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[Pressure] AHI vs. exhaustion
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catwhisperer59 Offline

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Posts: 1
Joined: Nov 2015

Machine: resmed s9
Mask Type: Nasal pillows
Mask Make & Model: swift FX
Humidifier: unsure
CPAP Pressure: 11
CPAP Software: ResScan SleepyHead Sandman

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Sex: Female
Location:

Post: #1
AHI vs. exhaustion
Hi, I'm new, so pardon me if this has been covered before. I have read through a lot of the board, but there is so much information. I've been lurking here for a couple of years, but just joined.

A big thank you for all of you who gave information for how to camp with a CPAP and a deep cycle marine battery. I am thrilled to be able to camp and breathe.

My question: I have a Resmed S9 Elite, and have been using it in 100% compliance for 2 years. This July, I started waking up with "those" headaches again, called the doc, and sent my SD card in for reporting. She called me and said my AHI was below 3 and that was fantastic.

So how come I felt like crap.

After reading about adjusting your own pressure, I upped my pressure from 10.0 to 10.4...not waking up with the headache, but still feeling constantly exhausted.

A few mornings ago, as I was waking up (feeling like I couldn't face the day) I realized that when I was lying on my back, and breathing out, my airway blocked completely.

I raised the pressure to 11.0 and have woken up the past two mornings with no headache and feeling like I can take on the world.

My question is, how come if I could tell I couldn't breathe out through my nose (because of blocked airway), this wasn't registering on the SD card (also, my machine was set to summary info only, which I've changed).

Should I be going by how I feel, or by the numbers?
11-08-2015 10:16 AM
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justMongo Offline

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Posts: 3,839
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Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

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Sex: Male
Location: Калифорния

Post: #2
RE: AHI vs. exhaustion
Welcome

To distill the efficacy of therapy to a single number is convenient; but does not tell the whole story.
How you feel is more important.

Your story is why an auto machine is better for most people. Given a little more max pressure, you wouldn't have run into the issue.

Since you have the Elite, perhaps you could put that in your profile...

Regards,

Mongo

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
11-08-2015 10:56 AM
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trish6hundred Offline

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Posts: 6,430
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #3
RE: AHI vs. exhaustion
Hi catwhisperer59,
WELCOME! to the forum.!
I think it’s good to go by how you feel, but it sure doesn’t hurt to look at your numbers. It’s good that when you raised your pressure a bit, the headaches went away, now to get rid of the exhaustion.
Hang in there for more suggestions and answers to your questions and much success to you as you continue your CPAP therapy.

trish6hundred
11-08-2015 11:26 AM
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bwexler Offline

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Posts: 563
Joined: Mar 2012

Machine: PRS 1 BiPAP autoSV Advanced, with Heated Tube humidifier
Mask Type: Nasal mask
Mask Make & Model: Sleepweaver Élan
Humidifier: Resperonics Heated Tube humidifier
CPAP Pressure: Max pressure 25.0 cm H20, Max
CPAP Software: SleepyHead EncorePro

Other Comments: CMS 50i with Software for SpO2

Sex: Male
Location: San Marcos, CA, USA

Post: #4
RE: AHI vs. exhaustion
How you feel when awake is what good sleep is all about.
Zeroing in on the proper settings with straight CPAP is much more difficult than with an auto machine. This is especially true since most of us don't sleep the same throughout the night let alone the week or years.
As you go through different sleep stages each night or move from side to side or back sleeping, your pressure requirements may change. The same is true with seasonal changes in the weather and humidity.
Over a period of years your body will change too.

If it were me, I would raise a ruckus until my doc prescribed an auto as medically necessary. Then I would do the same with the insurance company until I could swap the CPAP for an APAP.
I was lucky enough to find this group before I got my machine, so I started with an S9 Autoset.
If I could not get cooperation from the medical mafia, I would find a supplier like Second Wind and pay to swap my machine for an APAP.
Your sleep plays a major part in determining the quality of your life.
Do what ever is necessary to make it the best you can.
11-08-2015 11:30 AM
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justMongo Offline

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Posts: 3,839
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
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CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #5
RE: AHI vs. exhaustion
Agreed

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
11-08-2015 11:44 AM
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zonk Offline

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Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #6
RE: AHI vs. exhaustion
(11-08-2015 10:16 AM)catwhisperer59 Wrote:  Should I be going by how I feel, or by the numbers?
Both are important, the lower AHI is the better how I feel ... YMMV
Low or high level of unintentional leak rates can affect both too
What are the leak rates and AHI breakdown of events on the old pressure and the new pressure?
11-08-2015 01:11 PM
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PoolQ Offline

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Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
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CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

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Location: Sillicon Valley

Post: #7
RE: AHI vs. exhaustion
remember that AHI is an average count and has nothing to do with how long they last or total time in apnea.
My doc told me that headaches were caused by CO2 retention while sleeping. If you were not breathing then your CO2 would go up and raising the pressure would clear out the CO2. This sounds just like what happened with you (and me)
11-08-2015 01:32 PM
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Mark Douglas Offline

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Posts: 513
Joined: Apr 2015

Machine: Sys 1 (60) RemStar BiPAP Auto with Bi-Flex 760P Auto Bi-Level (Variabl
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CPAP Pressure: RiseTime 3 Fxd E-9.0 / I-11.5
CPAP Software: SleepyHead EncoreBasic

Other Comments: Hashimoto's thyroiditis.

Sex: Male
Location: SW Ohio

Post: #8
RE: AHI vs. exhaustion
Have you activated the user flag options in SH? I find I can have AHI's of zero and almost always less than 0.5 unless sanding or sawing or otherwise doing something dusty yet am often tired. (but MUCH better than pre CPAP). The use flag option often shows me many micro disturbances even at AHI/0. These micro-disturbances tend to correlate with elevated leakage rates an ongoing battle for me.

I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
11-08-2015 05:54 PM
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AshSF Offline

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Posts: 356
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: AHI vs. exhaustion
You should go by how you feel. AHI is just one variable that needs to be optimized (to below 5).

The other 2 things that the machine can not detect are:
1) Your O2 levels. This needs an oximeter to
Monitor. Sometimes your AHI fixes itself at a pressure of let's say 10cm BUT your O2 levels come up to normal range at 11cm. Another way to raise O2 levels is to use EPR. Higher EPR means more O2 (for same EPAP level).

2) Microarousals: These can only by detected by EEG. A microarousal is where your body gets out of a deeper sleep stage to a shallower one. This helps the body to oxygenate itself by warding off apnea events. But makes you feel like crap in the morning because you didn't have enough deep sleep (REM, SWS) where the brain refreshes itself.

So once AHI is optimized, you need to sometimes tweak a bit more. And since we don't have a oximeter and a EEG, we can only go with how we feel in the morning.

Hope this helps.

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.
(This post was last modified: 11-09-2015 11:47 AM by AshSF.)
11-09-2015 11:46 AM
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esrepairman Offline

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Posts: 22
Joined: Nov 2015

Machine: Phillips Respironics AUTO 60 series
Mask Type: Full face mask
Mask Make & Model: Quattro Air
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CPAP Pressure: 16cm
CPAP Software: EncoreViewer Other Software

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Post: #10
RE: AHI vs. exhaustion
All the above are good points, but you assume that your machine says 10.0 it is actually blowing at 10.0. Your machine may not be working properly, it can happen. We just had a patient come in today, with a pressure of 14 and his CPAP was only blowing 11.4 and he was snoring and feeling like "crap" (his words). Ask your DME to check your machine with a digital manometer.
11-09-2015 03:14 PM
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