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Acceptable AHI ranges
#11
The real goal is "as low as you can get it" and "as good as you can feel".

If you're not feeling good, it's not low enough.

However AHI isn't the definition of good sleep. It's possible to have a low AHI and still not feel good, if you still have disturbed sleep. If possible, check your data in SleepyHead and switch it to display RDI instead of AHI. RDI is Respiratory Disturbance Index and takes into account other things that can disturb your sleep.

Alternatively, you can keep complaining to your doctor and maintain your own standard of "Do I feel good?" instead of some generic benchmark like "Less than 5".

It's like if you complained to the furnace mechanic that you're cold and he told you "The house is 65 degrees, which is considered acceptable" If you're not happy, make sure your doctor knows.

Terry


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#12
Thank you all - this information is really helpful - I am learning all the time Thumbs-up-2
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#13
I found this helpful:

"What should your goal AHI be? First, understand that there can be night-to-night variability in this measure. Sleep apnea may be worsened by sleeping more on your back, having more REM sleep, or even by drinking more alcohol near bedtime. Therefore, it is not useful to chase a daily number. Rather, these variations should be averaged out over 30 to 90 days. In general, the AHI should be kept at fewer than 5 events per hour, which is within the normal range. Some sleep specialists will target an AHI of 1 or 2 with the thinking that fewer events will be less disruptive to sleep.

The optimal goal for you may depend on the severity and nature of your initial condition. It may be tempered by your compliance to treatment, with lower pressures allowed to improve comfort. The best pressure setting for you is best determined by your sleep specialist with the average AHI used in the context of your experience with the treatment.

If you have questions about whether your CPAP is working as well as it could be for you, contact your provider to discuss your status and the options available to optimize your therapy. Regular follow-up in clinic will ensure that you treatment is a success."

http://sleepdisorders.about.com/od/livin...-Apnea.htm
Coffee
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#14
Hi icewlf,

If you have access to a computer which runs Windows then I suggest downloading ResScan from Apnea Board and seeing what your detailed data says.

Your pressures 30/25 are unusually high. What therapy mode is your machine set to operate in, ST or simple S?

"S" mode stands for Spontaneous, meaning synchronized to your spontaneous (natural) breathing rate. "ST" stands for Spontaneous Timed, which adds a timed backup respiration rate if you stop breathing, such as during a Central Apnea. Not sure, but perhaps "ST-A" stands for Spontaneous Timed - Advanced or Spontaneous Timed - Alarmed, because it adds various alarms and IPAP can go up to 30. More recent ST-A models add even more therapy options.

http://www.resmed.com/int/assets/documen...ow_eng.pdf


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#15
I am an FNG (for those of not familiar with the term: something New Guy) to OSA and CPAP. In fact my first home use of CPAP was last night. I am also an FNG to the Apnea Board. As I read this thread, I am wondering where do my numbers fit in.

My OSA was suspected after a sleep oximetry where the O2 was down to 74%. I had a PSG which duplicated the oximetry and showed an untreated AHI of 81.9. A CPAP was put on and this reduced it to 9.11 using a titration min pressure of 7 cm H2O and a high of 12 cm H2O. Last night, my overall AHI was 9.46 (same pressures) which seems to confirm the PSG results. These then became my prescription numbers of my new CPAP.

I read the PSG: without CPAP, I had no REM. With CPAP I experienced some REM. No apparent heart problems. While I have a BMI of 30, I would be considered very active for a 68 year old male.

I live in the mountains at 6000 ft altitude and am frequently at altitudes of 10,000 ft. I do have moderate COPD which means that I have to stop frequently when exerting myself to both breathe and hydrate. (This was the complaint I had which led to the initial oximetry study.) I probably have some type of pulmonary hypertension. Lung X-Rays show signs of moderate COPD.

I have had severe pneumonia six times in my life with the last one resulting in a transverse myelitis and temprary paralysis at the C4 vertebrae in 1986 which I recovered from. I sleep well and do not appear to have the problems most people have with OSA. In fact, I would not have known about OSA if it hadn't been for the PSG. I apparently do not have CSA.

So that brings me to my question: what can I expect from CPAP?

So far, I would say I am sleeping far worse but that may be solely do to the fact I am new to CPAP. I don't really want to do CPAP unless I get some benefits. (In fact, my said I would last only 2 or 3 nights with this!)

Walt
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#16
Wolson, CPAP therapy can help you to be better ventilated and overcome the severe AHI you indicated on your diagnostic study and the nearly 10x reduction in events with CPAP. Your COPD presents a complication in that most people with restrictive lung disease benefit from bilevel (BiPAP) which provides a higher inhalation pressure and lower exhale pressure. This greatly improves both ventilation and comfort. Since your AHI is above what most considered "treated" level of 5 or less AHI, you should ask your doctor about bilevel and why he didn't recommend it. Not only does bilevel have obvious benefits for people with COPD, but is reduces the RERA (respiratory event related arousals) that are probably part of the reason you don't feel rested.

