(03-08-2014 11:22 AM)nunanie Wrote: I have many nights (50 to 60% of nights in a month) where the AHI will remain over 10 and stay there for up to 2 to 2 1/2 hours during sleep, but because these are all averaged out over the night, the average AHI is generally 3 and under - there are occasional nights where the average is 6 or 7 - maybe 2 or 3 x's a month.
I questioned my doctor on this on my last appointment. He just smiled and said "oh you're the one that watches the numbers !!" and then "that's fine, nothing to worry about". He told me that he wasn't concerned because "it's all based on how I feel. "
As a patient, I would encourage you to start thinking about efficacy of your therapy as being a combination of how you feel
and the numbers from the machine. I say that coming from the other end of things: Good to great numbers, but not really feeling much better on PAP than pre-PAP (and that's after 3 1/2 years of PAPing.)
As for how important the clusters are: It really depends. If some or all of those clusters are during times when you're awake or going back and forth between wake and light sleep, they may mean nothing, and they might not even be scored during an in-lab sleep test. But if you're sound asleep and if you feel lousy on a day after a really bad cluster, then something might indeed need to be tweaked.
Quote:So then I told him that I can have as many as 15 to 20 and sometimes as many as 40 apnea episodes during the night (I use Sleepyhead so it's easy to count the Central's, Hypoxia's and the Obstructive's). The length of the episodes are generally between 15 and 20 seconds but often they are in the high 20's and I've seen up to 40-50 seconds of apnea's.
Are these high AHI periods through the night "normal" and something I shouldn't be concerned about?
Are apnea periods 15 to 25 and occasionally 45 to 50 seconds "normal" and I'm over reacting?
15-20 machine scored events during eight hours of sleep is NOT unusual for a PAPer, and that many events is NOT a real concern unless you're having really bad clusters night after night during times when you know (for sure) that you were asleep. In which case, it might just be REM-related or supine sleep related.
And it's also important to not get overly worried about the random really bad night. While 40 events is a lot of events, if you're using the machine for 8 hours, that works out to an AHI = 5.0, and if that's only happening once or twice a month and you don't feel much different after a random "bad night", it's not worth losing sleep over ...
Quote:Centrals seem to rule the night - but I was told that by raising my pressure to 11. that *I* have created them. (Long story - I fell through the cracks with this clinic from the start, so between the Resp Tech and a VPAP study I had in August that showed an average pressure of 12.3, I gradually increased the pressure to 11 and I finally felt like I had actually had a decent sleep again - I had been feeling as if I was smothering, wake up choking etc. I was getting no response from the sleep clinic to concerns, and no help from the cpap provider I was assigned to so I was forced to manage on my own.
First, it's a shame that you've been allowed to fall through the cracks by the clinic.
That said, however, you likely HAVE created the problem with centrals by increasing the pressure up to 11cm. Approximately 15% of PAPers are seriously sensitive enough to positive airway pressure for them to develop pressure induced centrals once the pressure is increased past their personal "pressure threshold."
Since the problem seems to be with centrals, you need to figure out how to balance "enough pressure to prevent (most) of the obstructive events" and "not enough pressure to trigger an excessive number of central events."
Since you're basically being forced into managing things on your own, this is what I'd recommend as another PAP patient: Try lowering your pressure to 10cm and leave it there for a week or so. Then compare the whole week's worth of data to a typical week's worth of data at 11cm: Did the overall AHI go up or down? Did the number of CAs go down? Did the number of OAs and Hs go up? Were there more or fewer clusters of events?
If the overall AHI goes down because of a big decrease in CAs and in spite of a modest increase in OAs and Hs, then you might just be much better off with the lower pressure setting.
Quote:I know when I've had a rough night, I wake up tired and stay tired all day not feeling at all rested, my brain is "foggy" (only way I can describe it). I also find that I'm coughing a lot. I have the humidity at 5.5% (it's worse at a lower humidity) and with a heated hose now set at 81F - that doesn't seem to be a concern either. ("It's just the dry winter weather")
For now, I'd recommend tracking things in a simple log. Track a few of the daytime variables that indicate how well you are feeling on a simple 0-5 scale (0=not a problem, 5=an intense problem). Track the AHI, but also track how much sleep time you think you got during the night and how many wakes you remember in the morning. After a few weeks
, some patterns may emerge that will indicate whether a "rough night for AHI" or a "rough night for sleep continuity" is the more significant factor in how you're feeling.
Also see your PCP for the cough if it's been hanging around for more than a week or two. Upper respiratory infections (both viral and bacterial) can lead to a (temporary) worsening of the AHI and the quality of your sleep.
If you think the cough is PAP related, you may want to bump that humidity setting up from 5.5 to 6 or 6.5 (or higher). You may also find that a lower (or higher) temp in the hose might make the cough a bit better or worse. So it's worth playing around with the temp setting too.