for jumping to my defense, BlackSpinner. No worries, Mike6977 and rocklin are the same person.

Rocklin has been my net-nic ever since I've been on the net. I tried to enter it here when I first joined, but somehow the "process" asked for a different nic, claiming "rocklin" was already in use.

you don't own it anyway

Actually "we" both own a license to the exclusive North American non-profit rights to the use of that image, with an 20 year option to renew.

I have never had to resort to legal means to enforce that license, 99% of the BB members unknowingly "borrowing" it for their own BB avatar respond to a polite request that they cease and desist.


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Original post now edited with all the cardio stuff removed.

roc

[Lizistired]

I think a the total duration of all apneas should be included in the calculation.

[robysue]

By AHI standards, I "seem" to be doing quite well.

But look how much sleep I average per night.

It's been this way for the past month or so.

Since you say these nights are "average", you're trying to function on less than two or three hours of sleep per night---presuming you've got the mask on the entire time you are asleep. And I understand---I really do. Although my "usage numbers" never dropped this far for this long, my own battle with CPAP induced insomnia lead to many months of sleeping less than 5 hours per night with plenty of nights with less than 4 1/2 hours of sleep

So I agree: Technically your apnea is under control---in other words, when you sleep with the mask, you are having very, very few incidents of sleep disordered breathing. But you've got a nasty case of some kind of insomnia going on. Nasty enough insomnia to cause all kinds of problems with daytime functioning and general overall feeling bad.

Some observations and questions:

• On Sept. 23 you slept with the mask on from about 6:30 AM to 8:30AM. What did you do the rest of the night? As in what were you actually doing between midnight and 6:00AM? Bad case of the bedtime dreads? As in you simply dreaded going to bed because you knew you would not sleep? Or a bad case of the time getting away from you because you were actively involved in something interesting enough to keep you alert all night? And did you have to get up at 8:30AM for something like work? Or did you get up because you knew you couldn't sleep anymore?
• On Sept 24 you slept with mask on from about 12:30 AM to 2:30AM. What did you do the rest of the night? As in what were you actually doing between 2:30AM and 8:30AM? Did you lie in bed awake without the mask? (and fall asleep perhaps?) Did you get out of bed? If you got out of bed, what did you do? Get on the internet? Watch TV? Read a book that you couldn't put down? Sit and worry all night about how you just couldn't force yourself to go back to bed and mask up and get back to sleep?
• The summary data for Sept.19--24 shows some serious leaking going on (Median unintentional leak = 15L/m, 95% = 24 L/m). Has Mr. Red Frowny Face shown up on the Short version of the Sleep Quality report at any time? These numbers plus the leak curves themselves point to the possibility of serious comfort problems as being one possible culprit for the ongoing insomnia. More about this later.

So the real question then becomes: Did you have severe insomnia along with OSA before you were diagnosed?

• If yes, then the questions continue: Was the hope that the root cause of the insomnia was the OSA? And that "fixing" the OSA would fix the insomnia? Because in that case it's time to start doing some detective work in figuring out other, alternative causes of the insomnia and an additional way to treat it beyond simply expecting the CPAP to magically make everything better: CPAPs can and do many marvelous things for us OSA sufferers, but they really can't directly address health problems and sleep problems that are not directly the result of our sleep disturbed breathing patterns.
• If no, then the questions continue: Why has starting CPAP triggered the insomnia? Are there specific things about how the machine makes you feel when you are trying to get to sleep or stay asleep that you find phyiscally disturbing or that lead you to become more awake rather than more drowsy? Is the machine waking you up at night in some kind of fashion? Pressure changes? Mask leaks?

If I had to hazard a guess, I'd lean towards saying that mask leaks are a critical part of your on-going sleep problems. It may be that you know (up front) that you may be faced with fighting to get a decent seal on the mask each night and you simply stay up each night until you really can't avoid going to bed. That would explain the very irregular bedtimes on the back-to-back nights of Sept. 23 and 24. Or it could be that every time you finally manage to lie down in the bed with the mask on, the leaks wake you up after a couple of hours. (Dry mouth perhaps. Or aerophagia.) But once you're awake, you realize how deeply uncomfortable you are and you either take the mask off to try to get more sleep or you get out of bed.

