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Reasonable expectations for numbers
#1
Reasonable expectations for numbers
Ok so its pretty well known that AHI needs to be 5 or less but thats pretty basic. My question is more about the individual elements:

i know that large Leak ahould be as close to 0 as possible and if not 0 its not considered to be optimal/resolved completely.

But what about CA? Is under 5 considered stable/resolved or does it really also need to be 0?

What about flow limit? Looks like the scale goes only to 1 so I assume lower is always better but again is it even possible to have a flow limit of 0? What is a reasonable expectation for those numbers in a well resolved situtation?

Same for RERA.

Sorry am not sleeping well and looking at my numbers to try and see what is in spec and whats not.

Basically in a broader sense I am trying not to chase numbers just for the sake of getting a lower number. Once I know what limits are considered to be "resolved" I can stop chasing those and look at others areas.

Just for the record I have talked to my dr and he was no help at all he bascially said once AHI is under 5 there is no point in chasing numbers anymore at all, even though he knows I still feeling worse then before starting therapy.

I have posted oscar data recently in a thread that seems to have no answers so started this more general thread in hopes I could at least get some basic parameters
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#2
RE: Reasonable expectations for numbers
The bottom line is to get a good night's sleep and not worry too much about the numbers.  DO NOT chase zeros!!!

Don't worry about resolved, comfort is king.
Your doctor said "Once AHI is under 5 there is no point in chasing numbers anymore".  I more or less agree, I'd rather see AHI of 2-3 but you need to tune for comfort.  Sometimes comfort means that you will likely take a hit somewhere else, don't worry about it.



Note these are guidelines meaning you may be an exception.
AHI, OAI, CAI, RDI < 5, it depends where you are, some places are < 10 or 15.  We like to see 2-3
Flow Limits there is nothing official, we like to see 95% FL <= 0.10
Large leaks should be zero, <=24 lpm for ResMed
RERAs are added to AHI to get RDI, see above.
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#3
RE: Reasonable expectations for numbers
I appreciate the direct answer and agree, seems I have it all backward

See I am "chasing numbers" in order to try and IMPROVE my quality of sleep. Based on all you said and what I had deemed before posting my numbers all look great, however, I still feel pretty horrible most mornings and am more tired during the day.

In fact I feel worse and sleep less well then I did before starting the therapy. Last night was the first night after which I felt like I could get up in the morning and not need a nap by 2pm. Still not great but better.

Maybe I should have asked my question a little differently....

Not what numbers should I shoot for BUT which numbers are most important for quality deep sleep?

Also in my EXTREMELY limited testing it would seem I do better with my machine as a cpap (static pressure) then an apap. Now of course I needed the apap to find the correct target cpap value so kinda a catch 22.

I am still adjusting pressure numbers but based on your above answer my numbers are already well under control I just need to work on the comfort aspect, or more specifically sleeping better aspect.

Looking for opinions.... when your numbers all look good and you dont feel good in the morning or feel like your not sleeping well what do you look at and what do you change to try and improve that aspect?
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#4
RE: Reasonable expectations for numbers
There is no easy answer because ahi and Cai do not determine symptoms. It is a complex relationship between ahi, non apnea breathing, arousals, desats and other health issues that determine apnea induced symptoms and this all changes on a case by case basis.

There are people with 10+ ahi that do not have obvious symptoms and do not get improvement from treatment. This is why they only recommend treating mild apnea cases (5-15 ahi) if the patient is symptomatic (and symptoms agree with apnea diagnosis).

Then in the case of central apnea it becomes even more complex. Are the apnea spread out interrupting sleep continuously through the night or acting in one or two flurries during sleep transition?

In short we can't answer your theoretical question because there is no right answer.

The answer to your last question is that if your data looks good and there aren't any recommendations for potential improvement then it can be because it takes months for body to fully adapt to cpap, because breathing is an issue in a way we cant diagnose easily with oscar (for example reras) or because your symptoms aren't all caused by sleep apnea. If you are like me you might have to do a titration study to investigate how good or bad your treatment is working before accepting if breathing is or isn't still an issue.
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#5
RE: Reasonable expectations for numbers
I've looked back at your earlier thread. I think if you want to try a fixed pressure you could set max = min = 8, with EPR of 2 or 3. This would just be an experiment for maybe 3-4 nights, and it can't hurt you. Some people are sensitive to pressure changes, and if you are one of them, this would be a nice fix.

But I also want to raise the question whether some other medical problem is responsible for your continued feelings of exhaustion and sleepiness during the day. Here are some issues your doctor could help explore: side-effects of your medications, thyroid deficiency, autoimmune disease, Lyme disease, low testosterone, anemia. I'm sure there are many more.
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#6
RE: Reasonable expectations for numbers
To OP -

I notice you joined the forum in March 22, so am guessing you are about 1 year on PAP therapy. I would think any treatment emergent Centrals would have resolved by now. I recommend contacting the sleep center where you had your original sleep study and voice your concerns.
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#7
RE: Reasonable expectations for numbers
My personal answer for therapy and numbers: work to get all events as low as possible, work to sleep 8 or so hours, while adding the well rested feeling and yet without sacrificing comfort.

The numbers go down when you edit settings and optimize it for you. But there's a point that the return on the (dial turning) investment no longer yields your wanted results because it's stealing comfort. That's where you need to fine tune settings to get a great balance of well treated events and good comfort. Then after you find that place, camp out there.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Reasonable expectations for numbers
Wow, all these answers... its great , sorry for late reply but I m not getting notified consistently about when a reply is posted.
That said the theme I see here is all about comfort and I get that I guess the issue I am having is that as far as "comfort" I am not being kept awake by the mask or hose in fact I dont even recgnize it as being on anymore. Sometimes I even check the vent on my mask to be sure its actually working. So comfort as I am thinking about it is fine, no adjustment needed there.

The issue is that while "comfort" seems good and numbers are all well within spec I still dont feel very good in the morning or during the day. In fact I would say my absolute best day on cpap so far is equal to a fairly misreable day BEFORE therapy. I have no idea why and just want to feel better.

I started playing with static pressure and an epr of 1 to 2. You will see in the data I posed last night I changed ep[r from 1 to 2 after about an hour.

Not sure what else to do so I can actually wake up in the morning and feel at least as good as I did before the therapy.

As you can see am on a fairly low pressure already. I could probably go down a little further if that might help. Also in the past when I have tried EPR 3 I got clusters of CA primarily at the beginning or ending of a session.

Also the higher the pressure I used the more leaks I had. I guess thats normal.

       
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#9
RE: Reasonable expectations for numbers
Again, I hope you and your doctor can explore other explanations for your continuing symptoms. It’s awful to keep feeling that way.
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#10
RE: Reasonable expectations for numbers
I talked to him this last monday. He is of the opinion. that there is nothing more he can do and I should go see a psychiatrist about anxiety and depression. No explanation as to why my supposed anxiety and depression all of a sudden at exactly the same time i started therapy began causing my "sleep" issues?

Also in the same senetnce he said that BTW emory psychiatrists across the board are no longer accepting new patients, they are overwhelmed and not seeing any new patients for the forseeable future.

All the video based services are not allowed to prescribe the adhd meds that I supposedly need.

Great help, huh?

So back to the drawingboard of trying things till I can get a better result I guess.
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