robysue's summary graphs with UPDATE page 3

[robysue]

Ok NotMuffy and -SWS: Here are scanned in versions for everything I have on the diagnostic sleep test which was done 8/1/2010. I summarized the data in the long post that -SWS quoted back on the other thread.





Enlighten me?
Info for the other studies will be in their own individual posts to this thread.

[robysue]

Here are the data from the first (straight CPAP) titration study in late August. Note that ragweed was blooming heavily and my seasonal allergies were at their worst.

[robysue]

Here's the post with the summary of the above data and numerous questions that I had (and largely still have) about the data. Alas, the post went unanswered.

I'm a newbie here. I apologize in advance for the length of my posting about my sleep studies.

I've now had two sleep studies done, one baseline and one with titration. After a brief tussle with my sleep doctor's office, I've now got copies of the reports, but not the full studies. Having been reading a lot about sleep apnea both here and elsewhere, I'm pretty sure I understand most of the things on the report, but I am confused by a few things under the Respiratory Analysis and Movement & Arousals sections of the summarized data.

So here's the brief version of the original study without CPAP:

EEG/EOG
Latency to sleep onset was slightly prolonged at 55.8 minutes.
Latency to REM sleep was prolonged at 159.0 minutes.
Overall sleep efficiency was 69.7%
# REM Periods: 1
#Stage Transistions: 41
#Awakenings: 13
Total sleep time in Stage1: 8.6%
Total sleep time in Stage2: 71.9%
Total sleep time in Stage3: 9.4%
Total sleep time in REM: 10.1%
Patient was observed in both supine and non-supine positions.
Frequent arousals were present and were commonly associate with respitory events.
All stages of sleep were identified.

Repiratory Parameters:
Baseline respiration rate was 12-14 breaths per minute in REM and 12-18 breaths per minute in NREM sleep.
Soft snoring noted by technician.
Overall respiratory disturbance index was 23.1 with a minimum oxyhemoglobin saturation of 91%.
Mean oxyhemoglobin saturation was 96%

EKG:
Baseline heart reate was 66 beats per minute in REM and 64 beats per minute in NREM sleep.
No significant EKG abnormalities were observed.
Mean Pulse (beats per minute) for total time in bed: 65.3
Min. Pulse (beats per minute) for total time in bed: 55.4
Max Pulse (beats per minute) for total time in bed: 97.3

EMG:
7.0 periodic limb movements per hour of sleep noted. They were rarely associated with arousals.

Interpretation:
These findings indicate the presence of moderate obstructive sleep apnea consisting mainly of apneas and hypopneas, with associated disruption in sleep architecture and minimal oxyhemoglobin desaturation. (RDI: 23.1 and minimum oxyhemoglobin desaturation: 91%).

Additional Data of Respiratory Analysis
There's a table that looks like this:

Code: Select all

Type                       NREM count     REM count     Total Count     Total Index
Central Apneas:               0               0             0              0.0
Obstructive Apneas:          14               0            14              3.5
Mixed Apneas:                 0               0             0              0.0
Hypopneas:                   71               7            78             19.6
Hypopneas w/ Desat:           0               0             0              0.0
Hypopneas w/ Arousal:        71               7            78             19.6
Apneas + Hypopneas:          14               0            14              3.5
Supine Events:                -               -             7             15.3
Nonsupine Events:            -                -            85             24.2

AHI = (OA + CA + MA + OH w/desat) per hour of sleep:
AHI NREM:  3.9
AHI REM:   0.0
AHI total: 3.5

RDI = (OA + CA + MA + OH w/arousal + OH w/desat) per hour of sleep:
RDI NREM:  23.8
RDI REM:   17.5
RDI total: 23.1

Additional Data on Movements & Arousals:
This is in a table that looks like this:

Code: Select all

type                      NREM count   NREM index     REM count     REM index    Total count    Total index
Total PLMs:                 28             7.8             0           0.0           28            7.0
PLM Arousals:                1             0.3             0           0.0            1            0.3
Respiratory Arousals:       71            19.9             7          17.5           78           19.6
Spontaneous Arousals:       11             3.1             3           7.5           14            3.5
Total Arousals:             83            23.2            10          25.0           93           23.4

So here are my questions:
1) I'm real confused about why the Hypopneas with arousal don't seem to be counted in the AHI. They're clearly counted in the RDI. Any ideas or comments on why they're not counted in my AHI?

