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Has 'mild sleep apnoea' been redefined numerically?
#1
I've had disappointing CPAP results for a few months, AHI usually 5-8. For a variety of reasons I would prefer tighter control if possible.

I saw a new sleep doctor today (here in France) who told me that any AHI of less than 12 is now *not* sleep apnoea, even 'mild', so that no changes need to be made to my regime.

I thought 'mild' OSA was an AHI of 5-15?

Has anyone heard that is has been redefined, or was I told nonsense?

Thanks if you can help.
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#2
That's a question for DocWils who practices in Switzerland.
He's more familiar with what's going on in Europe.

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#3
10, 12, 5 --- They're just numbers on the blackboard. If you're not sleeping well due to nighttime arousals then for you something needs done.

Let's start with looking at the actual events. Not the AHI, that's not really helpful. But of the events, are they OA, CA, Hypop? How many of each? Then let's look at the pressure. Your sidebar says your min is 10 and your max is 14? What are the actuals? The median pressure, below 95% and the max?

If all these things are in order, then I'm going to suggest you look into a different mask. Very often a more comfortable sleep regimen can be achieved by moving to a pillows mask. That might just allow you to get where you want to be.

But start the numbers, and we'll go from there.

Docs have to restrict there time sometimes which can result in arbitrary decisions as to whether or not your particular symptoms require their time. Doesn't make it right, just makes it so.

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#4
(05-20-2015, 12:38 PM)retired_guy Wrote: 10, 12, 5 --- They're just numbers on the blackboard.

But of the events, are they OA, CA, Hypop?

Very often a more comfortable sleep regimen can be achieved by moving to a pillows mask

Docs have to restrict there time sometimes which can result in arbitrary decisions as to whether or not your particular symptoms require their time. Doesn't make it right, just makes it so.

Hello - thanks for your thoughts.

Sorry, my sidebar wasn't up to date. Currently APAP 9-11.4. Lower max doesn't adequately control obstructives, this and any higher pressure increases (slightly) centrals but much larger increase in hypos - to 90% of total AHI. Current 95% pressure is 11.3. Still tired and not very good sleep quality and increase in insomnia. Oxymetry results are acceptable. Have tried CPAP 11, intolerable even with long ramp. About to try CPAP 9 and go on from there.

Cannot use nasal mask of any sort (unsolvable issues), oro-facial very comfortable and leaks are zero.

Have complex medical issues which affect (1) it really would be a very good idea to get AHI lower (multiple medical publications say so) and (2) affect the effectiveness of the CPAP itself.

New doctor very helpful and 'on the case' but I was just surprised by her defining mild OSA as now an AHI of more than 12.
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#5
Sorry, I do not know what standards they use in France, but the standard medical dictionary, which is international, defines it as starting at 5 for a clinical diagnosis, so I don't know what she is talking about - this may be an insurance definition, but it is not a current medical definition. I sympathise and wish you good luck.
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#6
(05-20-2015, 01:41 PM)Asjb Wrote: Hello - thanks for your thoughts.

Sorry, my sidebar wasn't up to date. Currently APAP 9-11.4. Lower max doesn't adequately control obstructives, this and any higher pressure increases (slightly) centrals but much larger increase in hypos - to 90% of total AHI. Current 95% pressure is 11.3. Still tired and not very good sleep quality and increase in insomnia. Oxymetry results are acceptable. Have tried CPAP 11, intolerable even with long ramp. About to try CPAP 9 and go on from there.

When you see the hypops increase then it's pretty safe to assume the underlying flow limits have increased as well. All that can definately affect your quality of sleep. Generally what you want to do is set the max pressure a little above what is required to remove the OA's, then set the minimum pressure up a little at a time until the hypops pop, and the flow limit goes baby butt smooth.

So if it was me I would set the max to 12 and the minimum to 8. Any CA's you might see will probably go away after a day or two. You could also set the EPR on so that your exhale pressure could be a couple of points lower than the inhale.

The one thing to keep in mind is when you change something you have to give it a while to "soak in." I don't necessarily subscribe to the "2 or 3 weeks or more" school of thought, but a few days at least. Also, when you make changes try to not change any pressures more than 1 point at a time. Same with
EPR if you use it. Try it at 2, then maybe try 3 after you are settled in.

...and if you haven't already, tell the ramp feature to go away.
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#7
(05-20-2015, 12:04 PM)Asjb Wrote: I've had disappointing CPAP results for a few months, AHI usually 5-8. For a variety of reasons I would prefer tighter control if possible.

I saw a new sleep doctor today (here in France) who told me that any AHI of less than 12 is now *not* sleep apnoea, even 'mild', so that no changes need to be made to my regime.

I thought 'mild' OSA was an AHI of 5-15?

Has anyone heard that is has been redefined, or was I told nonsense?

Thanks if you can help.

Could be that France is redefining it because they don't want to pay for it. However, the diagnosis is based on your sleep study number(s), not what you are getting with therapy.
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#8
(05-20-2015, 01:41 PM)Asjb Wrote: Currently APAP 9-11.4. Lower max doesn't adequately control obstructives, this and any higher pressure increases (slightly) centrals but much larger increase in hypos - to 90% of total AHI.

Raising your pressure increases the number of hypopneas!? Can you verify that because it doesn't sound right.
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#9
If the hypopneas are central in nature then increased pressure could increase their number.

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#10
(05-20-2015, 05:34 PM)retired_guy Wrote: When you see the hypops increase then it's pretty safe to assume the underlying flow limits have increased as well. All that can definately affect your quality of sleep. Generally what you want to do is set the max pressure a little above what is required to remove the OA's, then set the minimum pressure up a little at a time until the hypops pop, and the flow limit goes baby butt smooth.

...and if you haven't already, tell the ramp feature to go away.

Thanks for this. Yes, I don't use the ramp.
It's all a bit strange - my obstructives went away almost from the start of treatment, fewer (usually much less) than 1/hr, almost as soon as they see the machine let alone put the mask on! But my hypos are much more difficult to control, very rarely below 3 and often more than 4. So I often end up with a combined index of over 5. I am not wedded to the numbers themselves, but it's a bit disappointing and cardiac-wise, the evidence seems to be that tight control of the AHI is a good thing.
E.g. Last night - obs 0.4, central 1.7, hypos 4.8, AHI of 7.O.
Any suggestions please?
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