Just got my machine - High AHI

Hi folks!

I just got my S9 AutoSet with Mirage Quattro medium mask yesterday. I had the opportunity to use it today (daytime sleeper, night time shift worker). I put it on, experienced no noticeable leaks, and laid down to go to bed. After about 20-30 minutes, I hadn't fallen asleep yet and I saw on the machine that I already had an AHI of 5.6.

Now, I know that awake events aren't relevant, but my question is: How can I ever get to 0.0 if when I'm awake and trying to fall asleep, it registers events?

Range: 8cm-11cm (based on my study. 8-9cm registered 0.0 AHI, 10cm registered 0.3 AHI, 11cm 0.0AHI)

I was awoken by a telephone call about 30 minutes prior to my normal wakeup time, so I tried to fall back asleep and was unsuccessful. When I finally did get up (about when I would have otherwise), I saw an AHI of 10.1 -- but only 1.5 hours of usage. From that, I gathered that the machine resets its daily data at 12pm according to the internal clock. I was able to adjust the clock to match my schedule (showing 3am when it's 3pm, since 3pm is my 3am if that makes sense). Unfortunately, I had to delete my data for the night in order to alter the internal time (invalid date/time due to existing data).

Anyhow, where I'm going with this is: Am I going to have to use SleepyHead to see my real AHI each night, taking into consideration actual waking time and wake events, or will the machine gather a better baseline of my conscious breathing?

Thanks!

First off.....IMO...you should ignore your AHI until you can sleep much of the night (or day) with your machine and mask. Then, you can look at your AHI daily right on your LCD screen without using Sleepyhead. After a couple of weeks start looking at sleepyhead to determine problem areas. Note...Your goal should be to sleep comfortably with the equipment and feel good when you wake up. An early goal of O.O is unrealistic for most users. I feel I am a successful user and I have only been below 1.0 3 times in my 5 years. I average 1.5-2.5 and feel great.

LSAT wrote:First off.....IMO...you should ignore your AHI until you can sleep much of the night (or day) with your machine and mask. Then, you can look at your AHI daily right on your LCD screen without using Sleepyhead. After a couple of weeks start looking at sleepyhead to determine problem areas. Note...Your goal should be to sleep comfortably with the equipment and feel good when you wake up. An early goal of O.O is unrealistic for most users. I feel I am a successful user and I have only been below 1.0 3 times in my 5 years. I average 1.5-2.5 and feel great.

Oh for sure. I did wear the mask for 7.8 hours according to the statistics, it's just since the S9 daily data reset happened while I was sleeping, it showed only 1.5 hours for the "day".

I did change the pressure from 8-11cm to 11-14 (11 was what my prescription was for).

We'll certainly see how things go! I don't mind the CPAP at all. I fell asleep quickly with it at my titration study, so thankfully I'm one of the ones that has no issues dealing with a "hurricane"

I would take it easy with the AHIs. It took me more than a year to sort out a mask, pressures on my CPAP and APAP, etc., until I achieved a decent treatment. See it here:

I started CPAPING at the beginning of 2011.

My progress in treatment since I started CPAPING was:

{pressures ranged from 7cm to 15 cm on S9 Elite and S9 Autoset in CPAP and APAP modes}

All the values in the following Stats are sort of MEDIANs of the nightly ones.

My Stats data in the first 60 days period after I started CPAP:

{were they not lousy?}



My Stats data for the first 6 months period after I started CPAPING:



Compare the above to my recent 6 months and one year Stats:





The way I set the pressures limit on my APAP machine, these days:

If my prescribed therapeutic pressure on CPAP was 13 cm then I would start the APAP pressures on 13cm maximum and 10.0 cm minimum. Next, I would spend a few nights with this setting and get pressure graphs on ResScan (b/c I have a Resmed machine). A graph would show the pressure curve plus the two limit lines. Next, I would start adjusting the set-up on the APAP so that the pressure curve only "kisses" those limit lines. The reasons: I don’t want the machine to suddenly boost the pressure needlessly and give me emergent central apneas (Complex Sleep Apnea) and also cause more leaks b/c of the higher pressure. As to the low pressure limit I set it low to have the machine respond more quickly to events.

Example




I took my time to experiment on my own, not following blindly "experts advice", including my Sleep Docs.

