[Diagnosis] How to Interpret My Low AHI

[factor]

Hi everyone,

Around 2003 I did a sleep study and was diagnosed with OSA. I was prescribed a CPAP machine with pressure set to 5. I could never get used to the machine even after trying several different mask types and I stopped using it. When I moved in 2015 the machine was lost and I didn't bother to replace it as I hadn't used it in years. 

Its a pretty common problem.  5 cmh20 isn't enough for an adult.  
People get frustrated and think they aren't that bad and go it alone.  Pretty common behavior.  If you had OSA back then you have it now.  Very few move on from the illness.  Read my story below.

Like one day in times past you woke up and realized you parents were right about a great many things.  So you set out to correct your path.  So glad you did.

The thing is we all have personal differences which cause variables in our treatment.  So some people 5 is another persons .2.  This is why you hear us say 'How do you feel'.  Also some have Central Apnea which is different for Obstructive apnea.

has ranged from 0.23 to 0.91. 

The AHI is never going to be dead nuts 0.0.  We are a living changing thing.  If you eat ice cream at night your AHI might be worse.  For me it will be.  Drink coffee after 3 pm AHI might be higher.  So many variables.  Thats why the standard of less than 5 AHI is considered good.  Although its not the best for most.  Like me if my AHI is 3+ I feel bad.

How do I interpret this? Is it telling me that I don't really need this, that the benefit I perceive I'm getting is just psychological?

If you had a sleep study and they told you you had OSA. you do..  Sleep and Breathing is Physical.

I'm always tired. I wake up several times per night. I take 3 or 4 naps per day. 

Is this better?  How do you feel?  If you feel better it working and its not (psychological) you making it up in your mind.  


Get OSCAR and post some data.  check my signature for how to.

[SteveSchechter]

Steve,
Without seeing the actual graphs, I can only assume the pressure is being driven by Flow Limitations.
The usual fix for that is to use EPR.  

Let's move your minimum pressure to 8cm and set EPR TO 3.  
So your new settings will be 8min and 20 max.  EPR 3  
Expect some adjustments as EPR may trigger clear airways.

Note:  Your AHI is good.  My recommendations are to try and limit Flow Limitations and provide more comfort by using EPR.

Next time you post a chart, use the F12 button to take a screenshot.  This way, the graphs we need to see will be included.

Thanks. I will try these settings tonight and post the results once they become available to me.

---

Its a pretty common problem.  5 cmh20 isn't enough for an adult.  
People get frustrated and think they aren't that bad and go it alone.  Pretty common behavior.  If you had OSA back then you have it now.  Very few move on from the illness.  Read my story below.

Like one day in times past you woke up and realized you parents were right about a great many things.  So you set out to correct your path.  So glad you did.

The thing is we all have personal differences which cause variables in our treatment.  So some people 5 is another persons .2.  This is why you hear us say 'How do you feel'.  Also some have Central Apnea which is different for Obstructive apnea.


The AHI is never going to be dead nuts 0.0.  We are a living changing thing.  If you eat ice cream at night your AHI might be worse.  For me it will be.  Drink coffee after 3 pm AHI might be higher.  So many variables.  Thats why the standard of less than 5 AHI is considered good.  Although its a the best for most.  Like me if my AHI is 3+ I feel bad.


If you had a sleep study and they told you you had OSA. you do..  Sleep and Breathing is Physical.



Is this better?  How do you feel?  If you feel better it working and its not (psychological) you making it up in your mind.  


Get OSCAR and post some data.  check my signature for how to.

Thanks Brent. I already do have OSCAR. I'm really happy I got the new machine and even happier with my progress with it to date. But it's also nice to get the validation and support that I'm getting here.

[SteveSchechter]

Steve,
Without seeing the actual graphs, I can only assume the pressure is being driven by Flow Limitations.
The usual fix for that is to use EPR.  

Let's move your minimum pressure to 8cm and set EPR TO 3.  
So your new settings will be 8min and 20 max.  EPR 3  
Expect some adjustments as EPR may trigger clear airways.

Note:  Your AHI is good.  My recommendations are to try and limit Flow Limitations and provide more comfort by using EPR.

Next time you post a chart, use the F12 button to take a screenshot.  This way, the graphs we need to see will be included.

Hi,

I tried your recommended settings last night, managed just under 3 hours, never uncomfortable but for some reason after getting up to go to the bathroom, removed the mask on return to bed. I could not display current data in OSCAR but managed to view it in ResScan for whatever that's worth. (Screenshot attached.) 

   

This morning I was able to reset the date and time to my time zone so that should be resolved going forward. Hoping to have more success tonight, and should have updated data in OSCAR tomorrow I hope. 

Thanks

[SteveSchechter]

Steve,
Without seeing the actual graphs, I can only assume the pressure is being driven by Flow Limitations.
The usual fix for that is to use EPR.  

Let's move your minimum pressure to 8cm and set EPR TO 3.  
So your new settings will be 8min and 20 max.  EPR 3  
Expect some adjustments as EPR may trigger clear airways.

Note:  Your AHI is good.  My recommendations are to try and limit Flow Limitations and provide more comfort by using EPR.

Next time you post a chart, use the F12 button to take a screenshot.  This way, the graphs we need to see will be included.

   


Now that I've successfully readjusted the time and have applied your suggested settings, here is a screenshot from last night's sleep. Just under 4 hours on the machine. The gap around 6:30 AM is when I went to use the toilet. I see the high AHI starts after I returned from the toilet, I wasn't able to really sleep again at that point until I eventually removed the mask around 7:15 or so. Will be interested to see your interpretation of all this. Thanks.

