AHI less than 5...Sleep Therapist says 'not to worry'

RuthArt wrote:Today was my day with the Sleep Therapist....I told her about the comments you have all made and she
feels I should stop being fixated on the numbers (she almost didn't give me back my SD card!) and not
look at the data but maybe once/month.

I don't always feel as sleepy during the day as I used to, but I have gained weight and don't get the
exercise I know would help, so now I will start focusing on that aspect.

Thank you all for your comments and suggestions.

Well, you shouldn't fixate on the numbers. However, it's important to get your therapy right. AHI is a useful number in order to do this, but it's not the complete picture. If your AHI is 30, you've probably got a bad problem.

What a lot of the medical community doesn't realize is that if you have an AHI of 3, you might be good, or you might still be sick. You might even have an AHI of 0 and still have some sleep breathing problems.

You might have long periods of time where you are breathing poorly enough to harm you, but you don't stop breathing enough to be recorded as an "event" by the CPAP. You might have short breathing pauses that wake you up enough to start breathing again, and disturb your sleep patterns, leaving you with poor quality sleep.

If your AHI is good, but you are still feeling bad, there might be some clues in your SD card data.

However, there is SOME validity in her comments. You can get too concerned with the numbers when there's really nothing to fix with your therapy. You can get classical hypochondria problems, although that's often an excuse for the medical mafia to just not do their job.

One other thing to watch out for is what I call "CPAP blindness." Us CPAP users have a tendency to blame all our health problems on CPAP or apnea. Don't forget we still suffer from all the health problems that non-apneacs suffer from. Even your doctor may suffer from this problem.

One more thing is that sometimes, your body takes a while to recover completely, even if your therapy is working perfectly.

While the seeming inattention of your of medical professionals yanks my chain, I would suggest a bit of a different approach for a couple weeks. Keep a "wellness" journal. Log things like how many times you remember waking, perceived quality of sleep, daytime sleepiness, energy level, etc. Don't look at you data until the end of the journaled week. See how your week correlates with your data when knowing the data is not an influence. I remember when the first thing I'd do every morning is look on the machine at my AHI. I'm afraid that may have affected my expectations for my day and resulted in self fulfilling prophecy.

That said, I disagree with the too-common perspective of anything under 5 is the end all. I agree with the quote attributed to a St. Jerome (?) - Good, better, best. Never let it rest. Til your good is better and your better is your best. Since we have machines that enable us to do so, why not get the best treatment possible? Ideally we will achieve our absolute best AHI without triggering pressure related issues that disrupt sleep more than those "few" events do. For some people that's frequent zeroes. Others can't deal with the pressure they'd require to get an AHI that low and decide to be content with a few short events as a compromise. It can be a balancing act. An AHI of 2 is your best only if upping your pressure a bit would cause a problem. These days my AHI runs between .7 and 1.7 most nights. I've pretty much accepted that as I have trouble with air in the belly with my last pressure increase.

Things may still settle in nicely for you. Too soon to tell. If poor sleep continues very long, I'd be looking for other contributors besides OSA.

Hydraulix989 wrote:I notice that how well rested I feel in the morning is VERY correlated with my AHI even down to <1. Whenever I feel amazing in the morning, I check my AHI and it's almost always < 1, but on crappier nights, I feel not so well rested, and when I check the machine in the morning, the AHI is usually in the 1.5-2.0 range. I'd say it's a pretty strong correlation, in that I rarely see the opposite cases (sleep bad, AHI < 1 or sleep good, AHI > 2).

To me it seems pretty illogical and arbitrary to draw a cutoff line at AHI 5. That means you still stop breathing FIVE times an hour in your sleep! It appeals to the human perspective that stopping breathing in your sleep at all shouldn't be considered normal.

The thing is, apneas are not that unusual while we are awake or semi-awake, and activities like rolling over, concentrating, tossing and turning, etc are often associated with interrupted breathing patterns. In a sleep lab they use an EEG to monitor brain activity and determine if the patient was fully asleep when the apnea was observed. We don't have that capability with our machines at home.

While it is possible that the increased apneas and hypopneas are causing your sleep to not be restful, it is also possible that the cause and effect is the opposite. A restless night with many micro-arousals can cause you to feel non-rested and cause a higher AHI reading due to increased semi-awake breathing irregularities. In that case, I would expect to see increased rates of CA events rather than OA events on those nights.