So, how would you handle this dilemma?

A couple of facts are in order here first. I completely understand that only getting around 4 hours of sleep isn't a good thing, but I'm trying to do better. And believe me when I say that it's far better than what I got before I began therapy back in April. And also, it's vey important to me that I get this PAP therapy right-sleep apnea has clearly had deleterious effects on my health so I take this seriously. They haven't all been perfect nights, but since my therapy started I haven't had a single night when I allowed myself to take the mask off and chuck therapy for the night because I was frustrated or couldn't sleep. But now I'm beginning to wonder if that was the right thing to do.

Until recently when robysue (and Pugsy too) explained to me how the machine often scored wake breathing as negative events, I have taken the position that it was better to just leave the mask on when awake in the hope that I might eventually fall back asleep and get some benefit from it. But it is evidently wreaking havoc with my AHI numbers! Witness two back to back nights, each of session duration a little over 4 hours and each with 0% Large Leaks reported by Encore and my machine.

Here's the first night. I know for a fact that I only slept for about the first hour and a half until I got up to go to the bathroom, with a short drift off of maybe 20 minutes right at the end. But I spent close to 2 hours after my bathroom break wide awake, conscious of every breath. And look where all the AHI damage came-during that period when I was awake!



But take a look at the very next night. Same mask, no LLs, but I slept straight through for 4 hours and look at the difference in the reported AHI!



In reality there likely really wasn't much difference in the actual sleeping AHI, and I wouldn't think I had any events while awake. So excepting lack of sleep, I don't see much difference in the efficacy of therapy between these two nights. And I should say I felt really good after each night. But it bothers me that the number is so high when this happens. I hate seeing it there and it screws up my averages. And when the doc reviews my therapy he just looks at average numbers and really doesn't have time or the desire to listen to explanations.

So what would you do? Get over worrying about the numbers and lay there and hope to get back to sleep at some point, or cash in for the night and preserve the actual sleep numbers?

Also, as an adjunct question, is there anything magic about the 4 hour therapy session other than insurance compliance in the beginning? Does the doc's version of Encore throw out sessions <4 hours? I see that EB does flag them as such.

old dude wrote:So what would you do? Get over worrying about the numbers and lay there and hope to get back to sleep at some point, or cash in for the night and preserve the actual sleep numbers?

Get over worrying about the numbers.
Which is more important..a good math score or using the machine while asleep? In the long term..those awake numbers won't make that much of an impact.
You don't ever want to not use the machine while you are asleep if you can help it at all.

old dude wrote:Also, as an adjunct question, is there anything magic about the 4 hour therapy session other than insurance compliance in the beginning? Does the doc's version of Encore throw out sessions <4 hours? I see that EB does flag them as such.

No, the doctor's version of Encore reports the 4 hours or more or less nights just like your Encore does. Nothing is ever thrown out.
Even if you only had 30 minutes on the machine during the night...the doctor can see it with his software just like nights with over 4 hours. You get red or green bars depending on if more or less than 4 hours. Nothing is ever thrown out in Encore.
Now in SleepyHead we can throw out short sessions but that is by choice.

So what would you do? Get over worrying about the numbers and lay there and hope to get back to sleep at some point, or cash in for the night and preserve the actual sleep numbers?

Same thing happened here. One night no sleep with mask on, one night slept through, so I can relate. I left the mask on and hoped to get back to sleep at some point. Didn't happen, but I have stopped worrying about individual nights. (but maybe that's just because I am so damned tired

It is better to get your compliance numbers (for insurance), and get used to the machine than to achieve low AHI numbers.
This is way better than to risk falling asleep without it.
If the false events occur when you are awake, then they are meaningless.
Fortunately, you have the software and data, so you know what's what.
It's not a competition for low AHI (though some can get into that rut)
It's all about you being able to breathe when you are sleeping.
It can be frustrating when it takes longer than we expect, but you can do it.

IMO...I see this as a problem....People starting on CPAP therapy should NOT worry about their numbers until they start sleeping most of the night with their mask on. We on this board stress numbers so much that new members think they must get a low AHI and use Sleepyhead no matter what. A new member should concentrate on adjusting to the sounds, pressure and mask without worrying about numbers on Sleepyhead. Once they feel that they have adjusted to this new contraption, they can start to fine tune their therapy.

LSAT, I understand that it is important to focus on getting used to the machine rather than getting the numbers low. However, it is important to make sure you have the right machine that will give you numbers when you are ready for them. There are too many professionals ready to maximize their profits at the expense of the ability to adjust the therapy as directed by the sleep doc in the early stages (while insurance is still paying for it). So, software is an important part of the equation, but it should never be the major part.

Sleepyhead tells me I have leaks. I know that already! Sleepyhead tells me I have "centrals." I know that I move a lot in the night, so that is probably the cause. I have a few apneas and hypopneas, but I feel good. So what's my problem? Nothing that I know of that is related to sleep apnea!

LSAT wrote:IMO...I see this as a problem....People starting on CPAP therapy should NOT worry about their numbers until they start sleeping most of the night with their mask on. We on this board stress numbers so much that new members think they must get a low AHI and use Sleepyhead no matter what. A new member should concentrate on adjusting to the sounds, pressure and mask without worrying about numbers on Sleepyhead. Once they feel that they have adjusted to this new contraption, they can start to fine tune their therapy.

