30 day stats - Suggestive of Underlying problems?

My 30 day Stats:
Average AHI = 1.86
Average OI = 0.12
Average H = ​1.06
Average CA = 0.55


Does that suggest that 60% of the AHI is due to hypopneas , 6% is due to obstructions and 30% is due to non-obstruction (clear airway apnea) ?

If so, does that suggest that obstructed airway is the least of the issues I need to deal with?

Using Resmed Airsense 11 Autoset (5-15) for the past 66 days with F30 mask

These are the treated results - in other words your machine is doing its job properly and your apnea / hypopnea is under control. You're correct in saying that the majority of events are hypopneas, but these are just the ones the machine let through. Without the machine, they may well have been obstructive apneas. It would be instructive to see what your original sleep study results looked like, to quantify how much of an improvement you've achieved.

It would also be good to look at the leaks, to make sure they are under control - prolonged large leaks can distort the numbers and disturb your sleep.

Finally, and most important: Do you feel better? Are you getting restful and refreshing sleep? That's the real bottom line.

If you're getting enough, good quality sleep, those results are really good after a couple of months. Getting overly-focused on AHI numbers can be a mistake. Also, it's worth keeping a diary. Write down briefly every morning how you feel, whether you think you woke frequently, spent lengthy periods awake, etc. I started doing this, even before I began treatment three months ago and it's been very useful. Why? Because there's a clear correlation between my bad nights and my lowest AHI numbers. It sounds counter-intuitive, but when you think about it, you're less likely to have apneas during shallow sleep and not at all if awake. So a good night's sleep, when you wake feeling refreshed, with an AHI of 3 is infinitely better than one where you wake feeling shattered and your AHI is only 1 or less.

MMcG wrote: ↑

Tue Dec 07, 2021 1:41 am

Respirator99 wrote: ↑

Mon Dec 06, 2021 11:01 pm

Finally, and most important: Do you feel better? Are you getting restful and refreshing sleep? That's the real bottom line.

Well, there is the problem. I feel no different (subjectively) when compared to prior to PaP therapy, about 66 days ago.
Other than having to wake to use the potty three or four times a night (a condition that is ascribed to taking HTCZ for kidney clearance), my nights have been restful and refreshing for a 75 year old.


Leaks do not seem to be a problem. (Except when caused by mask displacement caused by body movement)

I'll have to think about the notion that hypopneas would have been become obstructive were it not for intervention by "the machine". Is it possible that hypopneas are also the result of diminished respiratory effort (shallow breathing)?

You might want to talk with your doctor about the timing of your HCTZ dosing. It'd be nice if you could have fewer bathroom breaks during the night.

If you're feeling well rested, then that's a key datum, with number that are in the right zone, as yours are.

By definition, hypopneas are reductions in airflow lasting 10 seconds or more. You can zoom in on the H flags to see what's going on with your flow rate. I don't think respiratory effort can be inferred from the data we can see in Oscar, but others may understand that better than I do.

Miss Emerita wrote: ↑

Tue Dec 07, 2021 12:57 pm

You might want to talk with your doctor about the timing of your HCTZ dosing. It'd be nice if you could have fewer bathroom breaks during the night.

By definition, hypopneas are reductions in airflow lasting 10 seconds or more. You can zoom in on the H flags to see what's going on with your flow rate. I don't think respiratory effort can be inferred from the data we can see in Oscar, but others may understand that better than I do.

I've discussed this with doctor. I am currently taking 25 mg at approx 6 am in the morning (after sleeping). So we don't see how we can avoid the "potty" effect by changing the dosage time. (HCTZ's half-life is about 15 hours, so if I take 25 at 6am I still have 12.5 mg (on board) at bedtime. Overlay that with the possibility that the "potty" breaks maybe more driven by habit after years of "going" every 2.5 to 3 hours for the last 10+ years

Yes, respiratory effort certainly cannot be measured with standard PaP home equipment, and drawing inferences from OSCAR about respiratory effort is questionable. What I was really getting at was this, IF a hypopnea (50% reduction in air flow) could occur without any obstruction at all. If so, the hypopnea could be the result of brain just not ordering the chest to expand as much (what I would call "shallow breathing". In that specific case, I don't see how increasing the mask pressure would have much effect. ( somewhat similar to the situation of a clear airway central apnea).

All that said, IF the "Gold Standard" is simply "am I feeling better?", then it appears at this time that PAP therapy has done nothing but empty my pocket book. BUT, because that "better" is so very subjective, and relies on former memory (although only 65 days ago), I'm not inclined to disregard my doctor's direction and chuck the whole experiment.

You might be interested in this account of the changing definitions of “hypopnea.”

https://sleep.biomedcentral.com/article ... 018-0023-1

It includes some discussion of obstructive vs. central Hs.

Miss Emerita wrote: ↑

Tue Dec 07, 2021 6:33 pm

You might be interested in this account of the changing definitions of “hypopnea.”

https://sleep.biomedcentral.com/article ... 018-0023-1

It includes some discussion of obstructive vs. central Hs.