[OpalRose]

Hi Steve,
Good job on posting the graph.  It appears the the pressure adjustments helped... by using EPR, the Hypopnea, Flow Limitations and RERA are down.  These type of events can disrupt your sleep by causing mini arousals that you may not even be aware of.

There are still some Flow Limitations that tend to drive the pressure up. (See chart at around 4:40), so I'd like to have you adjust the maximum pressure and set it to 14cm.  Keep minimum at 8cm.

The apnea's that show after your break are simply what we call SWJ (sleep-wake-junk).  You are either between sleep or awake.  These events can be ignored.  Many of us experience this.  

Eventually, try to wean yourself from using the ramp feature.  

Your numbers look good and the machine is doing its job to treat your apnea.  Now the question is how you feel in the morning and during the day.  I suspect your tiredness is due to not getting enough sleep.  Only sleeping 3-4 hours will catch up with you eventually.  If I get less than 6hrs, I end of having to nap during the day. 

Try to keep a consistent schedule by going to bed at approximately the same time.  If you wake up during the night and don't need to get up for anything, keep your mask on and try to go back to sleep.

Keep at it... it takes time to adapt and get used to using a Cpap, and no doubt, it's just not normal to have something clinging to your face all night.   But we do get used to it, and there will come a time when you won't want to be without.

Post another chart in a day or two here in this thread and see if your numbers hold steady.

[SteveSchechter]

Hi Steve,
Good job on posting the graph.  It appears the the pressure adjustments helped... by using EPR, the Hypopnea, Flow Limitations and RERA are down.  These type of events can disrupt your sleep by causing mini arousals that you may not even be aware of.

There are still some Flow Limitations that tend to drive the pressure up. (See chart at around 4:40), so I'd like to have you adjust the maximum pressure and set it to 14cm.  Keep minimum at 8cm.

The apnea's that show after your break are simply what we call SWJ (sleep-wake-junk).  You are either between sleep or awake.  These events can be ignored.  Many of us experience this.  

Eventually, try to wean yourself from using the ramp feature.  

Your numbers look good and the machine is doing its job to treat your apnea.  Now the question is how you feel in the morning and during the day.  I suspect your tiredness is due to not getting enough sleep.  Only sleeping 3-4 hours will catch up with you eventually.  If I get less than 6hrs, I end of having to nap during the day. 

Try to keep a consistent schedule by going to bed at approximately the same time.  If you wake up during the night and don't need to get up for anything, keep your mask on and try to go back to sleep.

Keep at it... it takes time to adapt and get used to using a Cpap, and no doubt, it's just not normal to have something clinging to your face all night.   But we do get used to it, and there will come a time when you won't want to be without.

Post another chart in a day or two here in this thread and see if your numbers hold steady.

Thanks OpalRose, I really appreciate your taking the time to review that stuff and make suggestions. I'll try your latest suggestions tonight. 

I think I'm doing about par for the course, meaning that when I can get 4+ hours on the machine, I'm feeling pretty good the next day. Less than 4 hours and the impact is a lot less.  

In terms of the sleep - there are other factors impacting my life at the moment that are affecting my sleep schedule and my mood in general. Without going into tons of detail, my wife and I have been separated for 6 months due to travel bans related to COVID. We do video calls about 20 times a day but that's not the same as actually being together. It's dragging both of us down. 

Anyway, thanks again, I'll post some results and screenshots in another day or two.

[OpalRose]

That has to be tough being separated from your wife.   There's so many folk going through a lot of stress with this pandemic.
Hang in there!

[SteveSchechter]

That has to be tough being separated from your wife.   There's so many folk going through a lot of stress with this pandemic.
Hang in there!

   
   
   

These are my OSCAR screenshots from my last 3 nights. (I forgot to adjust the max pressure down as previously advised, sorry!) 

What I see here is that I am only managing 3 to 3-1/2 hours per night, AHI numbers are quite low. If anyone is checking this thread, any thoughts? 

I'm using the ResMed Airfit F30 medium size and it seems I have to clamp it onto my face quite tightly in order to not have major leakage. I'm wondering if I should have gone with the small size instead, which is what the sizing card that was packed with it would appear to indicate. Or next month I might try a nasal-only mask. Years ago I tried nasal pillows and it wasn't comfortable for me but I might try that again as well. The problem is the cost of these things and the inability to try them out until after purchase!    

Thanks all!

[SarcasticDave94]

Two things I'd try to work on, Ramp and mask fit.

Ramp is locking therapy down to pediatric airflow levels at 4 for up to 20 minutes. If you feel you must have this, increase the pressure off the very low 4 to something breathable like 6, 7, 8.

Also the mask fit. If you have to clamp it tight to control leaks, at least one aspect of that mask is wrong. Fit as in size could be ill-fitting, the method of adjusting straps might not be correct, how the mask sits on your face could be incorrect. Maybe the entire mask is the wrong choice for you. But something isn't for you if you have to make it tight to control leaks.

[SteveSchechter]

Two things I'd try to work on, Ramp and mask fit.

Ramp is locking therapy down to pediatric airflow levels at 4 for up to 20 minutes. If you feel you must have this, increase the pressure off the very low 4 to something breathable like 6, 7, 8.

Also the mask fit. If you have to clamp it tight to control leaks, at least one aspect of that mask is wrong. Fit as in size could be ill-fitting, the method of adjusting straps might not be correct, how the mask sits on your face could be incorrect. Maybe the entire mask is the wrong choice for you. But something isn't for you if you have to make it tight to control leaks.