Snr Sleep physician says AHI of 10-15 acceptable

[flocof]

Hi all,
I have had sleep apnea for many years but officially diagnosed November. Cpap journey: first week, I felt great! then gradually returned to not so great but much better than pre cpap. AHI was 60 and now with cpap varies between 10-15 with two thirds being CSA.
After five months on cpap with help from a member here to fiddle with the numbers...I finally got an appointment with the Hospital's Senior Sleep therapist. He tells me that there is nothing to worry about, it is quite acceptable to have an AHI of 10-15. He says I am being unrealistic to expect to achieve an AHI of 5 or under... That I may never feel any better, but reassured me that I was fine and should just go on with the CPAP at 10...
Is there any documentation that states that AHI over 5 is detrimental to my health, or that it is not effective therapy? He seems to think that it is widely accepted that from AHI60 down to 10-15 is effective therapy.

[Madalot]

This is interesting. Before I continue, please keep in mind that I am NOT a typical sleep apnea patient as I have other issues from a Muscular Dystrophy (including nocturnal diaphragm paralysis).

When I was having issues with bipap machines (not being triggered properly because of shallow breathing), my machine indicated my AHI was creeping up every night. I asked my Pulmonologist about it and her response was that they didn't get too worried unless it went over 15.

I don't know if this is a typical thinking (or accepted by the medical community). At the time, I took it to mean that in cases like mine, they didn't get upset with an AHI above 5 as long as it stayed at 15 or below.

I'm curious/interested in what other people say/think on this subject.

[Julie]

Absolute nonsense... if that guy were a sleep therapist here I would report him for being a quack of the worst order!

[flocof]

Absolute nonsense... if that guy were a sleep therapist here I would report him for being a quack of the worst order!

I know that is how I feel...What can I say? I have tried and tried and we have agreed to disagree... He is the senior doctor at the sleep centre specializing in complex sleep apnea...I know I will eventually need an ASV machine to treat the centrals...and I will probably try to buy one secondhand and get help to titrate it here... sigh... it's US and THEM!!

[deltadave]

And yet, this is essentially the same level of improvement expected in alternative therapies (HGNS, Provent, surgery, dental devices, etc.) that claim "success".

[flocof]

And yet, this is essentially the same level of improvement expected in alternative therapies (HGNS, Provent, surgery, dental devices, etc.) that claim "success".

So are you saying that this is "successful therapy"? I still feel tired...yawn all day...feel like I need a nap in afternoons...I am only 58 and not obese...although a bit overweight I'll admit But I need more energy if I am going to exercise...

[The Choker]

Hospital's Senior Sleep therapist. He tells me that there is nothing to worry about, it is quite acceptable to have an AHI of 10-15. He says I am being unrealistic to expect to achieve an AHI of 5 or under... That I may never feel any better, but reassured me that I was fine and should just go on with the CPAP at 10...

That SOB should be fired and sent to work changing oil in autos.

That this comes from a "Senior" in the land that invented CPAP is disgusting.

[Pugsy]

You already know what I feel.

You got close to 5 AHI once....around 8 AHI 50% obstructive and 50% centrals. After that almost always way more than 50 % centrals but always at least 50%.

Any chance of getting your hands on an overnight pulse oximeter to see if that AHI of "Acceptable" 15 is causing desats....did your sleep study mention destats with the last one done using your machine?

[flocof]

Any chance of getting your hands on an overnight pulse oximeter to see if that AHI of "Acceptable" 15 is causing desats....did your sleep study mention destats with the last one done using your machine?

He mentioned something about the oxygen levels being fine...I can't remember..I was so annoyed at him and trying to digest what he was saying!
I did request a copy of my sleep studies, hopefully they will come in the mail, or perhaps at the next visit.

[deltadave]

And yet, this is essentially the same level of improvement expected in alternative therapies (HGNS, Provent, surgery, dental devices, etc.) that claim "success".

So are you saying that this is "successful therapy"?

No.

Putting words in "quotes" (like "success") indicates "sarcasm" (although if "sarcasm" is in "quotes", does that then make it not "sarcastic"?).

Their idea of "success" means "better than nothing".

Except in Corky's case.

[Pugsy]

Since OP has this out here now on the forum.

Her centrals may be pressure induced or at least worsened with pressure. Home study initially so no in lab sleep study without a machine report to rely on. Her recent sleep study was with her existing machine..S9 Autoset.
At original Rx setting of 12 cm...truckloads of centrals and not many obstructives at all.
We played around with various settings from with EPR to no EPR and the best we got was with using EPR of 3 and sort of made a "poor man's" bipap out of the machine.
If we drop the pressure any more....the obstructives increase to above 5 per hour....but the centrals will decrease...we are just swapping events at the stage we are at now.

So roughly 9 cm with EPR of 3 gave us a couple of nights with AHI around 8...best we could do. Most of the time around 12 AHI and pretty much 50/50. Then the other doctor told her to use 10 cm....yeah..the obstructives reduced...but centrals increased and AHI was over 15..mostly centrals again.

[flocof]

[quote="Pugsy"]Since OP has this out here now on the forum.

Her centrals may be pressure induced or at least worsened with pressure. Home study initially so no in lab sleep study without a machine report to rely on. Her recent sleep study was with her existing machine..S9 Autoset.
At original Rx setting of 12 cm...truckloads of centrals and not many obstructives at all.
Pugsy, the latest sleep study was on their machine, I only slept 3hours as mattress was hard as a rock! AHI:30 with CSA17 OSA13
Then I cam home and slept like a log (So I thought) for 5 hours as I was so tired and that is when I got mostly centrals.

[Pugsy]

the latest sleep study was on their machine, I only slept 3hours as mattress was hard as a rock! AHI:30 with CSA17 OSA13
Then I cam home and slept like a log (So I thought) for 5 hours as I was so tired and that is when I got mostly centrals.

Oops sorry...which machine did they use? Do you know? Sounds like they did a regular cpap machine titration study.

[Pugsy]

You know here in the US....an AHI of 10 to 15 WITHOUT a machine will get you a diagnosis that will get you a machine. It is still diagnostic for sleep apnea even at those numbers. They don't start saying "no sleep apnea" until they see AHI below 10.

[flocof]

You know here in the US....an AHI of 10 to 15 WITHOUT a machine will get you a diagnosis that will get you a machine. It is still diagnostic for sleep apnea even at those numbers. They don't start saying "no sleep apnea" until they see AHI below 10.

I know and it would be the same here! doesn't make sense!
BTW I downloaded the resmed software and made a few screenshots to send to DR. no problems with the graphs for me..??