Someone please help this Newbie!

[DreamOn]

CONGRATULATIONS on a job well done, Alex!!!!! Keep doing what you're doing, because it's working great! I look forward to reading how you're feeling in another week or two. This is truly the beginning of a new life for you.

[Mary Z]

Lizistired, I'm confused by what you said. I thought an apnea was the cessation of breathing for 10 seconds or more. Where am I going wrong here? A hypopnea is reduction in airflow of 50 % for greater than 10 seconds. Thanks.

[AJimen05]

My sentiments exactly. Signing on and registering here was the best decision I've made. I must have had this condition for such a long time because I haven't felt this good in a LONG time. Lol

[DreamOn]

Signing on and registering here was the best decision I've made.

Me too!!!

[Lizistired]

Hi Alex,
Not the "flow limitation". Look at the "Flow" line. If you adjust the pane to view 10, 5, or 1 minutes you can see each breath
I have alot like this image where they aren't 10 seconds long so they don't register.

[DoriC]

Alex, Amazing! Congrats! Knowledge is Power! You have quickly become one of the "stars" on this forum. Pretty soon you'll be paying it forward! We've been at this over 2yrs and have never achieved a 0.0 AHI and it was never suggested as something to even strive for. It is nice though to see a 0.5 once in awhile.

Liz, I understand the flow limitations but what does the flow line indicate? Each breath for every 5 seconds? Our machine doesn't show that and it's interesting to see.

[LoQ]

We've been at this over 2yrs and have never achieved a 0.0 AHI

If I see a 0.0 on my LCD in the morning, my first thought is, "why didn't I go into REM last night?" You see, I could have a 0.0 if I don't get any REM sleep. NOT WORTH IT.

Of course, if I can get a 0.0 AHI and have REM sleep and all of my other goals, then I am glad, sure. But I can tell you from experience that the night to night value of the AHI has almost NO correlation with how I feel the next day, as long as the AHI is a reasonable number.

Like everything else, the AHI is a tool to help you treat your SDB. Achieving a 0.0 AHI is sometimes unrealistic and for some people, undesirable. If you get there, just make sure you haven't sacrificed something more important to get that goose egg.

[Lizistired]

DoriC, That image is showing one minute and I wasn't breathing for half of it with no noticeable leaks or limitations. But they weren't 10 seconds so they weren't reported as apneas.
I'm new at posting images.. first it was too big, then I shrunk it too small.
I'd like to see alex's when he had that solid clump of apnea flags up in the 40's! His volume was huge too. Mine runs under 20l/min and his looked to be up around 50l/min so I assume he was gasping.

[Pugsy]

Like everything else, the AHI is a tool to help you treat your SDB. Achieving a 0.0 AHI is sometimes unrealistic and for some people, undesirable. If you get there, just make sure you haven't sacrificed something more important to get that goose egg.

So true.
The other day I saw on another apnea forum where a newbie was reporting an AHI 0.6 feeling good, not much leak, and was wondering if they should increase their pressure...... I sometimes wonder if they think that with a big zero all the symptoms would magically disappear.
I am like you. Only way I ever get a 0.0 is with a short nap and I haven't had time to get to REM. My machine gets a workout when I hit REM.

[DoriC]

Thanks, it's good to get reinforcement on the subject of 0.0 AHIs!

[DreamOn]

(Thanks, Alex, for allowing us to discuss a few side topics in your thread. And, by the way, your thread here was referred to elsewhere on this forum as an example of success!)

I just looked back at my therapy records, and I've had 14 zero-AHI nights since I got my S9 Autoset in early June. Two of those were this week. These are nights with 7 to 8 hours of good, solid sleep too. I noted dreaming on some of those nights and chart patterns look like I had plenty of REM. So it is possible for some of us. I can't tell any difference in the way I feel whether it's 0.0 or 1.0 AHI. Psychologically, though, it sure is nice to wake up to all zeros!

Now, with my S8 Elite II, I did not get results numbers like this. I don't think it has anything to do with the quality of therapy, but rather, differences in the way the machines report events. I regularly had hypopneas scored on the S8, but I rarely have any on the S9. The S8 machine didn't differentiate between obstructive and central apneas, but the S9 does. On my S9, I rarely have any obstructive apneas -- only a few centrals. So I do think that reported AHI can depend on which machine is used. I guess my meandering point is that the numbers don't matter so much after a certain point. As long as AHI isn't too high and you feel good....that's what matters.