Leaks are most likely NOT your only problem with the current insomnia, but they are an identifiable problem that can be worked on. So my advice is:

• Start with the leaks. If you can get them under control, you may be more comfortable with the mask.
• Deal with any latent anxiety issues you have about the mask. Wearing the mask a bit in the daytime may help you figure out the leak problems. It will also help overcome anxiety issues. And if you are worried about making compliance, the extra daytime hours will help with that.
• Read up on sleep hygiene and critically examine your own behavior. Try to improve the sleep hygiene if you can. Read through Sound Sleep, Sound Mind; it will give you lots of things to think about concerning your behavior that is connected to being able to go to bed each night and sleep all night long and wake up refreshed and rested in the morning.
• Report the insomnia in the context of trying to use your CPAP correctly to the sleep doc's office---particularly if the insomnia is new or has become worse since you started CPAPing. And ask for some professional advice about how to tackle the dastardly combination of severe insomnia and CPAP adjustment all at the same time.

You need to deal with conquering the insomnia before the CPAP will be able to make you feel any better: The CPAP can only give you additional energy if you are actually sleeping at night. And in your case, you're not yet sleeping well enough for it to make a difference. Keep working on the insomnia, and as the insomnia resolves, you should slowly start to feel better.

[JohnBFisher]

Why AHI?

Why do we (people) settle for any "simple" metric that we can use to compare one thing against another?

Why? Because it makes it easy to compare!

For example, we might compare two vehichles MPG. Of course, one might be able to tow a trailer and the other would be better towed by the trailer!

We might compare the size of the engine (CCs or Horsepower) and not note the seating for the vehichle.

In essence, when we purchase any item, we have to decide if it meets our needs. Do I need a vehicle that can tow a trailer? Do I need to seat a lot of people? Do I need to just have an economical vehicle to get us around town?

So, it is with my sleep! What keeps me awake? Why do I not fall asleep early? Why do I fight sleep? Does that have anything to do with my xPAP therapy? Does my xPAP therapy address my apneas? Does my mask meet my needs? Does my mask leak a lot? Do I ache when I lay on the bed?

That is why you will see myself and many other posters noting that the most important question is "How do you feel?". Think of the AHI score as a simple wind sock that should tell you if the mechanics of sleeping well are in place. It might not mean that you ARE sleeping well. Only that the wind is a bit easterly and stiff enough to inflate the windsock. You can use it as guidance ... but ONLY as guidance. If you continue to feel poorly, then you need to tackle other issues that might be disturbing your sleep.

Hope that helps.

[rocklin]

THERE ARE TWO VERSION OF "WHY AHI?", THIS ONE, AND THE ONE HERE: viewtopic/t69106/Why-AHI.html

I am transfering jnks post here, and again ask the admins to remove the duplicate post.

I will reply to the excellent points made by the members in this thread in a few hours.

roc

__________________________________________________________________________

Post utterly revamped and EDITED FOR CLARITY

Clarity is overrated. Just shoot for interesting.

1. IMHO, AHI <5 = great result" is a lazy medical metric.

"Great result" is about how you feel and about getting events as low as possible, but no lower than that.

2. IMHO, Obstructive, central and hypopnea = clinical event of 10> seconds" is rather arbitrary.

Classification metrics are for purposes of proving to payers the validity of the diagnosis and the response to therapy. Users tweak to get home-machine-reported numbers as low as possible and then tweak for feeling as rested and refreshed as possible, which may mean slightly more, or slightly less, pressure than the pressure that yields the lowest overall home-machine-estimated events.

. . . what would you propose we use in it's place?

Use for what? The numbers proved you deserved to try a PAP machine and proved you responded to therapy, so the numbers did their job beautifully. Now it is up to you to figure what tweaks make you feel the best you can. You may choose to use numbers for that, but you can choose whatever you want to judge how well your body is sleeping. Meanwhile, AHI works just fine for the clinician doing his job. If insurance uses the numbers to deny patients the right to try PAP, that is not a problem with the numbers but a problem with how they are being misused. We need to be careful as patients that we don't misuse the numbers by drawing unscientific conclusions ourselves about them. Tools can be used or misused.

