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healthy vs not sick and symptom suppression
#1
Seems if one has an AHI under 5 is considered not to have sleep apnea? Is this not-healthy but less than sick? if so is this not like a car dealer telling me since my car engine only misses/stumbles 4 times an hour no maintenance is required? I certainly would not be happy with an engine that misses "only" 4 times an hour - if I were aware of it. Maybe it does and I just do not sense it? On the other hand does an engine miss or AHI of 4 or less actually cause problems? Now that I am aware of the collateral damage the perfectionist in me wants no stumble no AHI. Can one feel the difference in the morning? Will an AHI of 4 reduce ones life span or enjoyment? Will diddling with the machine to reduce any AHI above zero become an obsession? I have to think anything that adversely effects a steady supply of oxygen and release of waste products is not a good thing.

Is not a cpap machine treating a symptom? What would thorough medical RCA tell us if anything if one could afford the cost? Why sleep apena at all?

Ramble off.
Dont-know


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)
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#2
Mark,

I think of it like this...

Medicines and therapy aren't perfect and while they all relieve some level of pain and suffering they all have limitations. A person who walks with a cane would rather walk without a cane. A person who gets migraine relief from a pill would rather not have a migraine at all. Neither of these remedies make it perfect. So I suspect CPAP therapy also has its limitations, and beyond a certain point I can do more things to improve the quality of life by other means than tweaking the CPAP machine to eek out the last few points of AHI.

And so the medical industry that brings these solutions to us does a lot of experimenting to develop measurable targets to establish a standard for applying the medicine or therapy across a broad population. I'm sure there is a diminishing return on investment of time and attention required to achieve each level of effectiveness leading up to perfect, and perhaps it is not even possible to reach a general standard that is set too high across an entire population.

In that view of things, the CPAP industry has pegged an AHI of 5.0 as the standard to declare the therapy effective across the general population. With individual experimentation / doctoring, some people can achieve better. I have seen posts here indicating people reach AHI 0.02, so I know it is achievable. But the industry has agreed to set AHI of 5.0 as the therapeutic standard.

That sets a clear measurable objective for the medical community, with an AHI number above which more attention is required, and at that AHI or below they can declare victory for the majority of the population and spend time and resources on helping other people.

Now, based on our long relationship of about three weeks as anonymous pen pals posting notes on the internet, may I suggest it is the obsessive in you rather than the perfectionist in you that is about to tell yourself you are missing out on something if you don't get your AHI down to zero.

I suspect that this forum is largely a community of people who sometimes lose sleep fretting about things we aren't willing to change in our own lives. I'll go first... "Hi I'm Saldus and I sometimes fret about stuff that is in my power to change but I would rather fret about it than make lifestyle changes that I know would make me healthier."

So I accept that about myself and I work on the things I am willing to change. Hopefully as I feel better there will be more I am willing to change and turn the spiral around from downward to here to become upward from here.

In the mean time I am not losing even more sleep over how much further I have to go in order to get to perfect sleep. I'm after it, but if the only problem I end up with is an AHI of 3.5 and I feel great each day from the therapy, then I resolve to be a happy guy and not overly worry about the last few points. Whatever is lacking at that level is way better than where I started. The damage done by however long I suffered from untreated SA up to now is probably worse than living with an AHI 5.0 the rest of my life. In comparison it is probably down in the noise. And there probably isn't much I can really do about it.

Theoretical limits aside... Mark you are going to begin feeling a LOT better once you start your CPAP therapy. I have felt better from the first day, except for a couple of days this week in which I had panic in my life over some circumstances unrelated to sleep apnea. But even at that I am in so much better shape to think clearly and map out a way ahead than I was 22 days ago before I started. My AHIs aren't perfect. Only a couple of days so far that were below AHI 5.0, and a few that were above 20. But the lowest AHI days were not the days I felt my best (so far). And so there are other factors at play and I am still studying the data each morning to figure out which ones impact how good I feel in order to concentrate on improving those.

Bottom line: Be encouraged that you are on the threshold of a major improvement in your quality of life. I am hopeful for you to get through all the red tape it takes to finally get your machine next to your bedside and breathing life into your tired body soonest.

Once you get a handle on what affects the numbers (I am still learning), keep improving but along the way enjoy the gains and don't lose any of the good stuff by worrying about how far you have to go.

I and a lot of others here know a fair amount about the last days before it started getting better. You are there now. And I say with some confidence based on experience of myself and others I have learned from here, that it's about to start getting better for you.

Be on the lookout for it. Don't let worrying about perfection steal it from you.

Saldus Miegas
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#3
Most inspirational and comforting. I thank you very much! You are most wise.
.
Probably time to get myself to the zendo and stare at the wall for a while.

Wife says I'm obsessed with the subject as I sit among the piles of "stuff" around me not getting done - I prefer to think it is ADHD hyper-focus. LOL That same obsession or hyper-focus as you choose kept me sought after and gainfully employed in automation systems for most of my life. And now I will soon have a new toy to play with !

Again I thank you !
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)
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#4
Very nice Saldus. Great commentary. There are those who have been on this forum that due to other limitations can not live with a therapeutic pressure that might get their AHI below 5, who are happy with the results that they are getting.

I have a suspicion that the people who are able to score 0s regularly may have a more stable sleep breathing pattern (aside from the apnea events). My sleep breathing patterns seem to be all over the place and my AHI is normally well below 5 but I have reached 0 only once and I might never do so again. I am happy with where I am. I still experiment with some things in an attempt to improve my therapy but I am definitely not trying to reach 0.

