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[Diagnosis] What does it mean to have 35 A+H in 41 minutes of REM? noob, here.
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Kris the Crone Offline

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Post: #1
What does it mean to have 35 A+H in 41 minutes of REM? noob, here.
First, let me say how excited I am to have found this forum and all of you enthusiastic CPAPers this early on my journey! It is making my transition into the world of treating sleep apnea so much easier. For once, I have found great info and help before I had to work so hard figuring out things by myself as I have with a number of other issues.

I got results yesterday from my initial sleep study, and it says "mild-to-mpderate obstructive sleep apnea, which is more pronounced in the supine and REM sleep." I've been recommended for CPAP titration, which I will have next week. Yesterday I tried on several of each of full face masks, nasal masks and nasal pillows, was fitted for size, and got to try the best one of each with a CPAP machine, pushing the pressure up to about 11. I wanted to take the machine home with me! All the options felt pretty darn good, and I got the hang of breathing against pressure right away.

My combined AHI is 9.8, with a REM index of 50.6 and non REM index of 2.9. As I said in the title, I had 35 of my total of 47 apneas and hypopneas during the 41 minutes of REM. Is that unusual or bad? I googled around and read on the apnea board wiki articles, and searched the threads, but couldn't find anything about this. I know that it is more common for there to be apneas during REM, but I couldn't find any numbers. I got the raw data as well as the conclusions from the study. The specialist seemed surprised that I wanted it all.

I am looking forward to the titration next week, and really looking forward to getting a good night's sleep for the first time in a long time. I know I'll have many more questions in future, and I am trying to read everything in your resources here that I can. I got a bit overwhelmed reading about all the problems, but I am loving the success stories. Gives me hope!

I plan to go all the way, using software to track my progress. Can't wait!

"Perseverance, secret of all triumphs."
Victor Hugo
05-18-2016 10:02 AM
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Rcgop Offline

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Post: #2
RE: What does it mean to have 35 A+H in 41 minutes of REM? noob, here.
You need to look forward to the titration. It's the most important part. As for the technical part of your post, there will be other replies for you.

Keep positive and patient, it took 2 months before I started looking forward to going back to bed.

HuhDont-knowI am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
05-18-2016 01:26 PM
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Sleeprider Online
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Post: #3
RE: What does it mean to have 35 A+H in 41 minutes of REM? noob, here.
Your sleep study clearly indicates obstructive sleep apnea, and the intensity of the apnea changes with sleep stage (REM). This is not unusual and may be a good reason to request that you be issues an auto-CPAP with a range that resolves apnea in non-REM sleep at a lower pressure, but that will increase pressure during REM sleep. The titration study can identify a range of pressures if you sleep.

I don't think a titration study is particularly useful as auto machines are capable of titrating a patient and changing pressure as necessary; although a study may identify people with a tendency for CPAP induced central apnea. The study will usually identify a single pressure that results in therapeutically effective treatment in supine sleep position and REM sleep. That single pressure will be higher than what you need most of the night, which is why auto-CPAP is more comfortable. Since most titration studies endeavor to find a single effective pressure for the worst case, this is often used to recommend a single pressure CPAP.

Mostly you need to be sure your prescription will get you a fully data capable machine, and the best of those are going to be the auto CPAP like Resmed Airsense 10 autoset or Philips Respironics Dreamstation Auto. Try to have a discussion with your doctor about the RANGE of pressures that may be effective, as well as the maximum pressure needed to resolve apnea when you're on your back or in REM stage sleep.

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05-18-2016 01:47 PM
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Kris the Crone Offline

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Post: #4
RE: What does it mean to have 35 A+H in 41 minutes of REM? noob, here.
Thanks, Rcgop, I will be positive and patient. Knowing that the members of this board are around to help if I get stuck helps enormously!