. . . look how much sleep I average per night.

It took my body a while to figure out how to sleep all night with the mask on. Once it started getting good sleep, effective sleep, for the first time in my life, it didn't understand it could keep sleeping, cycle after cycle. Eventually it mostly figured it out, so that if I wake up after a cycle, I just smile, roll over, and go back to sleep.
It took a while for me to get to that point, though.

Sometimes treatment for sleep-maintenance insomnia requires help beyond PAP. If the amount of sleep you get does not increase no matter what you try on your own, you may need to speak to a sleep doc about that specifically.

As one online source says:

Whatever the original cause, difficulty staying asleep often gives rise to worry over not getting enough sleep, and a vicious cycle develops in which this worry itself becomes the main source of insomnia. Fortunately, there are many things you can do to remedy sleep-maintenance insomnia. Cognitive and behavioral techniques have proven effective, and you should usually try them before considering medications. It's especially important to develop habits that promote healthful sleep, a collection of practices called sleep hygiene. -- http://www.health.harvard.edu/newslette ... womens0710

That source is aimed at mid-life females, but the principles apply equally to all.

[jnk]

Sorry about the mixup, Mike9677. Here is my updated reply to the correct thread:

Post utterly revamped and EDITED FOR CLARITY

Clarity is overrated. Just shoot for interesting.

1. IMHO, AHI <5 = great result" is a lazy medical metric.

"Great result" is about how you feel and about getting events as low as possible, but no lower than "as low as possible."

2. IMHO, Obstructive, central and hypopnea = clinical event of 10> seconds" is rather arbitrary.

Classification metrics are for purposes of proving to payers the validity of the diagnosis and the response to therapy.

Users, on the other hand, tweak to get home-machine-reported numbers as low as possible and then tweak for feeling as rested and refreshed as possible, which may mean slightly more, or slightly less, pressure than the pressure that yields the lowest overall home-machine-estimated events.

. . . what would you propose we use in it's place?

Use for what? The numbers proved you deserved to try a PAP machine and proved you responded to therapy, so the numbers did their job beautifully. Now it is up to you to figure what tweaks make you feel the best you can. You may choose to use numbers for that, but you can choose whatever you want to judge how well your body is sleeping. Meanwhile, AHI works just fine for the clinician doing his job. If insurance uses the numbers to deny patients the right to try PAP, that is not a problem with the numbers but a problem with how they are being misused. We need to be careful as patients that we don't misuse the numbers by drawing unscientific conclusions ourselves about them. Tools can be used or misused. Many find that once they are in the ballpark (leak is under control, a mostly-effective pressure has been found), going by how they feel in general is a better personal metric than the medical ones used by docs and insurance.

. . . look how much sleep I average per night.

It took my body a while to figure out how to sleep all night with the mask on. Once it started getting good sleep, effective sleep, for the first time in my life, it didn't understand it could keep sleeping, cycle after cycle. Eventually it mostly figured it out, so that if I wake up after a cycle, I just smile, roll over, and go back to sleep. It took a while for me to get to that point, though.

Sometimes treatment for sleep-maintenance insomnia requires help beyond PAP. If the amount of sleep you get does not increase no matter what you try on your own, you may need to speak to a sleep doc about that specifically.

As one online source says:

Whatever the original cause, difficulty staying asleep often gives rise to worry over not getting enough sleep, and a vicious cycle develops in which this worry itself becomes the main source of insomnia. Fortunately, there are many things you can do to remedy sleep-maintenance insomnia. Cognitive and behavioral techniques have proven effective, and you should usually try them before considering medications. It's especially important to develop habits that promote healthful sleep, a collection of practices called sleep hygiene. -- http://www.health.harvard.edu/newslette ... womens0710

That source is aimed at midlife females, but the principles apply equally to all.

One point I would add is that until our bodies are used to sleeping with PAP, it helps us to remember that a few hours of sleep with PAP is worth more than several hours without it, if the sleep we are getting is of better quality. So the key in that circumstance is often patience as our body/brain figures things out on its own, in a sense.

