Which is More Important - AHI or Sleep?

[barrybd]

I have my followup with the Sleep Dr tomorrow. I have been on this CPAP for 2 months and have been struggling to get my AHI down (avg > 4.5) and to sleep comfortably. From what I have learned here, my pressure was set too low initially (7/15). It is now (11/18). My AHI is fallen with every increase in pressure. Last night AHI was 2.5 (lowest ever was 2.1). The problem is that the quality of my sleep keeps getting worse. I am a Zeo user and my sleep scores have fallen from the 70's (before this CPAP) to mainly in the 40's now. I am now averaging under 6 hours of sleep a night. The new CPAP is noisier than the old brick. I would not be able to sleep at all without ear plugs. Also, with each increase in pressure, I end up with more small leaks from the nasal pillows which are fairly disruptive. I am going to guess that the Sleep Dr will look at my data and want to adjust the pressure upwards. I too would love to get my AHI under 2 (can you sense the jealousy of AHI envy?), but am worried that the result is going to be even more sleep disruption. Any thoughts would be appreciated.

[Jay Aitchsee]

Barry,
Remember that an AHI of 5 or less is considered normal. A lower AHI doesn't necessarily mean your sleep will be more refreshing or restorative. Eliminating disturbances at the expense of some AHI may be helpful. In my case, I find CPAP less disturbing and more restful than APAP though my AHI with either mode is about the same.
J

[Lambeau]

I have the same machine as yours. My first night of using it was on July 8, 2013, so I have been on it for about a half a year. It is my first and only CPAP machine. I was diagnosed back in June with an in hospital sleep study, and that study revealed an AHI of 39.

That said, I find my PR system one to be so quiet that I can barely hear it at all. The only sound I can hear is the air venting out of my nasal mask, and that is also very quiet...so much so that I do not even notice it. Perhaps there is a problem with the your machine if it is that loud for you?

My AHI went down gradually. My first night on it, I got a reading of 15. Not great, but better than 39. My second night I went to an AHI of 8.1. After that it has never been more than 5.1. For the past several weeks I've been at around 2.1. I don't worry about getting it super low, as I sense most of my apnea events are centrals, and not obstructive.

I have had better success with the lower pressures. I do best when I am seeing pressures over the night that register 11.0 and 5.5.

When I first went onto this therapy, I could not make it past 4 hours for compliance and then would need to rip it off my face. But as my pressures decreased, I now make it all through the night with 8-1/2 to 9 hours every night with the only arousal being at around 3:00 a.m. to use the bathroom. I come back to bed, hook the hose up to my face and am sound asleep again in about 3 minutes.

This did not happen in two months for me. It was closer to 5 months to get to where I am today, and am now totally happy with it and adjusted well to sleeping with BiPap machine.

[HerbM]

I am new here and to CPAP so this is just reasoning from logic so feel free to totally ignore it.

The most important is QUALITY SLEEP, neither sleep in pure hours nor AHI as a pure number.

AHI is an indication of how many disturbances there are to your sleep.

If you had zero apneas, but we woke you up every minute with an electrical shock you would effectively get no decent sleep.

However, there is a least one other component to the apneas and that is the release of the adrenaline to rouse you to breath so maybe an electric shock is to close an analogy since this might well cause an adrenaline dump as well.

Maybe just a loud noise every minute or your machine causing noise that particially wakes you.

You need a fairly low AHI to get a decent sleep but if you suffer from other disturbances to get it "too low" then that becomes counter-productive.

As was mentioned earlier, <5 would be considered normal if you did a sleep study but of course they would also be measuring EEG to tell if you are rousing and what stage of sleep you are in.

I am beginning to believe that *I* am conscious in Stage I non-REM sleep. (Need to research that) and stage I doesn't get you much in the way of restorative rest.

Talk to your doctor about the tradeoffs (he may not know but at least find out his thoughts.)

[Wulfman...]

I have my followup with the Sleep Dr tomorrow. I have been on this CPAP for 2 months and have been struggling to get my AHI down (avg > 4.5) and to sleep comfortably. From what I have learned here, my pressure was set too low initially (7/15). It is now (11/18). My AHI is fallen with every increase in pressure. Last night AHI was 2.5 (lowest ever was 2.1). The problem is that the quality of my sleep keeps getting worse. I am a Zeo user and my sleep scores have fallen from the 70's (before this CPAP) to mainly in the 40's now. I am now averaging under 6 hours of sleep a night. The new CPAP is noisier than the old brick. I would not be able to sleep at all without ear plugs. Also, with each increase in pressure, I end up with more small leaks from the nasal pillows which are fairly disruptive. I am going to guess that the Sleep Dr will look at my data and want to adjust the pressure upwards. I too would love to get my AHI under 2 (can you sense the jealousy of AHI envy?), but am worried that the result is going to be even more sleep disruption. Any thoughts would be appreciated.

