Sometimes I take the time to scroll through the flow rate and just look for the evidence of arousal breathing...doesn't matter if there was a flag anywhere around it or not. Doesn't matter if I necessarily remember waking up either. I look for the arousal breathing because I know that the potential for crappy sleep quality increases the more arousal breathing I see.
Arousals can mess with sleep architecture in a way that we end up not getting the optimal amounts of each sleep stage in a nice normal progression for the restorative powers of sleep to work their magic.
The arousals aren't always related to airway collapse or Sleep Disordered Breathing either. It can't be any number of causes for the arousal and sometime there is that old "spontaneous" arousal thing where we simply don't know why the arousal happened.
I might have nights when the AHI is nice and low and the flow rate really looks good from the airway side of things but I might have 40 (over say 6 or 7 hours of sleep) episodes of arousal breathing seen and I don't spot anything related to the airway maybe causing the arousal. In my case I have a known potential culprit for my arousals being the pain stuff but it doesn't have to be pain related...it can be anything related. Sometimes we just don't know why we have the arousals but we know that when we have a lot of them we don't feel so great no matter what the AHI might be. It's not always so easy to eliminate the cause of the arousals even when we know what the cause is....damn near impossible when we don't know what to blame them on.
I like to show this guy's flow rate as an example...horrible flow rate in terms of sleep quality. He doesn't have OSA and pretty much all the flagged events are arousal related. He did have an in lab diagnostic sleep study and came out of it with AHI of less than 1.0...OSA isn't his problem. He did come out of it with a truckload of spontaneous arousals though....unrelated to airway issues.
He was hoping cpap would fix his problem of crappy sleep and feeling crappy. It didn't...big surprise because his crappy sleep was NOT from OSA or airway issues.
Add in the fact that just because we might have OSA....doesn't mean we can't also have something else messing with our sleep quality.
Like me...I have OSA...cpap takes real good care of that side of my sleep problems related to the airway issues but doesn't do a damn thing for my other problem which is pain from good old arthritis messing with my sleep. That's a separate problem that I have to work on dealing with. It's a struggle sometimes though....not so easy to deal with. Meds bring their own baggage that's not always so nice either.
I may have to RISE but I refuse to SHINE.
Indeed!