CPAP titration study - abnormally low numbers?

[cppoly]

I have two questions:

My N3 sleep time during a CPAP titration study was just ONE minute for the entire night (<.2% sleep time). The doctor who did the CPAP report said this is normal. Really? Isn't this the sleep stage your body recovers and regenerates and should be normally 30 to 45 minutes? At least admit it's abnormal or slightly abnormal, but don't tell me 1 minute is normal!

Also, my AHI at the highest pressure setting I could tolerate for the night was still a 7. To consider CPAP effective, wouldn't this number have to be much much lower and close to 0-1 ideally? And in my case therefore, CPAP isn't an effective form of treatment?

[Pugsy]

To consider CPAP effective, wouldn't this number have to be much much lower and close to 0-1 ideally? And in my case therefore, CPAP isn't an effective form of treatment?

Question for you...what would your AHI be if you didn't use the cpap machine? What was it on the diagnostic sleep study?

Actually less than 5.0 AHI on CPAP is considered acceptable by the medical community in the US and in other places of the world it might be 10.0 (I don't agree but that's another discussion)...trying for 0 to 1.0 is kinda unrealistic....yes a lot of people strive for it and some make it.

If your AHI was 30 per hour on the diagnostic sleep study...reducing it to 7 is a substantial improvement and by all means doesn't mean cpap isn't effective....all it means is that either the pressure isn't quite optimal or maybe you are having some events (like centrals) that pressures can't fix and might require additional detective work to figure out what to do about them.

One minute of N3 sleep is abnormally low. I have no idea why your doctor would tell you otherwise. Are you taking any medications? Sometimes some meds will mess with the sleep cycles. Everything I have ever read points to 15 to 20% of the night being N3.
See here and you might also google "sleep stages" to read more.
https://en.wikipedia.org/wiki/Sleep
and read this
http://healthysleep.med.harvard.edu/hea ... s-rem-nrem

[cppoly]

Thanks for being on my side about the N3 sleep time . It really does underscore that I felt horribly unrested, even more than I normally do without CPAP, and trying to explain this to the sleep center’s doctor who generated the report was very frustrating.

My AHI is normally around 7, without a CPAP machine. The study I had done was for a titration study to get a prescription for the machine’s pressure. Using CPAP, my AHI initially started at 12 (higher than I normally am at) at the beginning of the night and eventually came down to a 7 using the highest pressure that I could tolerate. So to me I believe this is an ineffective form of treatment. Although trying to argue with doctors is an uphill battle, even though I think the argument is simple.

Jaw surgery is probably my only savior at this point since I’ve had 5 or so procedures already done to attempt to reduce my AHI.

[ChicagoGranny]

5 or so procedures already done to attempt to reduce my AHI

What kind of "procedures"?

[cppoly]

UPPP, tongue base reduction, hyoid suspension, and a few minor others

[Pugsy]

Okay..another question for you...on that diagnostic sleep study (without cpap) where you had the AHI of 7...what was the Oxygen levels reported? Did the oxygen levels drop any with that 7 AHI or did they stay stable at near your baseline?

Your statement about cpap being ineffective is still not accurate. It might improve things a lot if you could use more pressure but your inability to tolerate more pressure to see how well it reduced the events prevented optimal therapy pressure.
What is the highest pressure you could tolerate and what happened (what symptoms) when they went higher?
There is another machine that can be used when people have trouble with the pressures. ....Bilevel

Finally...I assume you haven't got the cpap yet because you don't see it being able to help and it sounds like you want to pursue other measures...like surgery.
Is that where you are wanting to go? That's your choice but this is a cpap help forum and that's what we do here...try to help a person get to where they can use cpap effectively and get past the hurdles that can pop up.

If you want to try cpap....bilevel would be the next logical step since you can't tolerate higher pressures and higher pressures are likely needed to reduce that AHI of 7.

BTW....often OSA is worse in the deeper sleep stages (especially REM) so it might be that your AHI of 7 without cpap would be worse if you did get more deeper sleep. I am not saying that yours for sure would be worse but it might.
It's quite common...mine is...in non REM sleep my AHI is 12 but in REM it's 53 per hour. I never got much sleep because every time I went to deep sleep the apnea events would wake me up.

