Am I done tinkering?

[TyroneShoes]

Original test at AHI = 55.7

next 50 days at AHI = 8.9
next 60 days at AHI = 2.8
last 30 days at AHI = 1.8

There were 3 or 4 adjustments to APAP pressure along the way, a mask change, etc.; all indexes are consistently down (no one index has stayed level or increased).

So my inclination here is to stop tinkering and just let things be; stay at the same pressure, etc.

Or is there something I should be considering as a potential improvement?

[PaulaO2]

In CPAP treatment, there are two goals.

Get the AHI below 5.
Feel better.

If you can meet one or both of these, you are there. Your numbers look good but how do you feel?

___

Some think we should constantly work to get the AHI down to as close to 0 as possible. I am one of those who believe it isn't necessary. Why? Because an AHI below 0 is what folks without the diagnosis of sleep apnea have. Sooooo, why struggle to get it to zero? If I am feeling good, getting good sleep, and don't nod off during the day, why set myself up to fail by setting an impossible goal?

[TyroneShoes]

Honestly, I never felt bad in the first place, which is why it took way too long to be diagnosed and under therapy. So it is hard for that to be an index of efficacy for my particular case, and I am kind of left with just the numbers.

I do disagree just a tiny bit that an AHI "below"(?) zero is just what folks "without the diagnosis of sleep apnea have", because I don't think anyone's sleep is absolutely undisturbed by events that reach a certain threshold. Respiration is never that perfect, especially when we sleep, for any of us. SH regularly sees events (or changes in respiration) that are too mild to really count as "events", for instance (it counts and flags them, just does not include them in AHI), and even if events are counted, the technical diagnosis is not SA if the numbers are under 5 (and insurance abides by this). So at sub 2, I technically am "without the diagnosis of sleep apnea" also (as long as I use the xPAP).

IOW, it is not black and white; it is not absolute. It is a sliding scale, and those of us under 5 are technically not classified as sufferers or no longer sufferers, while those above 5, technically are. I apologize for not being able to understand or explain that a little better. But I pretty much agree with what you say, and I appreciate your input greatly.

I think being partially-strangled fewer times a night can only be considered better, but there is also possibly nothing to be gained by overmanaging this, micromanaging it, or tinkering too much.

If I was hovering just below 5, I would think that was a good thing, but I would still probably go for a lower number. But I am now under 2, so maybe I have wrung out all of the improvement that can be attained, practically speaking, and it is time for me to stop "telling the dealer to 'hit me' ".

I just wonder what the opinions of everyone else here might be regarding that.

[surferdude2]

I'm of the mind that you can indeed over manage this condition and cause anxiety issues that can actually be counter productive to getting proper readings. I consider <5 AHI as being fine and dandy if all the events are short duration and don't wake me. I have ran pulse oximeter recording and it always reassures me that I'm doing as good as need be.

To paraphrase: If it's not broke...or even if it's not perfectly fixed, lay off and see if abstinence doesn't tend to help you accept "good enough" as being good enough. Find something else to fuss over that's more fun.

Best regards, Dude

[justMongo]

Sleepyhead does not score events -- it just reports what the machine has flagged.
If the machine is overly aggressive in reporting; that's on the machine designers.

[Sparkle]

Honestly, I never felt bad in the first place, which is why it took way too long to be diagnosed and under therapy. So it is hard for that to be an index of efficacy for my particular case, and I am kind of left with just the numbers.

It makes me feel good to hear you say this because I never felt particularly bad either which made me feel as though I did not have sleep apnea or had a type that was temporary. Now, thanks to this board, I know better (at least a little bit better - I've only been here less than a week).

[TyroneShoes]

I am happy about that, and I have been here for a little longer. And what I tend to see is an over-simplification of "feeling" being equated with getting good therapy, and an alarming preponderance of folks blindly accepting that this is the single goal of OSA therapy, when in reality it can have enormous and numerous significant benefits that do not manifest in how you feel.

That is an easy rookie mistake to make. You have a headache, you take an aspirin, you feel better, the aspirin must have worked. You get a cold, you drink some chicken soup, you feel better, that must have worked. Cause-effect. Easy to understand, probably works for everything, right?

But it is not always a quid pro quo situation in medicine. Often how well something is serving your purposes can't be determined by how you feel afterwards, and it is an easy trap to fall into. It's human nature, but it is also quite helpful to evolve and understand this a little better.

Everything works better if you think things through and evolve beyond the simplest answers.

How you feel can indeed be an indicator, and it is for many OSA sufferers. But just not for all, and to place the focus there may have a tendency to distract you, head-faking you to get you to take your eyes off the ball. Otherwise, nothing wrong with it, and it can be a useful indicator.

It can be frustrating that xPAP might not make you feel better, but the numbers are the indicator of how well the therapy is helping you; there is a direct correlation there. It also allows you to then move forward and focus on what else might be making your feel the way you do

[vsheline]

So my inclination here is to stop tinkering and just let things be; stay at the same pressure, etc.

Or is there something I should be considering as a potential improvement?

Hi TyroneShoes,

When RDI (Respiratory Disturbance Index, which is the sum of the AHI plus the average number of RERA events per hour) is good and you feel fine, these are the standard criteria for declaring victory and continuing to use the same machine settings.

However, when the AHI is fine but one still suffers from Excessive Daytime Sleepiness, fatigue, memory problems, blood pressure, heart problems, etc., other things are probably happening, such as perhaps RERA events or other causes of sleep disturbances.

[zonk]

This is not a reply to any particular comment, just something from zonk (not zen) book

AHI combined with "how you feel" are important but for me, 3 things (could be more but suffice with 3) are equally important and have a direct effect on my quality of sleep
AHI is redundant, in the absence of a good night sleep

1- humidity level setting .... not too warm or too cold

2- Mattress and pillows
Mattress on the firm side and pillows just right
Otherwise I'll be tossing and turning all night and not getting any decent sleep

3- Mask of choice .... Activa LT nasal mask
Clean mask ... cushion and headgear are in a good condition (not worn-out)



PS: in my opinion ... tinkering with pressure range of auto-PAP is an intuition thing and knowing what works and what don't
Trial and error

[TyroneShoes]

Hi TyroneShoes,

When RDI (Respiratory Disturbance Index, which is the sum of the AHI plus the average number of RERA events per hour) is good and you feel fine, these are the standard criteria for declaring victory and continuing to use the same machine settings.

However, when the AHI is fine but one still suffers from Excessive Daytime Sleepiness, fatigue, memory problems, blood pressure, heart problems, etc., other things are probably happening, such as perhaps RERA events or other causes of sleep disturbances.

All good stuff, but it does not appear that my ResMed APAP is capable of flagging RERA events; I have it all turned on in SH, but it does not appear. If I change it to RDI, the number is the same as AHI, so I don't think it is counting them.