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LOW AHI vs actual REAL quality sleep
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waydavis Offline

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Joined: Jul 2015

Machine: ResMed Airsense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: Simplus
Humidifier: Resmed
CPAP Pressure: 7-14
CPAP Software: ResScan

Other Comments: 16Gb FlashAir 3 card, Win10, Sleepmaster (WOOHOO!)

Sex: Male
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Post: #1
LOW AHI vs actual REAL quality sleep
I've had my machine now for about 50 days. I ALSO have 2 infra-red camera's that watch me all night from 2 angles. They snap a pic every 2 seconds IF I move.
The idea behind doing this was to see if there was a correlation between my obstructive events and a particular position I'm laying in.

An additional interesting thing has come out of this.

Doing the math every morning, I am able to get a number representing movements/Hr and this has shown some disturbing data. Even though my CPAP numbers are great going from 43 events/Hr without cpap to under 4 with, I HAVE had nights with 63 movements/Hr and as low as 16. MANY of these high numbers were due to my mask. I am still trying different ones but having difficulty finding one that doesn't either bypass air out the perimeter at high pressures OR blow air from my nose through to my eyes via the nasolacrimal ducts. I'm in the process of trying another mask setup tomorrow hopefully. Right NOW, I have the best results with a Simplus using a pressure no higher that 14. I tried that new Respironics AmaraView and although it initially FELT like is was going to work, it failed the worst. The design just doesn't work for ME. I'm thinking of going to one of those full face gasmask looking things. At least then, I won't have air blowing THROUGH my eyes! Yikes!
<snip>
08-19-2015 12:31 AM
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Hanrahan Offline

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Posts: 42
Joined: Jul 2015

Machine: still testing
Mask Type: Nasal mask
Mask Make & Model: F&P Icon Premo non-Auto
Humidifier: Yes
CPAP Pressure: 7
CPAP Software: Not using software

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Sex: Male
Location: Tropical Nth Queensland, Australia

Post: #2
RE: LOW AHI vs actual REAL quality sleep
i'm at the same point as you are, about 50 days and wondering if it works.

I personally find pressures about 9 and above disturb my sleep and are possibly counter-productive. I ran min/max pressures 5 & 6 last night and got low AHIs. I am not a mouth breather [thats awkward, I once bred "mouth breeder" tropical fish] so I think I will find a pillow good enough, I have a larger size to try tonight. Smile

We can buy try and hope.

ps. If I get it quiet enough I might be welcome back in the matrimonial bed. Big Grin
08-19-2015 02:57 AM
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sonicboom Offline

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Posts: 474
Joined: May 2015

Machine: Airsense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10, Dreamwear
Humidifier: Integrated
CPAP Pressure: 4.6-7.6
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Washington

Post: #3
RE: LOW AHI vs actual REAL quality sleep
If you have not already done so go into the preferences area of SH software and configure it to allow both User Flag 1 and User Flag 2. This will show you events (I believe the default is set at 8 seconds) that do not "qualify" as apneas because they don't technically fit the definition (10 or more seconds in length). They are not counted in the AHI calculation but they do effect your sleep as they are arousal events. if you see many UF1\UF2 events then you have figured out the problem.

Coffee
08-19-2015 11:28 AM
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
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CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Orange County,California

Post: #4
RE: LOW AHI vs actual REAL quality sleep
How do we know that they <are> arousal events?
08-19-2015 03:22 PM
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sonicboom Offline

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Posts: 474
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Machine: Airsense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10, Dreamwear
Humidifier: Integrated
CPAP Pressure: 4.6-7.6
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Washington

Post: #5
RE: LOW AHI vs actual REAL quality sleep
(08-19-2015 03:22 PM)PaytonA Wrote:  How do we know that they <are> arousal events?


I use simple logic. The machine is programmed to record apnea events which our doctors tell us are arousals. I look at all of my graphs to see what happens to each one during a recorded event that is an arousal to see what happens during one. For an example, perhaps respiration goes up and tidal volume goes up, etc...I look for the same patterns for a UF1 or 2 event. If I see the same graph behavior I conclude its an arousal of a sort. If this is erroneous please feel free to educate me.

