Realistic Goal

I have had my cpap now for 2 weeks. I have adjusted well to it, since I got the correct size mask, and feeling not as tired all the time. I started out with a pressure of 13 and my AHI was in the teens. I upped the pressure to 14 and my AHI dropped to about 7.5 on average. Again I upped the pressure to 14.5 and last night it was 2.9. My question is what is a realistic goal? I don't think I will ever have a night of 0 AHI. As long as it is under 5, is that what should be the benchmark?
Thanks.

Hello cctex,

Yes, 5 is the clinical threshold. Anything under that is considered "treated". I routinely seen AHI's at zero or point something, so I'm curious what another 1/2 cm would do.

One of the comments I've been wanting to make about data collection, is that there are two sides to that story for sure. Yes, I do believe the stats are important, but also, how are you feeling? Are you rested? More energy? I wouldn't worry too much about any indication under 5, as long as you're doing well.

Congratulations on your adjustment to the equipment! Well done!

Jim

It took me a few months before I got my first zero AHI .... But I have been geting zero AHI about three times a week for several years now.

It takes time to get everything tweaked in. There is more to it than the pressure. Having the optimal mask fit, hose management, sleep hygiene, diet, and other medical/health issues.

Just be patient and focus on your general health now that your body is not being starved of air every night.

When looking at that AHI of 2.9....what is the event category breakdown? Is it mainly obstructive apneas and hyponeas?
Or mainly clear airway events? Or half and half?
Clear airway events we don't treat with pressure with this type of machine. The airway is already open and no amount of pressure will resolve the situation with the clear airway events.

So if your AHI of 2.9 had 2.2 Clear airway index..that leaves 0.7 for obstructives and that's pretty darn good and it's unlikely any increase in pressure will make any huge change.

Now if your AHI of 2.9 had 2.7 index with the total obstructive apneas and hyponeas...and only 0.2 in clear airway...well you might see a change in that number with a little pressure increase if you wanted to push things.
I think we all are tempted to try to get the AHI as low as possible...it's sort of human nature.

So make sure you are trying to fix something that is supposed to respond to increases in pressure and not trying to fix something that pressure doesn't treat if you go increasing the pressure. Clear airway events you can't kill with more pressure.
Only the apnea events that are caused from the actual collapse of the airway tissues.

Some people do see AHI 0.0...me...after 4 years I can maybe count them on one hand. I have had a lot of 1 or 2 events over the whole night but not many 0.0 unless I only got 3 hours of sleep.

Your AHI will change from night to night with no changes in pressure...it just does. I have been known to have AHI 0.56 one night and AHI 6.07 the very next night and changed nothing. 60 % of that 6 AHI was clear airway though. It was just a fluke bad night in general that happens from time to time. Mine are often related to issues outside of sleep apnea.

The goal is to get good quality sleep, optimally treated OSA, sleep good...feel good.
It isn't a math test where 0.0 is the goal. It's nice to brag about it when we do but that's not the goal.

I always tried for 100's on my math tests ... CPAP therapy is more like playing golf.

I was never any good at math, and I don't play golf. Does that explain why I have yet to see a 0 for a full night after 3.5 years?

@SleepWellCPAP - To answer your question I am feeling better each day. More energy, more alert and no more sneaking a nap after lunch.
@Pugsy - I attached last nights results.
Thanks All.

I've only had 1 zero night my entire first year; I'm just glad if the AHI is under 5 and I feel rested.

How about the detailed daily report so I can see the events themselves? All I can tell from the trend report is AHI is fine and you didn't have any large leak but you had some Periodic Breathing.
Do you have a "Detail" choice to pick for viewing of the reports that shows something like this?
I have a different machine than yours...so I have 2 pressure lines.

DreamStalker wrote:I always tried for 100's on my math tests ... CPAP therapy is more like playing golf.

You mean we can cheat?

Here ya go

Hmmm....did the aliens pay you a visit last night and experiment on you at that 5:00 hour mark?
I don't like clusters like that. Are you seeing many of them now? Your very first reports I just now glanced at and this one is obviously so much better than those. Wonder why this night was so stubborn with that one cluster?

