[Treatment] How low AHI is "good enough"?

[bsnelson]

Is the ideal target for APAP therapy to reach 0.0 AHI? I ask, because my Dreamstation seems happy with 1.0-1.5, when given free reign. I originally set my low pressure range to 10, and would consistently get 0.0, 0.1, maybe an occasional 0.5, with the 90th percentile pressure being at or a smidge above 10. But if I set the low to 8, which was what my DeVilbiss Intellipap2 had, the Dreamstation settles into about 9.0 as its 90th percentile, and my AHI is almost never below 1.0, but it's consistently between 1.0 and 1.9. 

I read that pressure being unnecessarily high can possibly cause an increase in central apneas, which obviously I don't want. Also, lower pressures, absent other factors, will help with mask leaks (Mirage Quattro full face). 

It seems like the DeVilbiss was more "aggressive" in upping pressure to keep AHI as low as possible, whereas the Dreamstation seems to think that anything below 2 is "good enough". 

Any thoughts? I'm not having any symptoms either way; I sleep great and feel refreshed in the morning, regardless of which machine I'm using. 

Brad

[Gideon]

When your numbers are S low as yours are you oh ore the numbers and make changes for comfort. So note how you feel before you even glan e at your numbers. Write it down when you wake, then you can look at the numbers,mostly for something that is uncharacteristic of your normal charts

[mesenteria]

Brad, technically, or based on current medical science, an AHI less than 5.0 is 'good enough', or 'treated'.  I don't know the proportion, but I'm going to guess that something like 30-40% of all users seldom get their therapy dialed-in to the point where their average weekly AHI is lower than 3.0.  If they don't come here for improvement, and rely on the industry and monitoring staff to make their therapy effective, anything less than 5.0 gets a thumb up from the.  So, a great many users will rise, check their smiley face or look at the number, it's 2.6, and they go about their day.  I don't think there's anything wrong with that, but maybe it could be halved to 1.2, or even under 1.0.  Is there anything to be gained, anything of substance?  Probably not.  But individual bodies and systems have a way of belying that comforting assertion.  We're all different, and some of us may need that 50% reduction in events per hour on average.

Unless you have a good whiff of OCD about you, or you like challenges, trying to eke out an improvement down to the 0.6 range or less can be daunting, and may not be achievable, or realistic.  As the previous person has suggested, once you're well under the 5.0 upper limit, it becomes more of a 'confidence interval' game.  Does the real value bother you for some reason?  Do you not really feel better after a couple of months on successful therapy, or do you not trust your machine's daily numbers report for some reason? What do you really need in order to feel secure about your therapy?  Once you answer that last question, you'll know if you need a lower number.

[bsnelson]

Thank you for the replies! Really, my only question was "should the Dreamstation be 'fighting' for better numbers by raising the pressure"? It sounds like it's just a difference in philosophy between the two machines - the DeVilbiss would raise the pressure to eke out that last little bit, but the Dreamstation won't, and that's OK from a medical perspective. Again, I like the benefits from a mask fit and dryness perspective of the lower pressure, so as long as I'm feeling good and the numbers stay comfortably below 5.0 as they are now, I won't worry about it.

Brad

[SarcasticDave94]

My opinion only of course, but if you want or expect a PAP to fight for you, the DreamStation possibly isn't the best machine. ResMed does better at fighting like you want. Take advantage of the recall and go get a ResMed. If you're using a DreamStation CPAP Auto the ResMed 10 or 11 AirSense AutoSet is the perfect answer for a better equipped PAP that fights for you. If your DreamStation is a BPAP, the ResMed AirCurve 10 VAuto is your best answer.

AHI below 5 is the medically set goal and below this, the lowest obtainable without sacrificing comfort is your perfect number.

[Steptoe]

I bought a Fisher & Paykel SleepStyle when the recall was announced. My AHI went from an average of 4.5 with the DreamStation to 2.5 with the SleepStyle. I just received the DreamStation 2 and my AHI average 6.5 for the first two nights. When I raised the minimum pressure from 8 to 9 on the third night, my AHI dropped to 3.3. I’ve been told that Philips does not have as aggressive of an algorithm as the SleepStyle or the ResMed machines.

I’m back using the F & P and will keep the DreamStation 2 as a backup.

[StevesSp]

I suspect that there is a 'sweet spot' and it isn't 0.0. That's not to say that zero apneas is bad, just that the process of driving it down that far might cause other problems.

That's been my experience anyway, based on how I feel when I wake in the morning. Anywhere between 3 and 5 seems best for me. Any higher OR LOWER usually coincides with feeling extra tired. That said, I never wake feeling great and never have since starting therapy. Having had one heart attack and with significant ticker troubles though, I think the CPAP-induced fatigue (if that's the cause in my case) is the lesser of two evils.

Talking of ticker troubles, I firmly believe everybody who believes or knows they had sleep apnea for some years before undergoing treatment should have a full cardio check-up, if they haven't had one for a while. My cardiologist believes my untreated apnea played a big part in my heart attack, given the absence of enough else to explain it (non-smoker, weight OK, nothing major in the family history).

My younger brother also had a hearty at about the same age as me - 52 - and he too had untreated apnea, despite my pleas to get tested.