2) What's a Spontaneous Arousal? Do they show up in the AHI? the RDI?

Sleep study done with CPAP titration results
On the sleep study with the CPAP titration, the sleep doctor's report indicates that once the pressure was set at 9cm of H20, "supine sleep was noted and the overall respiratory disturbace index (RDI) was reduced to 0 with a minimum oxyhemoglobin saturation of 95%" The chart showing sleep position also shows that this is the FIRST time that night that I'm asleep on my back. I don't like sleeping on my back because it makes my lower back hurt. Total time at 9cm was only 30 minutes and included no REM. Should I be concerned about this at all?

Also on the titration sleep study, the EEG/EOG notes say: "Latency to sleep onset was prolonged at 61.4 minutes. Latency to 1st REM sleep was within normal limits at 93.5 minutes. Overall sleep efficeincey was diminished at 73.7%. The patient was observed in boht the supine and non-supine position. Frequent spontaneous arousals were present." The sleep report also says:
# REM periods: 2
# Stage Transistions: 44
# Awakenings: 15
Total sleep time in Stage1: 5.5%
Total sleep time in Stage2: 76.1%
Total sleep time in Stage3: 0.0% [That's not a typo--it really says zero.]
Total sleep time in REM: 18.3%

All the numbers listed in the Respiratory Analysis section went down. Total PLMs and PLM arousals were 0. But the Spontaneous Arousals went way up:

Code: Select all

Total Arousals     without CPAP     with CPAP
NREM count:              11            20
NREM index:              3.1            5.8
REM count:               3             10
REM index:               7.5           12.9
Total count:             14            30
Total index:             3.5           7.1

So what does this mean? Is it unusual to have NO Stage 3 sleep during a sleep study? And why would my spontaneous arousals go up so much during the titration study? Could it simply be that the wires (and the mask) were bothering me more during the CPAP study? [Maybe because my breathing was bothering me less?] I do remember waking up several times that night with a super itchy nose and feeling like I needed to seriously rearrange the bedcovers too.

At any rate, I do have a second appointment with the sleep doctor scheduled in a couple of weeks. I'm hoping to have a CPAP at home by then, but I'm running into problems with my insurance/HMO/PPO not wanting to pay for a full data CPAP machine and I don't want to accept a basic level machine that only tracks compliance since I really think I need to be able to see that the CPAP machine is working on a regular basis in order to help me with compliance. At any rate, at that meeting with the sleep doctor, what kinds of things should I be insisting on having explained to me about either of the sleep studies?

Thanks in advance for any help you can give me.

[robysue]

Because of ongoing failure to adjust to CPAP (mainly the combo of aerophagia and excessive daytime sleepiness STARTING after CPAP), the PA switched me to bi-level. This titration was done the day before we left town for Thanksgiving. We had a nasty situation going on with our (then) AFS host son who had just told us he did not want to go to NJ for Thanksgiving (among other things) as we always do as a family. And there were vertigo tests earlier in the day. The insomnia monster shows up big time here.

[robysue]

By early February, I'd been working with the PA on the insomnia for about a month. Because she took the time to read my sleep log and notice on-going issues with aerophagia and in light of the less than ideal circumstances for the previous bi-level titration, we do it again on Feb. 4. The gap in the recording is when I told the tech I needed to go to the bathroom even though I really didn't because I could tell the insomnia was really beginning to go rampant and I needed to get out of the bed and go somewhere (the bathroom was convenient enough) to get my self settled back down to finish the test off.