Agreed, but IMO the real difficulty is deciding when to start fine tuning. Old dude has been on CPAP since April, and I have read many of his posts since June when I joined, so I know he had other things to worry about besides numbers in adjusting to CPAP. I have been on CPAP, in contrast, only since the beginning of July, but I know that if I hadn't asked some of the questions about fine tuning that I did, that I would be exceedingly frustrated right now. Everybody is different. I think there is danger in waiting too long for a newbie to "adjust to this new contraption," because some would give up if the adjustment takes too long without seeing some baby steps of progress in a software program.

I don't think any of the veterans on this board should feel responsible for pushing "the numbers" too fast on newbies. Remember, some of us newbies will just do this because they are used to "pushing hard for success" in other aspects of their lives.

I understand about not wanting non-sleep garbage to clutter your numbers. I use a very short ramp instead of just turning it off simply because i cough and clear my throat and fidget a lot when I first lay down and I don't want that mess in my numbers. However, having your total numbers look good is just one way of using this wonderful tool - our data. If you know you had wake time and you know the problems showing up in your data were during that wake time, you have used this tool in a more intricate manner than those who go strictly by totals, so that's reason for a sense of accomplishment, not failure in any way. The data is here for you. You are not here for the data. How you make it useful for your purposes is up to you.

Old Dude:

I occasionally have periods during the night in which I wake and can't get back to sleep. My rule is if I'm lying there for more than 20 or 30 minutes, I get up, turn everything off, and do something not too exciting until I feel tired again.
Then, back to bed and to sleep. The reports show a gap in usage but the report for total usage covers the entire time.

It's not particularly helpful to just lie in bed breathing through the CPAP but being unable to sleep.

Robysue has provided great guidance for sleep hygiene and you should look to your own to make sure you are not inadvertently causing some of this problem. Items to look at are what you are eating, what you are doing just before bed, what time do you go to bed, is bed time regular, do you wait until you are sleepy before going to bed, etc..

A journal may help.

As Pugsy said: The point of the therapy is NOT a fantastically low AHI every night. Or even most nights The point of therapy is to improve your daytime functioning and maintain (or improve) your health.

And taking off the mask at night to "improve" the numbers is counter productive. If you choose to take the mask off and then lie there in bed maskless during the night, one of two things happens:

1. You don't fall asleep (or get back to sleep) for an excessively long period of time and the excessive amount of "wake" time leads to exhaustion and daytime fatigue simply because you've been up most of the night. An AHI of 0.5 or less based on 2.5 hours of total sleep time is not enough to overcome the sleep deprivation from the insomnia.
2. You (accidentally) do fall back asleep without the mask on. And the apneas start up because without the mask, you're not protected And in the morning the body remembers and suffers from the 4 hours of OSA-disturbed sleep much more than it benifits from the 2.5 hours of sleep with an AHI of 0.5 or less. Think of it this way: If you unteated AHI = 30.0, then in the four hours of accidental sleep without the mask, your body had to deal with about 120 (unnecessary) near suffocations. And while the data from the machine might say your AHI = 0.5 based on the 2.5 hours you wore the machine, your effective AHI for the night (total number of events for the night divided by total sleep time) would be something like 121/6.5 or 122/6.5, which gives an effective overnight AHI of around 18.7 or so.

So rather than worrying about the AHI numbers, the thing you need to worry is the insomnia on these nights. If it's happening several times a week and it's been going on for several months, then the insomnia itself is an issue that has to be dealt with if its severe enough to be affecting the quality of your life and health.

JDS74's strategy of getting out of bed if you haven't fallen back asleep within 20-30 minutes is one that works for many people. It also helps if you don't spend a lot of time staring at the clock. You might want to check out the Taming the CPAP-Induced Insomnia Monster link in my signature. I've written a lot here about my battles with insomnia, and Taming the CPAP-Induced Insomnia Monster collects some of the most important things I've learned, both in my own battles and through listening to others.

It seems to me that your primary problem is your doctor.

He doesn't listen.

Personally, if I am laying in bed and not doing anything I wear the nose pillows and turn on the machine just in case I might fall asleep. I even wear my glasses and the equipment and have the machine on if I am reading and might fall asleep or on some apps on the smart phone.

Again, your problem is a doctor that doesn't listen. They aren't good for any type of medical treatment.

old dude wrote:So what would you do? Get over worrying about the numbers and lay there and hope to get back to sleep at some point, or cash in for the night and preserve the actual sleep numbers?

I don't know your history, so I'm answering this in a vacuum: I would totally do #1 above -- ignore the #s!

The numbers are just a guide to take you down the path you are at. Numbers tell you were to fine tune, and it sounds like you just need to worry about falling asleep, and once you can accomplish getting some sleep with your machine ON chances are everything else will fall into place. 2 Hours sleep is not nearly enough sleep. Some one told me that that any AHI less then 5 is acceptable so your doing just fine.

Thanks to all who chimed in. My rational mind of course knew the answer was to ignore the numbers and keep the mask on, given that there is always the hope of falling back asleep. It's just easy to fall into the trap of chasing numbers if one is so inclined as am I.

If my doctor has an issue with the results I'll just have to provide him with some night-by-night examples as I have shown here.

And robysue, I will read your writings on improving sleep times and study them at length. I feel like if I ever get up to 6 hours nightly it would really be an accomplishment for me. That's my medium-term goal in any event.

I completely understand that only getting around 4 hours of sleep isn't a good thing

This is about more than CPAP.

1. Educate yourself on "sleep hygiene" and practice it well.
2. Learn what a good diet is and eat well.
3. Have a moderate exercise program and practice it regularly.

Those are the three cornerstones of good sleep. (For those of us here there is a fourth cornerstone - CPAP.)