AHI vs Pressure Sweetspot

Oh, I don't know, I kinda like "ideal pressure" myself. But I think we've come to realize that Sleep Architecture, Sleep-Disordered Breathing and Pressure Therapy for SDB, taken individually, are complex phenomena, and taken collectively, comprise an extremely dynamic state, and my point is that the "sweetspot" philosophy ("nothing more or less will do", from baseball's "6 inches from the end of the bat") oversimplifies this dynamic state. Any given patient could very well have a selection of "sweetspot" pressures depending on sleep stage, body position, etc. An "ideal pressure" in fixed pressure therapy would be one that the most effectively covers all situations, understanding that some areas may be somewhat overtreated.

Relating this to Catnapper, perhaps when we get that graph squared away (show the IPAP and EPAP pressures, cause that pressure line is probably just EPAP) and maybe get a hold of the sleep study with the titration parameters, then we can get a better look at what all that surge beyond 8.9 cmH2O means. And if it turns out that there are a bunch of obstructive events that occurred, then all that 8.9 represents is a "sweetspot" for just one set of parameters.

Besides, what is a "sweetspot", anyway? A 0.0 AHI? I mean, a 0.2 AHI is one event in 5 hours of sleep. Depending on the machine, a pile of events could have gone by that simply weren't picked up, or these occasional events are simply artifact. And make sure you focus on an issue that will bring results. People with additional sleep issues thinking they will find the Holy Grail and "feel better" by bringing their AHI down from 2.1 to 0.0 when the problem is that they are running 65% sleep efficiencies or have 200 arousals from other causes (a la Yossarian and Snowden in "Catch-22") are sinking a lot of time, effort and money into something that will not produce results.
SAG

Well that last sentence went way over my head

While I agree with your assessment for folks with multiple sleep disorder issues ... I incorrectly/ignorantly assumed we were only referring to the typical and simple OSA patient.

I view that type of chart in a similar way to how I would view a sensitivity analysis. One observes the effects of a variable (ie. pressure) on a parameter (ie. AHI) in order to "opitmize" the desired result. The "optimal" value for the pressure (at least in my case) would be the value that generates the lowest AHI. In other words, the bottom of the "U" shaped curve(s) (aka - sweet spot). For APAP and BiPAP one can overlay multiple curves to show the effects of min/max or ipap/epap on AHI and/or AI and HI to determine an optimal range or "happy place".

If we are basically optimizing the treatment to minimize AHI for plain and simple OSA, maybe we should be calling it the "optimal pressure" for CPAP and the "optimal pressure range" for APAP ... at least for plain-jane/john OSA? ... then again "sweet spot" still means the same thing