[robysue]

Finally, here's the "summary" for those who need it:

I was tested in August in spite of my being asymptomatic in terms of daytime functioning and co-morbidity conditions because my husband had witnessed my stopping breathing "occasionally" and snoring sometimes, with the level of snoring growing from "cute robin snores" to more alarming louder ones. The frequency in which he was witnessing apneas or apnea-like behavior had also increased. So I was a good wife and listened to hubby and reported the problem to our PCP who referred me to the sleep doctor as part of my July physical exam, which confirmed there were no co-morbidity conditions, although I also did get a referral to an ENT for the vertigo problems that I've been dealing with as well.

From my point of view, my pre-CPAP sleep was largely decent, but only rarely excellent---as long as the insomnia was under control. And the insomnia was under control for the most part: I'd have a night or two here and there when I'd be too restless to get to sleep in a timely fashion---mainly due to stress at work or the weather being too hot and humid in the summer. And the occasional night (usually hot and muggy) where I'd wake up several times with it being difficult to get back to sleep. But for the most part, the insomnia would kick in maybe once or twice a month to once or twice a week at most when I felt stressed at work. Also the insomnia was well controlled by paying attention to sleep hygiene. And it had been several years since the last "night after night after night" type insomnia I've faced with CPAP.

[NotMuffy]

OK, I have a question (or two):

What exactly do you hope to accomplish?

• Live longer
• Sleep better
• Feel better

Do you think AHI 0.0 will accomplish that goal(s)?

Assorted stuff:

SBD has 3 components that make it a "Health Hazard":

• Desaturations that create oxygen deficits in organs
• Inspiration against resistance that causes hemodynamic changes
• Sleep disruption causing EDS

Yaggi et al (2005) looked at AHI and the risk of catastrophic events, and it became quite clear that severe OSAS (AHI > 36) was associated with much greater risk:



(As an aside, these patients were being treated:

Many patients with the obstructive sleep apnea syndrome received some type of treatment for sleep apnea after the initial evaluation. Thirty-one percent achieved a weight reduction of 10 percent or more; 58 percent were using airway pressurization for at least four hours per night for five nights or more per week; 15 percent underwent upper-airway surgery.

but let's hold on that for a while.)

It is not clear what the long term benefits of treating OSA with AHI < 20 (or for that matter even < 30) really are. The Yaggi study showed the significant incidence of catastrophic events didn't appear until AHI >36! And that was with treatment!

Equally important is that mortality increases with inadequate sleep (or for that matter, too much sleep). Kripke:



So "IMHO" if you've gone from relatively "good" sleep before treatment to "poor" sleep with treatment, now you have added "potential adverse health repercussions".

Interpretation of Sleep Efficiency values:

• >95% is excellent
• >90% is good
• >85% is "normal" ("they" say. I'd say 90%)
• <75% is poor.

A summary of selected RS NPSG values:



I am struck by the absence of respiratory events in REM and during supine sleep in diagnostic, as well as the improvement in event density as the night progresses.

[robysue]

OK, I have a question (or two):

What exactly do you hope to accomplish?

• Live longer
• Sleep better
• Feel better

Do you think AHI 0.0 will accomplish that goal(s)?

Well that is the $64,000 question, isn't it?

I wish I had a better and shorter answer for you: But the real scoop is that as much as I've been thinking about this question ("What exactly do you hope to accomplish?") for the last 9 months (since the diagnosis), I don't yet have a definitive answer because the answer has changed over time.

I can tell you the "moving line" answers:

At the time of DIAGNOSIS
At the very start of this misadventure, my answer to the question "What exactly do you hope to accomplish?" literally was:

• I have to do this thing because both my PCP and the sleep doctor have told me in no uncertain terms that I need to be put on CPAP because the diagnosis was moderate OSA and there is no other viable option for treatment.

