Would you accept a few events to get better sleep?

Most folks would automatically say yes but I suppose the answer lies in the definition of "a few".

Here's what I have going on. For five years I've used a PRS1 760P, which was originally set by my doctor [in my opinion incompetently] at fixed BiPap pressures of 17/13. Having evidently a large hard to fit face I struggled mightily with leaks, trying a dozen FFMs before settling on a Quattro Air. (I'm unfortunately a certified mouth only breather-no choice.) With a lot of help here I was able to re-evaluate my pressure needs and brought the machine down to an easier to manage 11/7. Between that and tightening the straps more than is recommended I've cruised along pretty well for all this time. My AHI has hovered around 1.0 with no real weirdness on my charts.

Fast forward to now, and although many would say leave well enough alone I have it in my mind that I really shouldn't need bilevel at only 11/7 so I want to try and switch to the simplicity of an APAP. I pick up a nice low hours Airsense 10 Autoset and started off with settings of 8 min. and 20 max., just to see where it will go. What I discover is that while my 95% pressure is in the 11-ish range, during what looks like REM sleep I can jump up to needing as much as 13-14 for a short time which causes leak issues that inevitably wake me up. So, what I tried to do is to cap the max pressure at 12 cmH2O, with results that look like this:
As you can see, at one point the pressure line is bumping up to the max of 12 and would have probably gone up to the 13-14 range if I had left the max open to 20. But I would have been wide awake by then.

So my question is this: Would you routinely accept a few events of this type in order to get a decent night's sleep? I know the docs say stay under 5 and all is well but from spending time here I know that isn't necessarily true.

My option would be to start playing mask roulette again but that hasn't worked out well historically.

ABSOLUTELY....You will drive yourself crazy trying to eliminate every last event.

old dude wrote: ↑

Mon Aug 06, 2018 12:07 pm

So my question is this: Would you routinely accept a few events of this type in order to get a decent night's sleep? I know the docs say stay under 5 and all is well but from spending time here I know that isn't necessarily true.

I absolutely would. I sought out diagnosis and treatment because I want to sleep well, not because I care if an arbitrary number is zero or not.

At the moment, low AHIs dont' mean I sleep well. By AHI standards two nights ago was great (Kaiser will think so), but by how well I slept, two nights ago was a disaster of disturbed sleep. I'd trade off a higher AHI (but still with decent Oxygen saturation) for a good night's sleep in a second.

For me, fewer events means better sleep. When I have leaks, I don't lower pressure, I fix, or tame the leaks... Mask liners were a huge help taming leaks when I was using a ffm. I still has some, bit they didn't bother me anymore.

Yep. Sure would. If allowing the machine to go higher caused more problems than it fixes...like messing with sleep quality then I would limit the max as long as it didn't allow a truckload of apnea events to happen and I was sleeping good AND feeling good.
The most perfect AHI in the world doesn't mean squat if we sleep like crap and feel like crap.

I would be doing a happy dance for sure if I had your report. I wouldn't care that the machine kissed the max a little bit.

My AHI hovers around 1 all the time--sometimes above, sometimes under.
My sleep is more important than a silly number--and my sleep doc agrees.

To be honest, my concern (or potential concern) is more about the actual events than the number that is comprised of the events.

How does one know which particular apnea is "the one"?

A case could be made that they're the same thing, but wouldn't a CPAP patient prefer that a given AHI on a particular night be made up of more hypopneas than fewer apneas?

old dude wrote: ↑

Mon Aug 06, 2018 3:55 pm

To be honest, my concern (or potential concern) is more about the actual events than the number that is comprised of the events.

How does one know which particular apnea is "the one"?

Sleepy head reports total time in apnea if that stat is something you want to keep track of.

Everyone that matters has already weighed in. But I'll add a resounding YES.

old dude wrote: ↑

Mon Aug 06, 2018 3:55 pm

wouldn't a CPAP patient prefer that a given AHI on a particular night be made up of more hypopneas than fewer apneas?

Not particularly.

If an air flow reduction is 78% and lasts at least 10 seconds it earns a hyponea flag.
If an air flow reduction is 80% and lasts at least 10 seconds it earns an Obstructive apnea flag.

Do to really think that the 2 % difference between the two flags is worth being more okay with 78% reduction than 80%?

Pugsy wrote: ↑

Mon Aug 06, 2018 4:56 pm

old dude wrote: ↑

Mon Aug 06, 2018 3:55 pm

wouldn't a CPAP patient prefer that a given AHI on a particular night be made up of more hypopneas than fewer apneas?

Not particularly.

If an air flow reduction is 78% and lasts at least 10 seconds it earns a hyponea flag.
If an air flow reduction is 80% and lasts at least 10 seconds it earns an Obstructive apnea flag.

Do to really think that the 2 % difference between the two flags is worth being more okay with 78% reduction than 80%?

No.

I was laboring under the false assumption that it was more like 50-100; I have no idea why. Clearly 2% is no biggie.

I appreciate you clearing this up Pugsy.

I'm in this dilemma now with my snores. I want to see if I can get less arousals in sleep if I can eliminate the snores, but I risk disturbing the sleep and increasing arousals with higher and higher pressures.

I've already become way more tolerant of my increasing pressures, and the extra pressure support from the bi-level is definitely helping to that end.

Fetou wrote: ↑

Mon Aug 06, 2018 5:57 pm

I'm in this dilemma now with my snores. I want to see if I can get less arousals in sleep if I can eliminate the snores, but I risk disturbing the sleep and increasing arousals with higher and higher pressures.

I've already become way more tolerant of my increasing pressures, and the extra pressure support from the bi-level is definitely helping to that end.

Something I've seen over and over through the years... for many people, what seems intolerable pressure at first, turns into 'is this thing on?' after a while.

palerider wrote: ↑

Mon Aug 06, 2018 8:46 pm

Fetou wrote: ↑

Mon Aug 06, 2018 5:57 pm

I'm in this dilemma now with my snores. I want to see if I can get less arousals in sleep if I can eliminate the snores, but I risk disturbing the sleep and increasing arousals with higher and higher pressures.

I've already become way more tolerant of my increasing pressures, and the extra pressure support from the bi-level is definitely helping to that end.

Something I've seen over and over through the years... for many people, what seems intolerable pressure at first, turns into 'is this thing on?' after a while.

amen! i can well remember the first time i woke up in the middle of the night, brushing at my face and thinking "is this thing on?".

ain't that a great feeling?

zonker wrote: ↑

Mon Aug 06, 2018 9:05 pm

palerider wrote: ↑

Mon Aug 06, 2018 8:46 pm

Fetou wrote: ↑

Mon Aug 06, 2018 5:57 pm

I'm in this dilemma now with my snores. I want to see if I can get less arousals in sleep if I can eliminate the snores, but I risk disturbing the sleep and increasing arousals with higher and higher pressures.

I've already become way more tolerant of my increasing pressures, and the extra pressure support from the bi-level is definitely helping to that end.

Something I've seen over and over through the years... for many people, what seems intolerable pressure at first, turns into 'is this thing on?' after a while.

amen! i can well remember the first time i woke up in the middle of the night, brushing at my face and thinking "is this thing on?".

ain't that a great feeling?

Yeah, sometimes I have to put my hand in front of the vent... just to check.