Appreciate your input, Sleeprider! I have been told that I will be getting the Resmed Airsense 10 autoset, and I will definitely ask the doctor for a range of pressures. It will be very useful for me to know the pressure needed to resolve apnea while back sleeping. I have much preferred side sleeping for decades, probably because I had so much trouble on my back. But a hip replacement last summer dictated that I back sleep for 6 weeks, which was torture. I had to sleep sitting up all that time, and got only 1 - 1 ½ hours at a time spread throughout the day, for a total of a maximum of 6 hours per day. I have to have another hip surgery (have complications from the first one) and I really want to be able to sleep on my back this time. And I have been just so exhausted since the surgery that I decided this was the time to get the sleep problems in order, if possible, to see if that relieves any of the fatigue..

So I am soaking up all the info here like a sponge.

"Perseverance, secret of all triumphs."
Victor Hugo
05-18-2016 04:30 PM
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0rangebear Online

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Post: #5
RE: What does it mean to have 35 A+H in 41 minutes of REM? noob, here.
Hi
Welcome
(05-18-2016 10:02 AM)Kris the Crone Wrote:  I am loving the success stories. Gives me hope!

I plan to go all the way, using software to track my progress. Can't wait!

I think your enthusiasm is great, it should make you quest easier. I was not a believer when I start down this journey, it is always better to have faith in any endeavor.

Don't hesitate to ask questions as there are many "Hosehead Sages" in the forum.

Looking forward to seeing how your journey tracks and to offer help if needed.

May the road rise to meet you
May the wind be always at your back
Sleep-well
05-18-2016 04:45 PM
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trish6hundred Offline

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Post: #6
RE: What does it mean to have 35 A+H in 41 minutes of REM? noob, here.
Hi Kris the Crone,
WELCOME! to the forum.!
You have a great attitude and that will go along way as you start your CPAP journey.
Hang in there for more responses to your post, good luck at your titration and much success to you as you start your CPAP therapy.

trish6hundred
05-18-2016 08:13 PM
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Kris the Crone Offline

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Post: #7
RE: What does it mean to have 35 A+H in 41 minutes of REM? noob, here.
Thanks, Orangebear and trish. I am thrilled with the warm welcomes and encouragement! Will be collapsing into bed early tonight, as I've been having numerous big-time frustration dreams every day just before waking for the last time in the morning. So it feels like I'm awakening even more tired than usual these days. I loved the feeling of that cool air flowing into my nose and easily down into my lungs while lying on my back at that face mask trial yesterday. I want more of that.

"Perseverance, secret of all triumphs."
Victor Hugo
05-18-2016 09:37 PM
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robysue Online
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Post: #8
RE: What does it mean to have 35 A+H in 41 minutes of REM? noob, here.
(05-18-2016 10:02 AM)Kris the Crone Wrote:  My combined AHI is 9.8, with a REM index of 50.6 and non REM index of 2.9. As I said in the title, I had 35 of my total of 47 apneas and hypopneas during the 41 minutes of REM. Is that unusual or bad?
It means that your apnea goes from "mild" to "severe" when you hit REM sleep, or possibly when you hit REM sleep while on your back.

That's not uncommon. Many, probably most, people's OSA is worse in REM, and you are not the only person whose OSA is substantially worse in REM.

It also means that you may do better with an APAP with a carefully chosen Auto range that can adjust the pressure upwards when you hit REM but also allows you to use lower pressure when you're not in REM. Even then, however, you want that min pressure setting to be reasonably close to what your pressure needs are in REM so that you don't have to experience a bunch of events before the machine gets the pressure up to where you need it.

Best of luck

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05-19-2016 08:56 AM
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Kris the Crone Offline

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Post: #9
RE: What does it mean to have 35 A+H in 41 minutes of REM? noob, here.
Thanks for your clear explanation, robysue. I will see what the doctor says and hope he recommends an auto range. If not, I'll be questioning him about it. I've looked through your guide to SleepyHead, and I thank you for your efforts to provide us with this valuable guidance. I'm sure it will be much easier for me having read your guide before diving into the program.

"Perseverance, secret of all triumphs."
Victor Hugo
05-19-2016 10:36 AM
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