Not a particularly good reason I admit, but this is what was going through my head during August and September when I was still in the stage of accepting the diagnosis and researching the local DMEs and learning what I could about OSA and CPAP machines in general.

Near as I can remember, the PCP's rationale of why I needed to be on CPAP was to minimize and/or prevent any further damage to my body from the OSA and to prevent the OSA from becoming worse over time. A bit of Start it now while you are still healthy instead of waiting for the OSA to get worse and start triggering real problems with your cardiovascular system and increasing your risk of strokes. if you will.

And as I've said on the other thread, the sleep doc's rationale for why I needed to be on CPAP was a heavy dose of You'll feel better soon with some treating the OSA will minimize and/or prevent any further damage to my body from the OSA and prevent the OSA from becoming worse over time thrown in for good measure.


At the time of STARTING THERAPY
By the time I took delivery on the S9 Autoset and actually started therapy, I'd become much more knowledgeable about the long term affects of untreated OSA. Several of the co-morbidities run in my family (on both sides). In particular I have cousins, uncles, and grandparents (of both genders) who have died of heart disease, stroke, or high blood pressure or diabetes related problems before the age of 75---sometimes substantially before the age of 75. I also have grandparents who spent the last decade or more of their life suffering from long term effects of one or more of these co-morbidities before dying at an age of less than 75. So at the start of this adventure, I'd say that MY answer to "What exactly do you hope to accomplish?" was clearly:

• Live longer and stay healthier longer by being on CPAP.

I expected some adjustment problems to therapy---particularly since I didn't have any of the severe daytime symptoms that so many report here. But I also didn't expect a severe crash and burn in terms of daytime functioning either.


During the worst of the Crash and Burn period last fall
The absolute worst period during my adjustment period has been late October through early December. Before the switch to BiPAP and while the insomnia monster was starting to grow fat and large and overwhelming. During this time, my answer to "What exactly do you hope to accomplish?" was highly pragmatic on a night-to-night basis:

• Don't give in to sleeping without the mask tonight because then I'll never sleep with the mask again in my whole life regardless of what happens with the untreated OSA in the future.

Fear can be a powerful motivator and at this point, the fear that I'd never be able to use the machine if/when it became clear that my OSA had deteriorated to the point of clearly needing it was a powerful motivator to keep me masking up every single night in spite of the growing disruption to my nightly sleep and my daily life.

On a more larger scale, my goal had become more vague and less satisfying:

• (1) Stick with it LONG enough to see if I might actually get used to sleeping with the hose without it so intensely bothering me and (2) stick with it LONG enough to see it might ever do me some good in some kind of (undefined) way.

The change to BiPAP seemed to make major progress towards my getting used to actually sleeping with the hose---as the stage 3 and REM percentages in that Feb. 4 titration study show.


By the END of January and beginning of February
At the time of the second bi-level titration study, the answer to "What exactly do you hope to accomplish?" had definitely started to change to:

• Live longer and stay healthy longer AND feel better NOW in some subtle, but important ways!

Where did this change in my goal come from? Well by late January, as the worst of the crash and burn symptoms began to lift with the positive work on taming the insomnia monster, a subtle, unexpected, but important shift started to occur in the sleep logs I was keeping as part of the war on insomnia: The low grade, but almost constant pain in my hands and feet had all but disappeared! And on some mornings I was waking up with significantly less headache pain. Now you have to understand: Back before CPAP, the hand/foot pain had been around for several years---I'd even had an x-ray or two done to confirm low grade, minor arthritis in my hands and feet. PCP said it was nothing to worry about and to simply take OTC ibuprofen when the pain was really bothersome. [Such as when cold wet weather aggravated it.]

