Why is an AHI below 5.0 considered normal?

The section labeled "CPAP Definitions" states that an AHI below 5.0 is considered normal, if a person sleeps for 8 hours and gets 40 apneas that night how can that not be a problem?
What am I missing? I thought the whole idea was to not to experience a sleep apnea event? I was diagnose with a AHI of 6.4 ( considered mild ) and with the APAP machine I now
average 3.7 I feel I sleep a whole lot better now than before the APAP machine and I am hoping on getting my AHI even lower, is this realistic?

Because the medical community had to come up with some sort of line in the sand for diagnosing sleep apnea and they came up with 5 per hour average.

Some people do need a lot lower than the 5 per hour average to feel better...some don't.

There's more to how or why we don't feel so good besides just the number of events per hour anyway that really isn't taken into account in the overall AHI numbers....but the medical community had to come up with something and that's what they came up with.

I can see why you would ask, especially having mild OSA the reduction to below 5 doesn't seem much compared to someone with moderate or severe OSA, but that's just the way it is.

Doctors draw their line at 5, but insurance often draws it much higher.
One number may be for apnea by itself, with a lower number for a patient with "comorbidities"
My initial dx was only 13, not enough for BCBS, but my HBP qualified to squeak me in under the lower line.
Oddly, diabetes was not considered a comorbidity in by BCBS.

Yeap comletely arbitrary. The lower the better, but 5 is generally considered acceptable. I really think that it should be somewhat lower, but the zero mark is elusive for most of us.

Maybe if our bodies were robotic Zero would be the normal. Unfortunately we are built by the lowest bidder. Jim

New poster golf writes...

Golf016 wrote:The section labeled "CPAP Definitions" states that an AHI below 5.0 is considered normal, if a person sleeps for 8 hours and gets 40 apneas that night how can that not be a problem?
What am I missing? I thought the whole idea was to not to experience a sleep apnea event? I was diagnose with a AHI of 6.4 ( considered mild ) and with the APAP machine I now
average 3.7 I feel I sleep a whole lot better now than before the APAP machine and I am hoping on getting my AHI even lower, is this realistic?

And I have long believed these to be excellent questions.

The preposterous notion that an AHI below 5.0 is somehow "normal" is completely arbitrary, and any number of us apnea patients hereabouts can attest to feeling crummy below 5.0.

My personal experience is that an evening producing anything below about 1.0 AHI yields a negative feeling morning. (Results do vary.)

As to getting the AHI lower than 6.4 lower? One suspects that it is entirely possible. I have learned much from this fine forum, including the wide-open range settings for an APAP of 5-20 inches sets a patient up for failure as too low of a low pressure range setting means that the patient must go into frank obstructive apnea before the level nudges up. Ick.

And, too high of a higher level setting means that the machine might chase snores and leaks, and take the patient far away from the optimum pressure zone.

Some have suggested that a very tight APAP range, beginning about your titrated pressure, and extending only 2 or 3 inches above, leads to the most successful APAP range.

BTW, my doc is fine w me experimenting w my pressure range. Hopefully yours is as well.

AHI below 5.0 is considered normal because the people who set the bar generally don't live with sleep apnea.
My original diagnosis was around 84. Now I hover around 1.0 + Or - with occasional bursts up to 3.5 or more. I actually hit 26.6 last December. Must have been a really bad night.

I've always thought an AHI of 5 was way to high... My AHI averages a .3, with only a few days in the last 7 years above a 1.0. I've notice that I don't feel crummy during the day when my AHI was above a 1. But... I don't feel as good when I get an AHI of zero... which I get 2 or 3 times a month. To get 40 events a night would drive me nuts. I have learned to get optimal therapy and let the numbers and the way I feel during day fall where it is.

Sheriff

After 8 years on the machine, I still average 1.5-2.5......Feel great. I only sleep about 6-7 hours on average. Have only been below 1.0 about 10 time in the 8 years. Every so often I'll get a restless night and score 4-5.

Golf016 wrote:The section labeled "CPAP Definitions" states that an AHI below 5.0 is considered normal, if a person sleeps for 8 hours and gets 40 apneas that night how can that not be a problem?
What am I missing?

What are you (and most of the people replying) missing? You are missing that an AHI below 5.0 is considered normal for someone who does not use CPAP.

If your untreated AHI was less than 5.0, would you go to the trouble to treat it with CPAP? Or, would you adopt some other strategies like - avoiding backsleeping, treating irritation of the nasal airway, losing weight, avoiding eating near bedtime, etc.?

You are thinking about treated AHI. For those of us who must use CPAP because our AHI is much higher than 5.0, once we go to the trouble to use CPAP, we want to drive the AHI down way below 5.0.

My untreated AHI was around 70. Treated AHI for the last six months is showing 0.88. And, much of that 0.88 appears to be SWJ (sleep/wake junk).

Golf016 wrote:The section labeled "CPAP Definitions" states that an AHI below 5.0 is considered normal, if a person sleeps for 8 hours and gets 40 apneas that night how can that not be a problem?
What am I missing? I thought the whole idea was to not to experience a sleep apnea event? I was diagnose with a AHI of 6.4 ( considered mild ) and with the APAP machine I now
average 3.7 I feel I sleep a whole lot better now than before the APAP machine and I am hoping on getting my AHI even lower, is this realistic?

Probably defined by the insurance companies based on cost analysis rather than what is actually "normal" -- just like all health conditions requiring medical intervention, insurance companies determine the severity of your diagnosis and treatment based on their bottom line and year-end bonuses. The American health-for-profit (not "healthcare") system is a racket.

Anyway, once I got my therapy dialed into optimal treatment, my AHI averages around 0.4 with a variability between zero and 1.5 AHI. So I guess for me, my normal is 0.4 AHI (NOT 5.0).

Golf016 wrote:The section labeled "CPAP Definitions" states that an AHI below 5.0 is considered normal, if a person sleeps for 8 hours and gets 40 apneas that night how can that not be a problem?
What am I missing? I thought the whole idea was to not to experience a sleep apnea event? I was diagnose with a AHI of 6.4 ( considered mild ) and with the APAP machine I now
average 3.7 I feel I sleep a whole lot better now than before the APAP machine and I am hoping on getting my AHI even lower, is this realistic?

What is the breakdown of your events? If your AHI of 3.7 comprises hypopneas and obstructives then you can certainly tweak your settings to lower the AHI.

Members here help new CPAP/APAP users to optimize their treatment, so if you wish to do so, why not post data here and see what changes can be made to your current settings?

If you felt rotten with an untreated AHI of 6.4, you may well have had very long apneas, and bad desaturations, and getting your treated AHI lower will greatly help.

Correction...

Captain_Midnight wrote: My personal experience is that an evening producing anything below about 1.0 AHI yields a negative feeling morning.

Should read...

My personal experience is that an evening producing anything above about 1.0 AHI yields a negative feeling morning.

I blame my keyboard operator.

I have 2.3 events per hour. 8 hour sleep that is 16 for the total night. Is that bad, normal, below average?