If you want help with cpap/bilevel...we can help.
If you just want justification for going down the surgery road...we can't help except to wish you good luck and maybe some of the forum member here now ...on cpap...that had surgery in the past and it didn't last or didn't work will chime in.

[Julie]

He already had the procedures... and I wonder if his anatomy is so changed by them that using Cpap is far less effective than it would have been without them.

[cppoly]

Well yea that’s what I was hoping for, some type of assurance that I’m not crazy and that CPAP doesn’t work for me. The highest pressure setting was at 7 cm and to me it felt so intense and overwhelming. So going higher doesn’t seem practical.

Regardless of the numbers whether O2 or AHI, RDI, etc. shouldn’t we be going instead of how I feel? Having sleep apnea has ruined my social life and put a significant burden on my marriage so we can talk about numbers but I’d rather talk about how I feel.

So at this point I’m willing to try anything and just wanted some type of justification for jaw surgery, given that I've tried almost and most likely everything else.

[TASmart]

My N3/4 was quite low during my titration also. However as I progress along my SA journey it is increasing on most nights. One reason is that during an in-lab study under the very difficult conditions of sleeping with a xPAP for the first time, I think its unusual to be able to relax enough to get into deep sleep.

Ignore the end of the alphabet, he is wrong about most things CPAP related.

[cppoly]

I should have added I did CPAP and bipap for one week each before any surgery. Did nothing. Only felt worse.

Maybe CPAP isn't for everyone.

[Pugsy]

Regardless of the numbers whether O2 or AHI, RDI, etc. shouldn’t we be going instead of how I feel?

Yeah...how you feel is important but there is one number that I feel moves to the top of the line in terms of importance.
That is the oxygen levels.
It's one thing to never drop below 90% with a low AHI and it's another thing to drop to below 85 or like me below 75%.

You feel like crap without cpap...you feel like crap with cpap...which is "less crappy"?

You want us to tell you that it is okay to say "cpap is not for everyone" and tell you it's okay to go down some other path???
Unlikely to happen here since this is a cpap help forum not a forum for alternative solutions to sleep apnea.
Now maybe you just can't handle it for whatever reason but if your oxygen levels drop much...you are doing more than just feeling crappy...you are damaging your body by low oxygen levels.
IMHO it's one thing to just feel crappy from not enough sleep but feeling crappy is pretty much it...it's a whole new ball game if the body is being damaged by lack of oxygen. There's crappy but no really bad damage and there's crappy with damage to the body.....So the O2 number is pretty important in my book because ultimately it will dictate how a person feels.

Surgery is no guaranteed fix as you have found out since you seem to have done all of the usual ones for curing sleep apnea which of course doesn't work so great for a lot of people ...and it sounds like you have done everything but the mandibular advancement. That might work if it can open the airway up (assuming that the problem is just a small airway and not an abundance of floppy airway tissues).

[Julie]

If you had come here for help before giving up on things after one week - you likely would have found lots and been able to use Cpap just as well as anyone else here, but you gave up, didn't look for help with it, but instead did irreversible surgery... and now want to do even more! You're really going about it backwards, but at this point I doubt if you're interested in getting our help, just want permission to have more surgery (after all, the others were so successful, weren't they?). Really sad.

[Guest]

I found no matter what I did or tried including using all the different masks, my sleep was definitely worse using the machines. If my sleep had improved just 1%, 2%, or more I would of taken that as a small sign of success and then possibly googled these forums and done something to improve my numbers. But being -15% sleep per night (apnea/hyponeas plus machine intolerance arousals) with CPAP/bipap just wasn’t a scenario I could live with and AT best if I somehow swung those numbers around improved 5% I don’t think living like this would have been tolerable. I am a very light sleeper to begin with so using the machines just wasn’t a good match for me from the beginning. It’s not like I tried the machines for one night, gave up, and returned them. I was on the machines for a whole two weeks total and my sleep only got worse each and every night.

[D.H.]

Assuming that you slept for seven hours, that's less than a minute! It does not sound like an adequate sample.

Note though that if you have an AHI of zero on a titration test, it means that CPAP is working well, not that you don't have SDB!

[Guest]

I should have added I did CPAP and bipap for one week each before any surgery. Did nothing. Only felt worse.

Maybe CPAP isn't for everyone.

Are you having "central" or obstructive events? If centrals surgery will not help.
Do you have a copy of your study results?