And as for my long, long history of headache pain: Was is a daytime symptom of OSA that I didn't recognize because it was just my normal "I feel OK but not great" way of dealing with it or something else? I don't know. And I suspect the answer is complex: From the time I was a small child, I've had headaches---and of numerous types and kinds. Like many a chronic headache sufferer, I can describe subtle differences in different types of headaches and even describe a particular headache in terms of different sub-types.

Migraines are clearly one of my well defined headaches: I was officially diagnosed with migraines back in my twenties when I had a classic "migraine with full aura" standing at the kitchen sink one sunny afternoon. And there is a strong family history of them. Moreover the topamax and lamictral both reduced the frequency and intensity of my (almost) daily headaches. But the side affects of these medications were not tolerable.

Sinus headaches in spring, summer, and fall have always been issues. The pollen filter helped alleviate some of my fall ragweed symptoms last fall, but the cost (in terms of Crash and Burn) was not worth it. And at this point, there's the nagging question of "how much pressure" do I need to deal with the sinus congestion that seems to be driving up the snoring (increasing the EPAP and IPAP both) and for all I know increasing the A's in the AHI's.

Tension headaches are an almost constant companion when I'm under stress. To the point where the neurologist's PA thinks they are actually migraines in disguise.

Food headaches, needing to drink water headaches, out in the sun too long headaches, noise-triggered headaches, and yes, "I can't sleep headaches" have all been part of my daily life. So it's not at all unreasonable to assume some of these headaches were related to the untreated OSA. And while I cannot say that using the BiPAP has eliminated any headaches, I can at this point say that by the end of January, throughout most of February, and during the first half of March, I had started waking up head ache free once or twice a week.


And at PRESENT?
And how do I answer "What exactly do you hope to accomplish?" TODAY? Well it's definitely a combination of:

• (Feel better NOW with Sleeping better as a subset of (Feeling better NOW)) and (Live longer and stay healthy longer)

where the change in order and the parentheses are both important in establishing my meaning. And by Feel better NOW, I mean the following:

• No more joint pain in the hands and feet. This has been an unexpected blessing that I genuinely can't attribute to anything BUT the use of CPAP/BiPAP. As my PA has explained it to me, OSA can apparently cause low grade inflammation throughout the body. And that, of course, can easily show up as joint pain. And I've done absolutely NOTHING to expressly address the hand and foot pain since starting xPAP. Ergo, it is quite reasonable to credit the use of xPAP with the reduction (rather---the near elimination) of my day-to-day joint pain. And the reduction in joint pain is well worth the hassle of using the BiPAP as long as the stomach problems don't become more painful than the joint pain was and the insomnia can be tamed. But alas, as spring allergies kick in, the joint pain may be coming back. I wonder if it's a hystamine related thing: The allergies trigger a hystamine reaction. Does the hystamine reaction increase the inflammation? And is the increase in inflammation leading to the seeming need for an increase in EPAP, which is so problematic for my stomach?
  
  Some headache relief. I don't expect xPAP to be a magic bullet for my headaches. But there had been a reduction in them during Februrary. It's too hard to tease out what is migraine and what is OSA for me to know anything yet though. And with the change to depakote, the headaches are returning. The vertigo less so, but there's also been an uptick in that too. *sigh*
  
  Sleeping (much) better now than I was last fall and (subjectively) sleeping at least as well as I did pre-CPAP. My goal for sleeping better now is twofold and hopefully modest in expectations: (1) Making sure the BiPAP does not interfere with taming the insomnia beast (so far so good, except for stomach problems) and (2) hoping the BiPAP will continue to help me get more restful sleep---in the sense of not kicking the covers off, not whacking my husband quite so often, not turning over in bed so frequently, not waking my husband up with my snoring, as well as in the more traditional sense of waking up feeling reasonably rested and willing to get up and (sometimes) face the day with the aid of coffee. As the insomnia resolves itself, I am finding that the best mornings now are definitely a bit better than the best days pre-CPAP in terms of waking up feeling refreshed and rested. There's just not enough of them (yet) and I'm greedy. The way I *feel* on one of the average mornings now is pretty definitely about the same as the way I felt on the average so-so mornings I had for the last three or four years pre-CPAP. Subjectively, if those best mornings were to increase in frequency they'd make xPAP worth it. But at their present level, I'm not sure I've reached the break even point yet.
  