Coffee
08-21-2015 02:48 PM
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
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Mask Make & Model: Resmed Mirage Quattro
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CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Orange County,California

Post: #6
RE: LOW AHI vs actual REAL quality sleep
But an event of shorter duration may not be an arousal. I do not know this but am just speculating.
08-21-2015 07:08 PM
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sonicboom Offline

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Machine: Airsense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10, Dreamwear
Humidifier: Integrated
CPAP Pressure: 4.6-7.6
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Washington

Post: #7
RE: LOW AHI vs actual REAL quality sleep
True enough. It may not be. With a UF default of 8 seconds it's close enough to the standard 10 and if one is not feeling rested in the AM with a very low AHI, UF 1s or 2s might help explain why. It's a place to look to try and find a reason why.

Following up on your point it would be interesting if one of our members who is seeing a sleep doctor soon could ask the question of whether an 8 second "event" is enough to constitute an "arousal".

Coffee
08-21-2015 08:32 PM
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quiescence at last Offline

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Machine: REMstar System One with Autoflex
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Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

Sex: Male
Location: US

Post: #8
RE: LOW AHI vs actual REAL quality sleep
Sorry, but the term arousal and the term apnea event are so different they cannot be describing the same thing. There are many apneas that resolve without arousal per se. There are many arousals that are not scored as apnea or even hypopnea. Case in point, RERA or respiratory effort related arousals are detected by some machines, and those wave forms do not resemble the hypopnea or apnea events. There are arousals that are not connected with any apnea, such as periodic leg or arm movement, or from being startled by noises inside or outside. There are apnea that get resolved by central nervous system feedback, without arousal; there are apnea caused by mechanically overventilating which may not lead to arousals. My natural arousals throughout the night are not the product of apnea, hypopnea, or mini- or micro- UFish partial unscored apneas.

I applaud your use of the experimental SH parameters of UF1 and UF2 to try to correlate the feeling you get when the frequency of these parameters are higher versus lower. But, there may or may not be a direct correlation. Many suffering from sleep disorders do not even exhibit apnea.

soap box has been removed, and my rant is now over - Smile

QAL

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
08-23-2015 05:16 AM
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AshSF Offline

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Joined: Oct 2014

Machine: PRS1 D560TS
Mask Type: Nasal pillows
Mask Make & Model: ResMed P10, Bkup: Airfit F10 & Quattro Air
Humidifier: PRS1 60 series with Heated Tube
CPAP Pressure: 8 - 8 w/ Aflex 3
CPAP Software: SleepyHead

Other Comments: Using APAP mode with fixed pressure

Sex: Male
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Post: #9
RE: LOW AHI vs actual REAL quality sleep
My AHI has always been below 1.

FWIW, I have tweaked UF1 and UF2 parameters and recomputed these indices for values of 5-8 seconds and 10% to 80% reduction in airflow. I found no correlation with how I felt in the morning. So these may be of dubious value to diagnose sleep issues and sleep related arousals.

Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
08-23-2015 10:20 AM
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MobileBasset Offline

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Machine: ResMed AIRCURVE 10 V Auto
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Sex: Female
Location: Florida

Post: #10
RE: LOW AHI vs actual REAL quality sleep
I find that when I am really examining the data for some purpose other than a routine check, that zooming in on the flow rate and scanning through the whole night is best. Rather than trusting an algorithm I can actually see all the nuances of my breathing. I don't have to wonder what the algorithm settings might have missed. In addition to seeing every apnea/hipopnea no matter the length, I can also assess areas of rough or distorted breathing.
When I was first setting up my APAP this allowed me to understand that I needed a little more pressure than the auto wanted to settle at. I had good AHI but was not getting rested. So I nudged the run pressure up with my min EPAP setting.

if you can't decide then you don't have enough data.
08-23-2015 11:58 AM
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