Have you checked this report: THE APNEA-HYPOPNEA INDEX, USEFUL OR USELESS?

http://www.respiratoryreviews.com/sep02 ... Index.html

Medical reports published in 2009 are saying that: "Martinez and Cassol are correct that the currently accepted cutpoint for abnormality proposed by the American Academy of Sleep Medicine (AASM) and Centers for Medicare & Medicaid Services (CMS) in the US is an apnea-hypopnea index (AHI) ≥ 5 per hour but less than 15 per hour – but only if symptoms such as EDS are present." See it here: http://www.ncbi.nlm.nih.gov/pmc/article ... $=activity
My understanding from it, is, that the cut-of point for SDB abnormality is at AHIs above 15.

You're probably right. Did you have similar issues when you first started regarding it registering events while you are awake? Or did it pick up your baseline from the get-go?

BigBennyB wrote:You're probably right. Did you have similar issues when you first started regarding it registering events while you are awake? Or did it pick up your baseline from the get-go?

If you are asking me, then of course I had them. The machine does not know if you're asleep or awake. You can just pinch the airline while awake (or asleep) and the machine will register an Obstructive Apnea or a Hypopnea of it. Or cough or giggle and the machine might register a Central Apnea. The machine wants you to keep a "stationair regime" to register correctly. No, it did not get-go with any baseline at all for the first 3 months while I was on a Brick machine for a month and then replaced with an S9 Elite (used) by the DME. It was also a NO-GO after 3 months when I purchased (by paying cash. The first 2 machines were rented by Medicare) for an S9 Autoset. After about 6 months I found out that the lousy leaks that I had while using those full face masks Fisher& Paykel #431 & #432 came from me not using my removable dentures during sleep. My cheeks without the dentures caved- in and did not support the mask cushions sealing. I am ashamed to show you my ResScan graphs from that time! They were LOUSY!

Big Benny B - I have more Central Apnea / Clear Airway events when I am awake. For me , these are times that I stop my breathing to concentrate on issues like a leaking mask. I will do this and feel for the leak and it will register as a CA. During my sleep time, my AHI is usually pretty low. SleepyHead is a great way to start understanding your breathing habbits and follow your progress.

avi123 wrote:

BigBennyB wrote:You're probably right. Did you have similar issues when you first started regarding it registering events while you are awake? Or did it pick up your baseline from the get-go?

If you are asking me, then of course I had them. The machine does not know if you're asleep or awake. You can just pinch the airline while awake (or asleep) and the machine will register an Obstructive Apnea or a Hypopnea of it. Or cough or giggle and the machine might register a Central Apnea. The machine wants you to keep a "stationair regime" to register correctly. No, it did not get-go with any baseline at all for the first 3 months while I was on a Brick machine for a month and then replaced with an S9 Elite (used) by the DME. It was also a NO-GO after 3 months when I purchased (by paying cash. The first machines were rented by Medicare) for an S9 Autoset. After about 6 months I found out that the lousy leaks that I had while using those full face masks Fisher& Paykel #431 & #432 came from me not using my removable dentures during sleep. My cheeks without the dentures caved- in and did not support the mask cushions. I am ashamed to show you my ResScan graphs from that time! They were LOUSY!

Lol. Well we'll just let the machine do its thing!

When I first started therapy I had large clusters of centrals -- mostly at sleep onset and transitional periods. I also had many obstructions as well.. I think your body needs to get used to xPAP therapy and all that goes with it.

I noticed that my AHI improved quite a bit after the first month or two.

And as mentioned by other posters, events will be flagged and scored even when you are awake -- the machine has no way of knowing if your asleep or not.. And being new to therapy will no doubt make you a bit more susceptible to higher numbers than you'd like. It takes your body time to adjust.

Think of it just as you would as monitoring your blood pressure. There is no "magic number." Just keep an eye out for patterns and changes. Let your body get accustomed to the mask, pressure, and new challenges. Figure out the best routine, sleeping position, try to get a handle on leaks, and give it time..

You will no doubt discover things that will help just as you will discover issues you'll need to work on. Hang in there!

My advise would be to just get used to the machine and mask and worry about getting some good sleep. If you can get these done your AHI will fall into place.
Sometime we worry about the numbers, and the numbers are just numbers. How you feel when you wake up is what counts.

Thanks all! I will focus on how I feel in the morning versus just a number on the machine. Once I've got a solid week or two of data, I'll import it into SH and see where some improvements (if any) might need to be made

You can change the time on your machine. I am a severe night owl, so I normally go to bed between 4 and 6am, and i get up about 1pm on work days. I changed the time on my machine so that it thinks that noon is at 4pm. I just have to remember to adjust times when I am looking at data.

It will make your data look a lot easier to examine if you adjust the time and have your sleep sessions together instead of split up.

