AHI not a measure of sleep quality

[stevos2000]

I'm still new to this, having been on CPAP for 40 nights now after 20 years of untreated and progressively worsening sleep apnea. Having switched from a nasal pillow to a nasal mask in the last 10 days. I've consistently gotten my "official" AHI readings under 1. Last night, for example, EncoreViewer reported my AHI at 0.3, SleepyHead at 0.27. Looks great. The trouble is that I've noted that on some days when I have an AHI under 1 I can still feel like crap, while on other days I feel much better. Turns out that when I examine my waveforms much more closely in SleepyHead on a bad day that there are dozens of non-AHI events occurring where I seem to be struggling to breath, gasping for air, or not breathing at all for up to 9 seconds or so at a time. So much for restful sleep. For examples of these, which get worse as the night goes on, see the slide show at:

http://s1124.photobucket.com/albums/l57 ... =slideshow

My suspicion is that my current sleep doctor will look at my AHI numbers, shake my hand, and send me on my way. My inclination is to kick up my pressure from 12 to 13 and see if things improve any before my next visit in 3 weeks. I do have respiratory issues which might be involved in these events, including mild asthma and on-going nasal congestion, which I treat in all recognized ways possible. Are my experiences similar to those of other people? Are these events in any way normal and just part of regular sleep? Or are they a problem I should address? Do I have such a severe sleep deficit that it is just going to take me a much longer time to stabilize my sleep breathing patterns and I should just be patient? Looking for help on this since I don't expect to get it from the doctors.

Oh, and just out of curiosity, why is it officially OK to not breath for 9 seconds but bad to not breath for 11?

[BlackSpinner]

I'm still new to this, having been on CPAP for 40 nights now after 20 years of untreated and progressively worsening sleep apnea. Having switched from a nasal pillow to a nasal mask in the last 10 days. I've consistently gotten my "official" AHI readings under 1. Last night, for example, EncoreViewer reported my AHI at 0.3, SleepyHead at 0.27. Looks great. The trouble is that I've noted that on some days when I have an AHI under 1 I can still feel like crap, while on other days I feel much better. Turns out that when I examine my waveforms much more closely in SleepyHead on a bad day that there are dozens of non-AHI events occurring where I seem to be struggling to breath, gasping for air, or not breathing at all for up to 9 seconds or so at a time. So much for restful sleep. For examples of these, which get worse as the night goes on, see the slide show at:

http://s1124.photobucket.com/albums/l57 ... =slideshow

My suspicion is that my current sleep doctor will look at my AHI numbers, shake my hand, and send me on my way. My inclination is to kick up my pressure from 12 to 13 and see if things improve any before my next visit in 3 weeks. I do have respiratory issues which might be involved in these events, including mild asthma and on-going nasal congestion, which I treat in all recognized ways possible. Are my experiences similar to those of other people? Are these events in any way normal and just part of regular sleep? Or are they a problem I should address? Do I have such a severe sleep deficit that it is just going to take me a much longer time to stabilize my sleep breathing patterns and I should just be patient? Looking for help on this since I don't expect to get it from the doctors.

Oh, and just out of curiosity, why is it officially OK to not breath for 9 seconds but bad to not breath for 11?

The sleep doctor works for you.He /she is your employee. Treat them like the employee they are and not the boss they think they are. Bring your data as print out and show the number of arousals that are not being treated by your machine and INSIST that these have to dealt with.
If the doc is not willing to deal with this then fire him/her and find another one who IS willing to work with you.

Walk into the office with a list of questions on paper with space for answers, with a copy fro the doctor. Take control of the interview by going through the list step by step FIRST.

[Lizistired]

... why is it officially OK to not breath for 9 seconds but bad to not breath for 11?
Probably for the same reason that a 10 second apnea counts the same as a 47 second apnea. Whatever that reason is.
Also, if you have REM related apneas as I do, and never get into REM, you probably won't have any apneas. But you didn't get any restorative sleep either.

[ameriken]

AHI is just a guage and we and the medical community get stuck on the numbers and forget that the most important guage we have is how we feel. It's like if you're cold and uncomfortable, they'll blame it on the room temperature being 55 degrees. Since most people are comfortable at 70, the solution is to turn up the heat to 70. Later when asked what the room temperature is, you say it's 70 and they figure the problem is solved, thank you and have a nice day.

Yet you still feel cold. But because the guage reads 70, it's like there is nothing left to talk about. Same with AHI, just because your AHI looks good doesn't mean you are sleeping well or feel any better.

So, before the doctor shakes your hand and sends you on your way, you've got to voice how you feel and not leave the room until the doc has not only acknowledged that you don't feel any better, but is also trying find ways to address it. And like Spinner says, if the doc doesn't satisfy you, say goodbye and find someone who will.