Should I worry about snoring with AHI < 1?

[sleepylynn]

Hi, all -

So, to preface this: I am self-employed and under-insured. So, rather than taking on the expense of a sleep lab titration, I'm doing that part myself using APAP. I've been on it for a little over two weeks, and after bumping my minimum pressure to 9.5 and switching to the Dreamwear mask I appear to have hit the "sweet spot" - my AHI average for last week was .92. Super excited about that, especially since I'm basically DIYing it.

The other bit of background - I live alone, so I can't monitor my own snoring and see if the machine's accurate on that point. Here's last night's graph, which is pretty representative:



My question is...should I even worry about the snoring on the chart? I know CPAP is supposed to elminate that...but I feel fine, don't wake up with headaches like I did before, etc. I'm leaning toward just letting it go, but thought I'd see if anyone had other thoughts.

Thanks!

[Wulfman...]

That's a whole lotta pressure changing goin' on there........

If it were me (and I've been there with higher snore numbers than that), I'd narrow the pressure range or go to single pressure.
Snores are one of the things that APAPs chase. And, personally, I don't feel that they're worth the effort if the apneas and hypopneas are under control.
So, I'd find the pressure that keeps those at bay and then do a little fine-tuning around the snore numbers.


Den

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[Pugsy]

If you are sleeping well and feeling good then I wouldn't worry about that small amount of snores.
If you just want to clean up the reports then probably just a little 0.5 cm more to that minimum would do a decent job of cleaning the snores up but there's nothing urgent about it.
That's not a horrible number of snores at all... I have seen reports where the snores were solid bars on the reports...now those are bad enough to need fixing. Yours aren't bad at all.

[LSAT]

I would increase the minimum pressure to 10 for a few days and see if the peaks and valleys even out.

[sleepylynn]

Thanks, everyone! And yeah, Wulfman, that was my other question - the pressure bouncing around so much. It's done that from the beginning. I started out with a min pressure of 8, and bumped it to 9.5 because it never dropped below that, but I didn't want to fiddle with it more before now because I figured I needed to get used to the machine first.

So, I'll bump the minimum a tad and see what it does. Much appreciated, folks!

[Wulfman...]

Thanks, everyone! And yeah, Wulfman, that was my other question - the pressure bouncing around so much. It's done that from the beginning. I started out with a min pressure of 8, and bumped it to 9.5 because it never dropped below that, but I didn't want to fiddle with it more before now because I figured I needed to get used to the machine first.

So, I'll bump the minimum a tad and see what it does. Much appreciated, folks!

And, it's going to keep doing that (because of the snores) until you reign it in.


Den

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[Wulfman...]

I would try lowering the maximum pressure.......like "significantly"!


Den

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[Pugsy]

it's going to keep doing that (because of the snores) until you reign it in.

Maybe...maybe not.
Other things drive the pressure besides the snores.
My snores & FLs were easily squashed with the minimum pressure tweaking but I still had the significant pressure swings during REM and there weren't any snores or FLs being flagged during some 6 to 8 cm pressure swings (usually during probably REM).
Snores and FLs were non existent once I got the AHI to around 3 or less....but I still had the pressure changes during probable REM.

[Guest]

unrelated to the above and only as a due diligence item, maybe check that the "system one resistance" setting matches the recommended setting for the mask (or whatever works best after experimenting). that setting seemed to make or break it for me when i used the respironics auto with pressure relief of 1. years ago my dme commented that if that setting wasn't right, the pressure wouldn't comeback fast enough and a collapse could happen when using pressure relief. not sure if you are using pressure relief. with nasal pillows large i used a setting of x3 with good results, and found that a setting of x1 for the system resistance was impossible. but now with the respironics asv model and limited testing, a setting of x1 for system resistance works better for me.

[sleepylynn]

Sorry for the late reply on this thread, folks - just want to say a big thank you to everyone!

Wulfman: You'll be happy to note I eventually settled at a fixed pressure. I'm now at 16, and my AHI is <1 every night. Snore numbers fluctuate a little, but that's mostly due to congestion issues (just started nightly nasal irrigation to try to straighten that out).