Do you sleep on your back very much? Maybe at that time????

If this is a fluke and doesn't happen again or happens rarely...I don't know that I would do much except scratch my head but I don't like clusters that intense and if this happens every night...another 0.5 cm increase to see if that cluster would break up would be my next step. That's a truckload of events in one short time span.

Or..if you were awake at that time...maybe just awake breathing irregularities getting flagged by mistake.
Then of course it should not happen again.

Yeah I know. I had about a thirty minute span there where everything went to hell. I remember waking up around then but figured I woke myself up from not breathing. I'm going to keep it at this pressure for a week our more to see what happens. I am feeling better though so that's good.

I'v e been at this for 11 months now, and I have only had two nights that went over 5. Most nights are under 2 with many of those under 1.

So far, I haven't noticed any real difference between a night with 1.7 and a night with 0.3. All of those nights are considered good nights.

The difference that I DO notice is how long I sleep with the mask, and how few times I wake up. For example, if I sleep 4 hours, use the bathroom and sleep 4 hours, all with the machine, that is a great night. If I sleep 6 hours straight, bathroom, and then 2 hours, all with the machine, that is an awesome night. Doesn't matter what the ahi is. Anything with the machine is good enough to make me full good as long as I get enough time with it.

A night with 3 hours, 2 without, and 3 with, is still a good night for me, but won't qualify for awesome, even if the ahi is less than 1. For me, it really is a combo of consistent sleep with the machine on. My first night with over 5 hours straight was awesome. I had a very busy day the next day, and I felt so energetic, like I had drunk multiple energy drinks (which I had not). It was especially good timing as the next night, I had major problems with a project. I was going to an event the next morning, and I needed to take 100 printed booklets, and all 3 of my printers went down. I was up all night fixing them and printing, and was actually still printing at 6am. I had to fold and staple the booklets at the event. So, that really awesome night ended up getting me through 2 days. Then I had a really LONG night to make up for it.

I have had only 5 nights of getting over 7 hours straight, so that is still pretty allusive for me. And about 10-15 nights with 6 1/2 to 7 hours.

Right now, I am really struggling as my stupid cough came back, and I cannot keep the mask on during a bad cough. It has been almost 3 weeks, and I am much better now, but still coughing a bit. I am getting some partial nights now, but I can't go a whole night without the cough returning, and then it takes awhile for the medicine to work again. In the last 3 weeks, my longest night with the machine was 3.6 hours. I am so frustrated. At least this time, my doctor believed it was allergies and not a side effect of medication or just being stumped. I actually coughed badly for 6 weeks straight last July. And I didn't even bother going in when I had the cough in October and again in January. I still had cough syrup which helped. This time, I have a new inhaler and a pill version of a cough medicine. It lasts longer, and I don't have to deal with the horrible taste of syrup.

I am interested in the idea of using a pulse oximeter as an alarm as I do still take my mask off sometimes. Mostly because of drool, and now because of coughing. I am too sleepy stupid to get up, fix it, and get it back on. And strangely, even if the machine is off, I do not go to the bathroom as much as I used to, so I can't count on a bathroom trip to get me up to fix it. I will fix it once I am up for the bathroom since I am more awake and thinking clearly. The good ones look expensive, so I am hoping my insurance might pay for one if I can get a prescription. I go to the cardiologist next week, so I will ask. Can't hurt to try. If not, I will look into buying one that has an alarm and records data. I think I could also use a good scare to see how bad I am when the machine is off.

See how you feel correlated to the AH - but usually somewhere in the range of 2 or 3 or lower is pretty good. Some people feel fine with AHI <= 5, some it has to be <= 2.

As long as your AHI is below 5 and you're feeling awake and all the symptoms of sleep apnea are gone, you're good.

Obsessing over getting AHI 0 is a bad idea - you can get an "event", or a few events, in so many ways - without it being anything bad at all. A lot of people will be quite jealous of you if you can get in the ~2 range consistently.