  Functioning in the daytime once again at pre-CPAP levels. I want to be able to once again get up in the morning and by the time I finish breakfast be able to concentrate on teaching, grading, committee meetings, etc. without falling asleep or feeling like I'm going to falling asleep. I want to find my once superb memory for details and the ability to manage a complex calendar for the whole family instead of struggling just to keep my own commitments straight. I want to have the energy to recover my not very high level of organization that went AWOL last fall and in the process find the floor to my office. Not yet there. And seeming no progress in site. Maybe there will be some progress once I'm sleeping longer, I don't know.

My current frustration is that the Feel better NOW end of things has hit a "one step backwards" stage I think. I know I just need to work my way through it but still, that is part of the current angst. And I try to remind myself that this too shall pass. But in the meantime, the combination of (migraine, vertigo, lack of sleep, an unresolved anger/angst) makes for a potent and negative mixture to deal with on a weekend. Fortunately, things seem to be much better today.

[robysue]

OK, I have a question (or two):

What exactly do you hope to accomplish?

• Live longer
• Sleep better
• Feel better

Do you think AHI 0.0 will accomplish that goal(s)? (emphasis added)

Truth be told, I don't think an AHI = 0.0 would accomplish anything.

I do know that I seem to subjectively feel worse when the number of events (mostly apneas) scored my machine gets on the high side of fifteen for the total night. I don't know if that's psychological or real----after all in my diagnostic study there were ony 14 OA's for the full night. That knowledge might be giving me some kind of a psychological reaction to nights with 15+ events I suppose.

And I do know that I seem to subjectively have less pain in the joints and less headache pain when there are no clusters containing six or more events.

And I also know that subjectively I can't tell any difference between a night with two events versus a night with about seven or eight events, as long as there are no really nasty clusters. So an AHI of 0.4 or an AHI of 1.4 both feel the same to me. But by the time the AHI hits 3.0, I'm feeling it.

And I do know that I've been puzzled right from the start that both the Resmed S9 Autoset and the PR S1 BiPAP Auto score way more OA's than hypopneas for me. And since all four of my sleep studies have far more hypopneas with arousal than OAs, I've wondered all along:

What assurance have I really got that my SDB problem is really being addressed by the machine?

I mean: If I still have nights where the machine number of OAs is roughly equal to the number of OA's scored on the diagnostic sleep study, how do I know that the machine is actually preventing any of those far more numerous "hypopneas with arousal"? Are those "hypopneas with arousal" too subtle to be caught and scored by the machines as hyponeas? or flow limitations? or reras? Wouldn't be so important if I were feeling substantially better tan the old days. But I'm now only back to about as well as I did last summer on most days.

[JDS74]

RobySue:

What an extraordinary set of data on your apnea travels.

A couple of questions:
During one of your titrations, the OSA's were completely suppressed at 9 cmH20 but not below.
Your current settings have IPAP Max at 8.
How did that happen?

In my circumstance, I never had a titration but went directly to the PRS1 Auto Bipap with settings of IPAP Max= 20 and EPAP min of 5. My AHI dropped from about 30 to about 12. But ... the 90% numbers showed that I'd need an EPAP min of about 11 cm H20 to suppress the OSA's so I have been titrating myself and am now at EPAP Min = 9 cmH20. AHI now hovers around 6.

What I noticed is that even though the PRS1 'handles' the OSA's by increasing pressure, When I had them, I felt lousy in the morning. I think that my machine is just not fast enough in crankin up the pressure to prevent me from having a disturbance related to the OSA.

