AHI Under 5 Unacceptable?

I've been thinking a lot about the definition some use of effective treatment. One of the things I've noticed since I got a data-capable machine is that my AHI is almost always under 5. That should be good, but I'm still tired a lot.


However, in looking at my graphs and other data, it seems to me like I am still having periods of intense events, interspersed with periods of no events. So while my AHI is under 5, my AHI during those intense times is double digits, sometimes over 20.

Those periods I am pretty sure are periods of REM.


So my question is, is an overall AHI of 4.3 acceptable if your REM sleep AHI is 17.2? Do the non-REM periods of no events cancel the fact that I have lots of events during REM?

If you think that's still a problem, how would you go about solving this? I have not been able to see any improvement with manipulating the pressure. Suggestions?

I'm also curious about this. My AHI has been around 6-7 lately, and I always have 'peak' periods in the middle of the night when my AHI jumps up to 15-20, but overall for the night its much lower. I've spoken to two sleep docs about this - one wouldn't hypothesize, other said REM or maybe I was turning onto my back. Either way, both said not to worry about it, but I want to solve this problem anyways. If the breathing problems result in an arousal during deep sleep, thats an issue for me.

If I were you I would want to fix this, especially if the REM AHI is so high, and especially if the events are so long. I assume they are not correlated with leaks. Sorry LoQ I don't know what machine you use but perhaps an APAP can help? And when you refer to manipulating pressure, how far up from your normal pressure have you gone? You might needs lots more pressure to dislodge those last few stubborn apneas.

Did you ever read Rooster's story? His positional apnea was so bad, he needed something like 20cm on his back, but much less on his side (maybe 10? I don't remember exactly). I also don't know if just the fact that you're in REM sleep could cause a large increase in your pressure needs, but its worth exploring. And speaking of the devil, were the heck is that chicken, I haven't heard from him in a while (or I missed his posts).

I agree with Echo.

Although many don't agree with me on this matter, my experiments determined that I have to stay below AHI 2.5 in order to keep my O2 blood saturation level at 93% or above. My wife's therapy reflects the same findings. We periodically run tests on ourselves using a SPO-7500 recording oximeter.

I don't think that an AHI below 5.0 is OK. I'd rather say that anything above 2.5 is NOT OK. When I went for my sleep test, my AHI came in at 4.9 and I didn't qualify for any insurance assistance. I knew, however, that I was in DEEP, DEEP trouble. My BP systolic was going above 200 in the middle of the night......and I knew I was in extreme danger of having a stroke

My doctor was unconcerned.....but I realized that he was just going through the motions. Because my AHI was below 5.0, I wasn't a prospectively profitable customer.... there was no insurance company to milk.

I bought my own gear....and I manage my own therapy....thanks to the help and knowledge I've recieved from people on this forum.

If you don't already have it, get a data capable APAP, software to go with it....along with a recording oximeter with good software. Once you realize that sleep apnea is simply "suffocation"...your blood O2 goes below 93%....you're in trouble if you can't maintain 93% while sleeping. Your APAP doesn't measure O2 levels....so, you're guessing when you only rely on AHI scores to determine if your therapy is effective....or not.

You can't manage what you can't measure.

Gerald

I think that is absolutely unacceptable. At one time my sleep study showed me to be in a similar situation - AHI overall low, but during REM, pretty bad. Not sure about your pressure or delivery type, but it does seem you have not optimized your treatment yet. If this were me, I'd want to methodically experiment. No one wants to introduce more leak and other issues that may come with increasing pressure unless necessary. Can you take steps to assure you stay off your back for a few nights and see how your data looks? Maybe that will be enough. I'm interested in hearing how this progresses for you.

kteague wrote:. Can you take steps to assure you stay off your back for a few nights and see how your data looks? Maybe that will be enough. I'm interested in hearing how this progresses for you.

Yep, as the "keeper of the cpap", I can tell you that I've experimented with this. If I observe Mike sleeping on his back during the night and can't get him to turn over or am not aware of it, his AHI will always be higher, sometimes over 3. If it happens on a second consecutive night, I start seeing signs of fatigue during the day. But then he seems to become aware of it himself and corrects it himself. He hasn't had that problem in awhile but back sleeping seems to be the culprit .

The whole object of doing this treatment is to get the best outcome you can. Why stop at ATI >5, if you can do better, fine tuning is part of the plan. I can tell if I am over ATI >5, I feel foggier, two days of over AHI 2.5 and I feel bad, so I don't allow it, I do whats need to keep under AHI <2.

BTW: Gerald, my O2 levels in the daytime are 92 to 93, at night they drop as low as 88, but maintain a 91+ avg. Jim

Thank you all for your comments. I wish it were as easy as not sleeping on my back. I'm already an inveterate side-sleeper. I put barriers up on both sides, but I don't think I would sleep on my back, anyway, as I am not comfortable in that position.

I guess I will just have to keep playing with the settings. I will ask my sleep doctor when next I see him, but his answer will be to put me on anti-depressants. I'm not sure I object to that, but I don't think it gets to the root of the problem. Still, if it makes me feel better, then maybe treating the symptom is good enough. I just wish he were more willing to tackle the actual problem than just handing out pills.

I am fortunate that my PCP did not approach it like this. He asked about depression when I first told him about the fatigue but specifically said he didn't want to just assume depression was the source of my fatigue, and eventually he figured out that I have SDB, so he sent me for a sleep study. God bless him.

Hi LoQ

I agree with what is said above, and experimenting sounds in order.

And I just wonder why your machine is not shown with your mask and humidifier ?

cheers

Mars

mars wrote:And I just wonder why your machine is not shown with your mask and humidifier ?

It's not on the list, but it's a %@$#@& machine, $7 model. %@$#@& is the name of a company behaving badly. I suppose the word is now a cuss word, so I encrypted it.