Also, don't expect many zeros. I have a lot of nights less than 1 and it is rare to be above 2 for me. But I think I have only seen 2 zeros in a year in a half. For me, any ahi is good (I think I have only had two that went above 5). What really matters for me is the total length of sleep and the length of sleep before my first wakeup. For example, if I sleep for 4 hours, wake up and then sleep for 8 more hours, all with the machine, that it is a really good night. But if i sleep for 7 hours straight, it doesn't matter whether I get another hour or not. That 7 hours straight was downright awesome.

Most nights, I sleep about 3.5 to 4.5 hours before I wake up the first time. Okay, but not great. I definitely feel better if I get past 5 hours before my first wakeup. This is much more important to me than the ahi as any ahi with the machine is good (without is 79+). But sleeping straight means better sleep stages. That is a big deal for me.

zoocrewphoto wrote:You can change the time on your machine. I am a severe night owl, so I normally go to bed between 4 and 6am, and i get up about 1pm on work days. I changed the time on my machine so that it thinks that noon is at 4pm. I just have to remember to adjust times when I am looking at data.

It will make your data look a lot easier to examine if you adjust the time and have your sleep sessions together instead of split up.

Also, don't expect many zeros. I have a lot of nights less than 1 and it is rare to be above 2 for me. But I think I have only seen 2 zeros in a year in a half. For me, any ahi is good (I think I have only had two that went above 5). What really matters for me is the total length of sleep and the length of sleep before my first wakeup. For example, if I sleep for 4 hours, wake up and then sleep for 8 more hours, all with the machine, that it is a really good night. But if i sleep for 7 hours straight, it doesn't matter whether I get another hour or not. That 7 hours straight was downright awesome.

Most nights, I sleep about 3.5 to 4.5 hours before I wake up the first time. Okay, but not great. I definitely feel better if I get past 5 hours before my first wakeup. This is much more important to me than the ahi as any ahi with the machine is good (without is 79+). But sleeping straight means better sleep stages. That is a big deal for me.

Yep! I've adjusted it so that when it reads 12pm on the S9, it is really 12am where I am. I typically sleep from 8-9am to 4pm in the afternoon, but on days I'm off, I may stay up until 11 and sleep until 8.

I'm just ready to feel better! =D

BigBennyB wrote:Now, I know that awake events aren't relevant, but my question is: How can I ever get to 0.0 if when I'm awake and trying to fall asleep, it registers events?

Chasing a 0.0 AHI is NOT the point of PAPing. Feeling better and functioning better is. Typically most of us start to function better once our AHI is down below 5.0 night after night. For some people, the AHI needs to be closer to 0, for others, it doesn't. For people who KNOW they take a while to get to sleep and who KNOW the machine is likely to record some events during that "wake" time, the long term AHI data tends to settle down at a number that reflects what's going on. In other words, long term if your AHI settles down to around 2.5 and you know most of those events are scored during the times when you are settling down to get to sleep or while you are waking up each morning, you simply don't worry about AHI's around 2.5 as long as you're feeling and functioning fine.

Anyhow, where I'm going with this is: Am I going to have to use SleepyHead to see my real AHI each night, taking into consideration actual waking time and wake events, or will the machine gather a better baseline of my conscious breathing?

No PAP machine has an EEG attached to it. So no PAP machine can reliably "gather a better baseline" of your conscious breathing versus your sleep breathing and then discount the events that likely occurred in wake.

Even with SleepyHead you are not going to see your real AHI each night. The SH AHI in the panel on the left of the Daily Data is directly off the machine's daily data. (On an S9 it's going to agree (up to rounding off errors) with what you see on the machine's LCD if the SH day and the machine's day change at the same time.)

And even if you take the time to analyze the entire night breath-by-breath, you're still just going to get a good approximation of the real AHI. Why? Without the EEG data you have no way of identifying any microwake and microarousals, and hence you have no way of telling which events might be "false" events. For example: Many people arouse themselves to a wake state in order to turn over in bed and it's not uncommon to hold your breath while turning over. If you hold your breath for 10 seconds, the machine scores an apnea of some sort, but the apnea would NOT be scored on a PSG because the EEG data (and the video data) would indicate that you were AWAKE when you held your breath and hence the breathing pause was part of a normal WAKE breathing pattern. Is it possible to identify this kind of breathing pattern from the wave form alone? Sure, it's possible to identify certain patterns as "that might be a wake due to turning over in bed", but because the wakes are so short we don't remember them and the breathing patterns are not always completely clear. In other words, what might be a "turn over in bed with a bit of holding ones breath" could also be a "start of REM with the first REM-event" breathing pattern.