Perhaps that is happening to you. Have you experimented with raising the EPAP Min up to 7 or 8 cmH20 to see what happens in the data?

Second, You mention a sleep diary or journal. Are you recording the times you wake up at night and correlating those times with events in your data? I found that I now have clusters of CSA's and that they correlate almost perfectly with times I wake during the night. What wakes me up are episodes of headache, a feeling of being hot, and sweating profusely. Can you identify any set of circumstances that are associated with waking up?

Third, Are you having any problems with your mask? Leaks, fitting discomfort?

Fourth, You mention episodes of insomnia. I find that I need to have a rigorous schedule for sleep preparation to avoid that. NO reading in bed, NO TV in bed. When I go to bed, it's for sleeping. Perhaps another closer look at sleep hygene will reveal some detail that will correlate with the insomnia.

[avi123]

My first impression:

1) Very few REMs
2) Desat O2 down to 70% lots of times (Amherst)
3) Lots of arousals
4) Lots of Hypopneas=> check: http://www.sleepnet.com/apnea92/messages/124.html
In your post here viewtopic/t62022/Treating-hypopneas-and ... pneas.html
you wrote that Hypo is dealt same as Obstructive but in the link that you gave it does not support it.

Prevalence of OSA Severities:

http://ajrccm.atsjournals.org/cgi/conte ... 7/1/144/T1

Source:

Am. J. Respir. Crit. Care Med., Volume 157, Number 1, January 1998, 144-148

Effects of Age on Sleep Apnea in Men

I. Prevalence and Severity

EDWARD O. BIXLER, ALEXANDROS N. VGONTZAS, THOMAS TEN HAVE, KATHY TYSON, and ANTHONY KALES

Department of Psychiatry and Center for Biostatistics and Epidemiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania

*********************************************************************************

Am. J. Respir. Crit. Care Med., Volume 163, Number 3, March 2001, 608-613

Prevalence of Sleep-disordered Breathing in Women, Effects of Gender


http://ajrccm.atsjournals.org/cgi/conte ... /163/3/608

[SleepingUgly]

SBD has 3 components that make it a "Health Hazard":

• Desaturations that create oxygen deficits in organs
• Inspiration against resistance that causes hemodynamic changes
• Sleep disruption causing EDS

Can you explain what you mean by #2 above?

[SleepingUgly]

Apparently per their scoring criteria, they subsume hypopneas with arousals into the RDI and not the AHI, but at other labs, like where I was tested, they do not. You meet criteria for OSA according to the AASM alternative criteria, I believe.

I'm very interested in what Muffy has to say about what this business about treating someone like you, which is why I brought it up in another thread. You didn't have EDS, so you don't need treatment by virtue of that (I do). You don't have the cardiovascular risks associated with desats (nor do I). But I am not sure what he meant about hemodynamic changes.

I think you will do much better with this therapy if you feel it's a choice and under your control whether you do it or not, rather than something imposed on you and uncontrollable. Minus #2, hemodynamic changes, which I don't yet understand, the other two suggest you do not necessarily have to do this. There might be Free Will in here somewhere... Looking forward to hearing more.

[SleepingUgly]

My first impression:

1) ...
2) Desat O2 down to 70% lots of times (Amherst)

I don't see any saturations below 90% in the Amherst study.

[SleepingUgly]

And I'm sorry to ask this if the information is buried in there somewhere, but did you ever FEEL better on CPAP than without CPAP?

A couple of issues that stand out to me are:
(1) You need to decide what your dependent/outcome variables are. Is it an AHI below a particular #? It can't be oxygen saturations because that's not an issue. Is it improved EDS? Is it # of headaches per week? What is going to tell you that you're on the right track? You need an outcome variable.
(2) Is the anger/angst--which admittedly I don't know what they are for you--related to this being imposed on you? (The anger may be, I don't know what you mean by "angst").

OK, 'nuff for tonight. I'll let you answer.