Download Sleepyhead software from the link at the top of the forum. You can analyzed the data from your Auto CPAP on the SD card and see what kind of events, including RERA that may be a problem. This will give you more ammunition to discuss an upgrade to BiPAP with your doctor.
______________________________________________
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Robysue's Beginner's Guide to Sleepyhead
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#17
THank you, Sleeprider
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#18
Just a side comment. An earlier post mentioned restless legs. I had a terrible problem with restless legs prior to apnea treatment. The longer I have been treated, the less I notice my legs wanting to twitch and jump around. It is now a rare occurrence. Yay
Sleep is worth the effort.
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#19
(12-30-2015, 11:23 PM)wolson Wrote: I am an FNG (for those of not familiar with the term: something New Guy) to OSA and CPAP. In fact my first home use of CPAP was last night. I am also an FNG to the Apnea Board. As I read this thread, I am wondering where do my numbers fit in.

My OSA was suspected after a sleep oximetry where the O2 was down to 74%. I had a PSG which duplicated the oximetry and showed an untreated AHI of 81.9. A CPAP was put on and this reduced it to 9.11 using a titration min pressure of 7 cm H2O and a high of 12 cm H2O. Last night, my overall AHI was 9.46 (same pressures) which seems to confirm the PSG results. These then became my prescription numbers of my new CPAP.

I read the PSG: without CPAP, I had no REM. With CPAP I experienced some REM. No apparent heart problems. While I have a BMI of 30, I would be considered very active for a 68 year old male.

I live in the mountains at 6000 ft altitude and am frequently at altitudes of 10,000 ft. I do have moderate COPD which means that I have to stop frequently when exerting myself to both breathe and hydrate. (This was the complaint I had which led to the initial oximetry study.) I probably have some type of pulmonary hypertension. Lung X-Rays show signs of moderate COPD.

I have had severe pneumonia six times in my life with the last one resulting in a transverse myelitis and temprary paralysis at the C4 vertebrae in 1986 which I recovered from. I sleep well and do not appear to have the problems most people have with OSA. In fact, I would not have known about OSA if it hadn't been for the PSG. I apparently do not have CSA.

So that brings me to my question: what can I expect from CPAP?

So far, I would say I am sleeping far worse but that may be solely do to the fact I am new to CPAP. I don't really want to do CPAP unless I get some benefits. (In fact, my said I would last only 2 or 3 nights with this!)

Walt

When I asked this question, probably a question that most people have with Obstructive Sleep Apnea (OSA), I had not read the book Sleep Medicine by Richard Berry. I would suggest that everyone with this disease, that has a deep interest in the subject and the ability to read a medical text, read Chapters 15 forward. The book is available on Kindle and is very good. This book answers most of the questions I had about OSA and CPAP.

Walter W. Olson, Ph.D. P. E.
Professor Emeritus

PS: If I could figure out how to put a picture on this site using an IPAD, I would give some pertinent screen shots. /WWO

PPS: I have exceeded my wife'e two day adherence. I am still on it and the book has convinved me to continue. The benefits are too many to ignore! /WWO
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#20
(12-30-2015, 11:34 PM)Sleeprider Wrote: Wolson, CPAP therapy can help you to be better ventilated and overcome the severe AHI you indicated on your diagnostic study and the nearly 10x reduction in events with CPAP. Your COPD presents a complication in that most people with restrictive lung disease benefit from bilevel (BiPAP) which provides a higher inhalation pressure and lower exhale pressure. This greatly improves both ventilation and comfort. Since your AHI is above what most considered "treated" level of 5 or less AHI, you should ask your doctor about bilevel and why he didn't recommend it. Not only does bilevel have obvious benefits for people with COPD, but is reduces the RERA (respiratory event related arousals) that are probably part of the reason you don't feel rested.

Download Sleepyhead software from the link at the top of the forum. You can analyzed the data from your Auto CPAP on the SD card and see what kind of events, including RERA that may be a problem. This will give you more ammunition to discuss an upgrade to BiPAP with your doctor.

It appears that many people with COPD and OSA, such as I benefit from APAP. Thus the protocol recommended by AASM is to try this first. If APAP does not improve their AHI or they can not tolerate APAP, BPAP is the next alternative. So far, I have not had problem with APAP but it is early in treatment. What I am seeing is a daily decrease in AHI which is very encouraging. It is now down to 6.41. I will have to see if this continues.

Walter W. Olson, PhD, PE
Professor Emeritus
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