Excellent thread, by the way. It gets at the heart of the matter for many of us.

-Jeff

[rocklin]

Not over yet, just gathering more evidence.

Thanks to all who replied, I will answer each of you in the near future.

[DaveLP]

I average 7.x hours of sleep per night, but there are periods where I fight the chinstrap and try to keep it from slipping and the times I wake up with a dry throat caused by and open mouth for who knows how long. Then there are those times when the pressure maxes out and wakes me up.

Who knows how much "optimum sleep" I get per night? I judge that by whether I need an afternoon nap in front of the TV. Today, I just may need one after the wakeups last night.

[rocklin]

Last night was my best night of sleep . . .

EDIT: It's simply amazing how sleep deprivation utterly distorts your ability to see your posts as others see them.

Let me if I can start fresh in the next post.

[rocklin]

On Sept. 23 you slept with the mask on from about 6:30 AM to 8:30AM. What did you do the rest of the night?

Involve myself in one of the many "projects" in my life. Some, like viewing art online, are pure pleasure. Others, like studying up on cardiac disease because I am actively in a huge fight with this disease, are not so pleasurable.

Did you have severe insomnia along with OSA before you were diagnosed?

No. I have had mild insomnia at times, but never so severe as when I started CPAP.

Over the years, I have become arthritic, and this has made me quit the sports I used to love. In turn, I have slowly—but surely—been gaining weight.

My wife said the pure chainsaw noise of my snoring is what pushed her to push me toward a sleep study.

Yet, even at my worst "pre-diagnosed" OSA, I slept for long hours, and dreamed incredible, technicolor dreams, dreams that I loved so much that I actually looked forward to going to sleep.


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If I had to hazard a guess, I'd lean towards saying that mask leaks are a critical part of your on-going sleep problems

Looking at my latest data, I would say you are right. But I haven't been able to fix the leaks consistently, not after months of trying.

The sleep labs (accepting my GHI insurance) in NYC have pretty much said: "This is above our pay grade. Good luck and God Bless".

____________________________________________________________________



I had high hopes for DD's sleep lab, and it got off to a great start. I've never seen any place like it.

Then, it all turned bad, and, as of this moment, hospital admin doesn't want me to return to actually do the study.

Like The Man Without a Country, I am a man without a sleep lab, at least for the moment. Of course, finding one like DD's won't be easy. If it was, I would've done it long ago.

____________________________________________________________________


I try to address other member's questions later. Right now, I am preparing for two major surgeries, and hoping they turn out well.

Hey, with that anesthesia, I'll probably sleep like a baby.

[rocklin]

.

Why AHI?

Why do we (people) settle for any "simple" metric that we can use to compare one thing against another?

Why? Because it makes it easy to compare!

For example, we might compare two vehichles MPG. Of course, one might be able to tow a trailer and the other would be better towed by the trailer!

We might compare the size of the engine (CCs or Horsepower) and not note the seating for the vehichle.

In essence, when we purchase any item, we have to decide if it meets our needs. Do I need a vehicle that can tow a trailer? Do I need to seat a lot of people? Do I need to just have an economical vehicle to get us around town?

So, it is with my sleep! What keeps me awake? Why do I not fall asleep early? Why do I fight sleep? Does that have anything to do with my xPAP therapy? Does my xPAP therapy address my apneas? Does my mask meet my needs? Does my mask leak a lot? Do I ache when I lay on the bed?

That is why you will see myself and many other posters noting that the most important question is "How do you feel?". Think of the AHI score as a simple wind sock that should tell you if the mechanics of sleeping well are in place. It might not mean that you ARE sleeping well. Only that the wind is a bit easterly and stiff enough to inflate the windsock. You can use it as guidance ... but ONLY as guidance. If you continue to feel poorly, then you need to tackle other issues that might be disturbing your sleep.

Hope that helps.

JohnBFisher, sadly, I found nothing in your post that I could argue with.

So, I must ask you: please stop posting in my threads, it's very annoying.



.

[jnk]

very annoying.

It's the Internet. Anyone who isn't annoyed is simply not paying attention.