All that being said, for some reason, I seem to sleep much better with my S9. I was still turning several times during the night with my S8, but I don't do that with my S9. I have experimented with pressure settings, but I was at 8.0 when I last used the S8 and now I'm using pressure of 7.8, so there's really not much pressure difference. I'm not really sure why I sleep better. It could also be the different humidifier and heated hose that made the difference for me. Or perhaps it's something completely unrelated to sleep. Whatever the reason, I'll take it!

[rested gal]

I can't tell any difference in the way I feel whether it's 0.0 or 1.0 AHI. Psychologically, though, it sure is nice to wake up to all zeros!

I can't tell any difference in the way I feel either, whether it's 0.0 or even as much as 3.something. I feel completely refreshed and rested in the mornings...either way.

Now, with my S8 Elite II, I did not get results numbers like this. I don't think it has anything to do with the quality of therapy, but rather, differences in the way the machines report events.

Right. I agree... therapy can be the same, but the definition of events (thus the reporting) can be quite different between different models and/or different brands.

I regularly had hypopneas scored on the S8, but I rarely have any on the S9.

I think that would be true of many people if they used an S8 and then an S9. True ever since the ResMed designers changed where they would draw that arbitrary line-in-the-sand for where a flow limitation will be labeled "hypopnea" -- or will labeled just a "flow limitation."

The S8 machine didn't differentiate between obstructive and central apneas, but the S9 does.

Yes, that was another change ResMed made when designing the S9.

So I do think that reported AHI can depend on which machine is used. I guess my meandering point is that the numbers don't matter so much after a certain point. As long as AHI isn't too high and you feel good....that's what matters.

I agree. I think that's a very good point you make, DreamOn.

[tschultz]

Alex that's great to hear, I think you may actually now have therapy that works for you.

When you get a chance I do suggest you take a close look at your detailed data across several nights, especially the flow data when zoomed in on a 1 minute or 5 minute time scale and compare how things look on average as compared to when you are having an apnea even as well as when hypopneas have been flagged. Knowing how your breathing looks will help you to better understand things as time goes on and will help you determine if anything has changed significantly. It would be good to look at some of the data from before you got treatment straightened out as comparing this with your newer data may give you more insight as well.

I find that keeping a log of how you feel when you wake up helps when fine tuning things as well, but be cautious about jumping to any conclusion on just a single night's information. I am sure you will soon realize that the index numbers only tell part of the story, how you actually feel is much more important. You certainly have made significant improvements in your therapy with only a small adjustment in pressure and are well on your way to improving now that treatment is more effective. I do hope you start to feel it working soon as well.

I was told to expect the metabolism to start to settle to something more normal in the first month or so with heart and brain issues mostly repaired in 3 to 6 months. I know I have certainly seen significant changes in my energy level and overall mood in the past couple of months and now eagerly await things to improve further. Now that I actually have energy I am planning to return to exercising very soon and try to tackle the weight gain, which resulted largely (pun intended) from the untreated OSA.

[idamtnboy]

Can you explain a bit more about flow limitation? I'm not to knowledgeable about that. What does it mean and what am I looking for?

Good question. We've discussed it here before and essentially concluded it's a slippery indicator, hard to define clearly, and does not have a meaningful numerical value. In other words, we really don't know much about it, other than it is a measure of sorts of how much the upper airway passage is blocked. Here's a quote from a medical paper I just came across. "Flow limitation is a dynamic obstruction event characterized by the fact that inspiratory flow remains constant regardless of the increase in the pressure applied by the patient’s inspiratory muscles [10,11]." From what I find even the professionals in the business have difficulty characterizing it.

Of all the data on your Resscan screen, this is one you would be better off to ignore for the time being. After you've been in this game for 6 months to a year and have a more complete understanding of all the various aspects of your therapy, then come back and cogitate on it. Not to be flip, but by then you'll have learned enough that it makes some sense, or learned enough to know not to care about it! Or better yet, that graph may diminish to only a few short spikes.

But hey, the fact you care enough and are aware enough to ask about it is commendable!

[idamtnboy]

Lizistired, I'm confused by what you said. I thought an apnea was the cessation of breathing for 10 seconds or more. Where am I going wrong here? A hypopnea is reduction in airflow of 50 % for greater than 10 seconds. Thanks.

That's the official definition. It could have been 5 secs, 8 secs, or whatever. The general consensus is that 10 seconds was chosen as that is the threshold that clinical data shows to be the point where there is a measurable or significant adverse effect on the body. The generic definition of apnea is a cessation of breathing, but what is cessation? The time span of one normal breath, or two breaths, or ..... You get the point I'm sure.