I started with a Resmed S8 VPAP Auto and now on the S9 version of the same machine. I started using it as a straight bilevel machine per my prescription. I tried going to bilevel auto mode several times and my AHI seemed to increase each time. About a month or 2 ago I was able to successfully change to bilevel auto and maintain the same level of AHI with the resulting lower average pressure and I may well try a nasal mask down the road to possibly lower my average pressure some more.

Note to SuperSleeper: Could you please hide this post from Retired_Guy. I don't want him to think that I am going soft(er) in the head. Laugh-a-lot

Best Regards,

PaytonA

Admin Note:
PaytonA passed away in September 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#5
(04-30-2015, 09:19 AM)Mark Douglas Wrote: Seems if one has an AHI under 5 is considered not to have sleep apnea? Is this not-healthy but less than sick? if so is this not like a car dealer telling me since my car engine only misses/stumbles 4 times an hour no maintenance is required? I certainly would not be happy with an engine that misses "only" 4 times an hour - if I were aware of it. Maybe it does and I just do not sense it? On the other hand does an engine miss or AHI of 4 or less actually cause problems? Now that I am aware of the collateral damage the perfectionist in me wants no stumble no AHI. Can one feel the difference in the morning?

From my perspective, lower is better. There is no amount of "not breathing" that I consider to be beneficial.

Whatever the lowest AHI/RDI I can get is just fine with me.

"5" is just a number that everybody can point to and declare "success". It's by no means "as good as it can get"



Terry
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#6
(04-30-2015, 03:16 PM)Mark Douglas Wrote: That same obsession or hyper-focus as you choose kept me sought after and gainfully employed in automation systems for most of my life. And now I will soon have a new toy to play with !

Ha ha, I totally appreciate that. I don't know about you but I learned some of the best lessons working all-niters solving technical problems on systems I was developing or debugging.

The CPAP machine is just another computer system to conquer (except the goal is now explicitly to sleep all night). And we are the peripheral systems that get tweaked when we turn the CPAP knobs.

Plus it comes with lots of new data to hyper-focus on.

woot!

Saldus Miegas
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#7
I'm pretty happy with an under 1.0. It may be psychological but anything over 2 I feel like garbage.
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#8
(04-30-2015, 02:49 PM)SaldusMiegas Wrote: In that view of things, the CPAP industry has pegged an AHI of 5.0 as the standard to declare the therapy effective across the general population.

The establishment of AHI of 5 as the borderline for clinical Sleep Apnoea was not established by the CPAP industry - they had nothing to do with it - it was established by medical research as the threshold after which disturbance moves beyond a minor every day occurrence in the entire population to a clinical level that may or may not impact on one's health (to be clear, AHI of 5 -7 is not considered high enough to have much in the way of permanent damage to the body, but will cause greater sleep disruption and a loss of quality of life - after 7 it escalates quickly, but but from 5-7 it is at the clinical level where disruption becomes the threshold to greater health problems, but it is just that - a threshold, not a full blown "I'm gonna die in 5 years from a heart attack" type thing. If you are between 5 and 7 you are a lucky person - very minor increases in back pressure will effectively deal with your condition, and that is a wonderful thing - even devices ineffective at higher pressure requirements, like Provent nasal strips, will likely work at those levels if you have simple OSA).

This idea that an AHI of 0 every night is a sort of holy grail is utter rubbish. One thing that years and years of sleep studies and sO2sat recordings has told us white coat types is that no one in nature consistently has no AHI score night after night. The healthiest person doesn't. It simply is not the nature of the beast, human or otherwise (yep, it was also tested on a wide variety of animals. Yay, veterinary medicine!). We are not built that way, just as the wonderful diagrams of a perfect EKG don't actually exist in nature very often - the heart is messy and the signal is inconsistent - out of every 30 beats, at least two will show some sort of irregularity, minor though they be, and you shouldn't run screaming to the cardiologist for it. We are not perfect machines, and even in as near perfect condition as our bodies can get, AHI scores of 0-4.5 will show up with regularity. Nature of the beast. Don't obsess about the numbers, just get effective therapy and if you stay consistently below clinical levels, then breath a sigh of relief. To go further, these scores include a lot of things that don't actually necessarily desaturate your O2 levels, and that is actually more important to consider, since it is the desaturations that remain the greater danger, but since machines score AHI based on "events" as a gestalt, including events that do not create clinical level desats, like periodic breathing and flow limitations, still count in the score. In short, it can be deceiving - that is why you look over the graph and not just the numbers, and why you spot check it every now and again with a recording pulse oximeter. 93% does not equal a clinical desat and is normal both in sleeping and at rest while awake(although not ideal). There is a good reason why we set the upper threshold of sO2desats at 88%, just as we set the lower threshold for clinical apnoea at AHI5. That is where we have observed that things start to lean toward dicey but are not absolutely dicey yet (although the number is far more critical in sO2saturation than in apnoea definitions).

And yes, well said - once therapy has begun one will feel much better and well done. i support your statement not to obsess about the numbers, just accept that it is working and work with the therapy, don't treat it like an Olympic sport.
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#9
DocWils,

Wow, thanks for the informative post!

You shed a lot of light on what's really behind the numbers and which thresholds really matter.

Your counsel is very reassuring and much appreciated by newbies like me.

Saldus Miegas
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#10
No worries, SM. Glad to help.

Just to be really clear, if your sO2sat drops for any length of time below 88% things go south very fast. If your AHI stays at 7 for a long time, things don't go south very fast.

So what is interesting about SA as a whole is the combination of the mental deprivation that an interrupted sleep pattern brings, and the real physical harm that constant, although short, desats below 88% bring to the table. Hence we get worried about it if the AHI strays above 8 or 9 to 10 or so (the clinical limit between mild and full blow SA) or if you have long consistent desats below 88% (which happen without SA, thank you very much). It is the combination of the two that make this a bothersome and potentially dangerous cocktail.
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