Try straight pressure......CPAP mode. You may find many of the problems you're experiencing will go away......and your AHI and sleep quality will improve.

I presume you're using software to see your details, so you should be able to see in your reports what the best pressure should be to start with.


Den

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[Bill44133]

It is very important that you sleep, but it is equally important that you be able to sleep and breath at the same time. If you are not breathing than most likely you are not sleeping. There is a balance.

Are you sure it is the machine that is waking you up and not the leaks that are waking you? What are your leak numbers looking like? Are you using SleepyHead or Encore? I have the same machine and I never hear it running.

[ChicagoGranny]

barrybd,,

You fail to mention the most important thing. How do you feel the next day at the different settings?

Don't get hung up on "the numbers".

ChicagoGramps

[Sir NoddinOff]

I'll go with better sleep every time as long as one's AHI doesn't vary too much. As a matter of fact, I'm doing that now since I switched from a ResMed machine to an equivalent PR machine. My AHI numbers were better with the ResMed at AHI considerably less than 1.0, every night - however I sleep better with the PR machine which yields an AHI typically less than 2.5 nightly. In a nutshell, I wake up less during the night with my new PR and feel more rested all day long. (Note: Machine preferences are a VERY personal choice, so don't get on my back all you ResMed fans Both are fine machines.)

Hey, like I said, if I feel rested all the next day, then that's what it's all about for me.

[jencat824]

I have the same machine as you and so does my hubby. Both as so quiet you can't hear them when they are running together. You might want to try to get your DME to replace. That loud noise does not sound normal.

Jen

[Sheriff Buford]

If the machine-noise is a big enough factor, take your machine to your sleep doctor (if he has a supply of machines at his office) or to your DME. Plug in your machine and listen for a bit. Then plug in a demo or new machine of the same model and see if the noise of your machine is "normal". Something may be wrong with it. That way, you'll know.

Sheriff

[barrybd]

I met with an RT and the Sleep Doc today. It really did not go as I had expected. The respiratory tech plugged in my CPAP to check the settings and data. I mentioned that this new CPAP was much nosier than my 10 year old one (Respironics brick). She insisted that these new ones are noisier because of the Auto technology, even while it was making this loud wheezing noise when I was inhaling with it, in front of her. I also told her that the pressure was causing leaks with the nasal pillows, so she insisted on turning down the minimum and maximum pressures and giving me a nasal mask to use instead of the nasal pillows.

The Sleep Doc's response to these issues was to say that keeping the AHI under 5 was just an arbitrary guideline and that the main criteria should be about how I feel when I wake up. Since I told the Dr that I was having problems sleeping with the pressure higher, he agreed with the RT that we should turn down the pressure.

So, I know it is not a perfect world, but I was hoping to have someone take the CPAP noise complaint seriously. And, I already had figured out there was competing goals of getting my AHI lower, vs not being wakened by the CPAP noise/pressure.

As for how I feel after sleeping with the CPAP, I still regularly fall asleep sitting at my desk at work. Is it because the AHI's or the poor sleep because issues with the CPAP? I don't know.

Thanks for all the help!

[Setj]

Barry,

What I learned on here even before I started (12/16/2013) is not to depend on anyone but yourself to manage your CPAP therapy. May I suggest you download the SleepyHead software, read your SD card and learn to interpret the results. Learn how to change you own settings and never depend on another somewhat disinterested and usually pressed-for-time person to take care of you.

I have done this myself in a short time and have changed my settings and improved my therapy and my sleep. This seemed pretty intimidating at first, but it is not so complex that you won't catch on quickly. I understand a good bit about interpreting the reports, but intend to learn more with the help of the forum.

It is so nice to be able to do this on my own and not depend on the medical profession.

Good luck,

[Julie]

Hi - this may be a 'Duh' question/answer, but have you considered that you might not be getting optimal therapy because you might need a full face mask instead?

[Sir NoddinOff]

So, I know it is not a perfect world, but I was hoping to have someone take the CPAP machine's noise complaint seriously.

If you really think your CPAP noise is compromising your therapy, here's one way to go:
http://www.amazon.com/Macks-Pillow-Sili ... +ear+plugs
You can use each pair of earplugs for 4-5 nights before they lose their stickiness. You can also get similar brands at any pharmacy.

[Bill44133]

Hi - this may be a 'Duh' question/answer, but have you considered that you might not be getting optimal therapy because you might need a full face mask instead?

I agree with you Julie.. I wonder if it is the leaking that is keeping him awake, and considering his high pressure. I struggled for months with leaks..