Huge and very technical discussion there. Going to take some time to digest fully. But the overall theme seems to be that the term “hypopnea” was not well settled.

That said, I’m trying to understand a justification for my therapy. As I stated before, I don’t “feel” better having experienced therapy. In fact I don’t “feel” any difference at all.

Doctor’s justification is “but you are still having hypopneas”. (What I did not ask…. But perhaps should have….”Doc, what is the hypopnea goal?)

dataq1 wrote: ↑

Tue Dec 07, 2021 12:11 pm

MMcG wrote: ↑

Tue Dec 07, 2021 1:41 am

Respirator99 wrote: ↑

Mon Dec 06, 2021 11:01 pm

Finally, and most important: Do you feel better? Are you getting restful and refreshing sleep? That's the real bottom line.

Well, there is the problem. I feel no different (subjectively) when compared to prior to PaP therapy, about 66 days ago.
Other than having to wake to use the potty three or four times a night (a condition that is ascribed to taking HTCZ for kidney clearance), my nights have been restful and refreshing for a 75 year old.


Leaks do not seem to be a problem. (Except when caused by mask displacement caused by body movement)

I'll have to think about the notion that hypopneas would have been become obstructive were it not for intervention by "the machine". Is it possible that hypopneas are also the result of diminished respiratory effort (shallow breathing)?

Something is wrong if you are getting up 3-4 times a night. I take hctz and since using pap only get up once, if that.

babydinosnoreless wrote: ↑

Wed Dec 08, 2021 10:29 am

Something is wrong if you are getting up 3-4 times a night. I take hctz and since using pap only get up once, if that.

Well one thing we know for sure is that people are different, and can react differently to the same medication.

If I didn't mention it above, I've been taking HCTZ for at least 10 years and during that ten year period I'd estimate that my nightly bathroom calls have stayed fairly consistent at 3 to 4 per night. Being on Pap therapy has not altered that routine (neither would I have expected it to).

i don't want to lose track of the fact that your numbers are very good. What's not good is how you feel during the day.

One experiment you could try is to use an oximeter to see whether you're getting any significant O2 drops below 90 or 89 during the night. If you are, that would be a good thing to talk with the doctor about. You can see whether your doctor would provide one for you, or you can buy one yourself if that's within your budget. Some oximeters are compatible with Oscar; click on the Oximetry Wizard link on the welcome page.

Your need to get up so many times during the night must also be contributing to your feeling unrefreshed. Those episodes may well be messing with your "sleep architecture" -- your progression through all the stages of sleep that your body needs. Another good topic to take up with the doctor -- the trade-offs the drug may be entailing for you.

Finally, there are conditions unrelated to sleep apnea that can cause people to feel tired, fatigued, or sleepy during the day. There, too, a talk with the doc would be in order.

Miss Emerita wrote: ↑

Wed Dec 08, 2021 1:04 pm

i don't want to lose track of the fact that your numbers are very good. What's not good is how you feel during the day.

As I mentioned before, I don't feel any different than I did before I began therapy.
But what I just did was take the Epworth Sleepiness test, my score was 8. Scores of 8-9 mean: " You have an average amount of daytime sleepiness".
I also just took the Pittsburgh Sleep Quality Assessment (PSQI). There I scored 4 points, that is still within the range of adequate sleep quality.

What I'm wondering about is the high fraction of my AHI that is assigned to Clear Airway (is that indicative of a neurologic issue?)
And the high fraction of my AHI assigned to Hypopneas, but don't seem to indicate any obstruction (is that indicative of incomplete chest expansion or effort?) If my brain is just not telling my chest wall to expand or my diaphragm to contract to the same level that situation also (seems to me) to be a neurologic issue.

In any event, doctor just tells me to keep on using the Pap equipment. But I can't help thinking that I'm missing some (maybe neuro??) problem>

BTW, My sleep study (home study) - according to the doctor - was 11 AHI with no PaP equipment.

ALSO, the Oximeter - particularly if I can find an affordable one that will sync with OSCAR - is a great idea. I'll work on that.

A few CAs and Hs don’t indicate any problem whatsoever, but if this worries you, pursue a more detailed conversation with your doctor.

What I'm wondering about is the high fraction of my AHI that is assigned to Clear Airway (is that indicative of a neurologic issue?)

Your (treated) central index is 0.55. In other words, one central apnea every two hours. This is not indicative of any problem at all. I can't help thinking that you are over-thinking all this. Your numbers are great and the machine is doing its job.

I can't comment as to whether you really need to be on CPAP - as I said in my earlier post, it would be illustrative to see your original sleep test report(s) if you can share them.

What should I see in the original sleep study? I asked the doctor’s office for the sleep study and what surprised me was there were no graphs at all. Rather there was just a recitation of statistics, number of hypopneas, number of obstructions, % of time below O2 baseline, etc. (in other words similar to what we see in the left hand panel of a OSCAR daily report).
So I’m unsure that the sleep doctor has actually sent me the complete report? Would there normally be any graphs?