There's More To Sleep Than Just AHI
Posted: Tue Apr 17, 2007 4:53 am
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
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