I'm doing CPAP entirely on my own, and I don't know what I would have done without forums like this one and the generous advice shared. THANK YOU.

[ChicagoGranny]

Wulfman: You'll be happy to note I eventually settled at a fixed pressure.

teehee

[avi123]

Sorry for the late reply on this thread, folks - just want to say a big thank you to everyone!

Wulfman: You'll be happy to note I eventually settled at a fixed pressure. I'm now at 16, and my AHI is <1 every night. Snore numbers fluctuate a little, but that's mostly due to congestion issues (just started nightly nasal irrigation to try to straighten that out).

I'm doing CPAP entirely on my own, and I don't know what I would have done without forums like this one and the generous advice shared. THANK YOU.

Try putting the machine on straight CPAP at 10 and check the results.

A pressure of 16 is regarded as high.

From Resmed:
The higher the pressure,
the more central hypopneas you will have. At a
pressure somewhere around 10 cmH2O, the central
hypopneas become central apneas. On the other
hand, the vast majority of obstructive apneas are
already well controlled by 10 cmH2O, and we are
only fine tuning using snoring and flattening. So it
is a pretty good bet that if the pressure is already
above 10 cmH2O, any apneas are most likely
central, and you should leave them alone (except
in patients with central apneas due to heart failure).
But if the pressure is below 10 cmH2O, most
apneas will be obstructive and you should put the
pressure up. There’s nothing magical about 10
cmH2O, it’s just a good place to put the line in the
sand.

[Wulfman...]

Sorry for the late reply on this thread, folks - just want to say a big thank you to everyone!

Wulfman: You'll be happy to note I eventually settled at a fixed pressure. I'm now at 16, and my AHI is <1 every night. Snore numbers fluctuate a little, but that's mostly due to congestion issues (just started nightly nasal irrigation to try to straighten that out).

I'm doing CPAP entirely on my own, and I don't know what I would have done without forums like this one and the generous advice shared. THANK YOU.

Try putting the machine on straight CPAP at 10 and see the results.

A pressure of 16 is regarded as high. The higher the pressure,
the more central hypopneas you will have. At a
pressure somewhere around 10 cmH2O, the central
hypopneas become central apneas. On the other
hand, the vast majority of obstructive apneas are
already well controlled by 10 cmH2O, and we are
only fine tuning using snoring and flattening. So it
is a pretty good bet that if the pressure is already
above 10 cmH2O, any apneas are most likely
central, and you should leave them alone (except
in patients with central apneas due to heart failure).
But if the pressure is below 10 cmH2O, most
apneas will be obstructive and you should put the
pressure up. There’s nothing magical about 10
cmH2O, it’s just a good place to put the line in the
sand.

NO!
I think she's got it pretty well figured out NOW.
The pressure you're suggesting is about where her minimum was to begin with.
Not everyone is susceptible to pressure-induced Centrals.......only about 15% according to the statistics.
And, 16 cm. isn't that terribly high.......even for CPAP pressures. She's got Sleepyhead software and is capable of tweaking her therapy.


Den

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[Wulfman...]

Wulfman: You'll be happy to note I eventually settled at a fixed pressure.

teehee

As Bartles and Jaymes used to say...... "Thank you for your support!"

Editing to add a sad note about one of those guys:

http://www.latimes.com/local/obituaries ... story.html


Den

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[Pugsy]

I would disregard Avi's recommendation...while there is a small grain of truth in what was said but it is true in only some very special rare circumstances with an even smaller number of people.... it doesn't address the fact that some people simply need pressures in the teens and even 20s to hold the airway open for plain old obstructive sleep apnea tissue collapse that has nothing at all to do with centrals.
That's why we have bilevel machines and people using even pressures of 20 something to deal with plain jane OSA and centrals are a non factor.

This part is true though...

There’s nothing magical about 10
cmH2O

If someone is going to have centrals in response to cpap pressure....it can happen at even 4 cm. Doesn't have to be higher pressures and it isn't a given at higher pressures either. Sounds like something that was mentioned by ResMed to explain the old S8 (and older) algorithm which was redone with the S9 and new machines.