[Health] AWAKE AHI?

[newtothis1]

Hi. I attached a chart from Oscar. I just lied 26 minutes awake with the Cpap mask on and I got an AHI of 34 with 7 Obstructive Apnea events and 8 Clear Airway Events. Is this normal? Are tje

[SarcasticDave94]

Unfortunately, you're not winning the AHI prize. If you're definitely awake, it's not Sleep Apnea that's causing the event flags. Wake breathing is typically more irregular than sleep breathing, and can be a likely cause for the events you're seeing.

AHI defined: "The apnea-hypopnea index (AHI) is the combined average number of apneas and hypopneas that occur per hour of sleep."

[newtothis1]

Thanks. The reason I am investigating this is because I suspect that my real AHI is better than my sleep report shows. My problem is that I wake up every hour or so. And since my sleep episodes are short I get many awake events...

On a separate topic. I heard that EPR is causing central Apneas. Is this true? Is EPR causing the machine to register false central apnea events? Or is EPR actually ruining sleep quality by causing actual central apneas?

[staceyburke]

EPR does not cause centrals.  It is the lack of CO2 that stops us from breathing while we are asleep.  EPR treatment can wash out more of the CO2 and with it SOME people (certainly not all).  These are called treatment emergent apnea and usually go away when the person gets use to the therapy.  If they are to many we suggest you turn it down for a few weeks and then give it another try moving in 1 at a time.   EPR is the main way we lessen flow limits and they are apnea also but are not counted in the AHI...

[newtothis1]

Flow limitation is a partially blocked airway? So why would regular pressure not help? Why EPR is needed? I thought EPR is only for comfort so we dont need to breath against pressure...

[SarcasticDave94]

EPR is advertised as comfort by ResMed and possibly others, and believed to be a comfort feature by doctors. Here on Apnea Board, members that used EPR have demonstrated that adding EPR affects events such as flow limits much like PS (pressure support) does with those using bilevel like a VAuto.

EPR and PS both contain a pressure differential between exhale and inhale, it has a leveraging effect, potentially making exhale easier than without the machine. This can cause the situation where treatment emergent centrals can exist, I'm thinking most specifically for newer users. It's this boost to leveraged exhalation that's above what you normally experience, and then it's that flushing out extra CO2 that is more than what your brain is accustomed to dealing with that sets up those breath pauses. It typically makes itself known in CA flags. CA in any form can be reduced by reducing the pressure swings caused by the differential, except with bilevel devices with a backup rate that are capable of nudging you to breathe during the breath pause.

None of this means you need a backup rate machine. It does not mean you'll have long term CA. This is only my attempt to explain how treatment emergent CA come about, and that the settings used to combat obstructive events including FL are opposite to combatting central events. If you attempt to use settings to combat both, it's going to diminish therapy in some way, because they oppose each other.

OK now if you believe your sleep report was in error, you can retest I suppose. But it comes back to your waking experiment with a CPAP can't give evidence you don't have apnea to treat. Also even if you were asleep using minimal CPAP pressure, that cannot give evidence to prove you do or don't have apnea. The CPAP itself is not a test device used to recommend actions about treatment, that's where the PSG diagnostic comes into play. The CPAP and OSCAR can tell members how to make your treatment better by giving advice that's gathered by suggesting actions that others have used and given results. You aren't obligated to do anything we suggest.

[newtothis1]

Thank you for the detailed explanation. I did sleep this time with EPR turned off. I probably got the best AHI today since I started the therapy. I attached the Oscar Report. I still am waking up a lot however and have no idea why. If I understand you correctly, you are saying that EPR helps with flow limitations however can make central events worse. So I am confused and am not sure what to do then. Based on the Oscar Report that I attached, are you able to see if my flow limitations are ok or problematic? Also I am wondering what is your opinion about my sleep report? Does this look like good sleep (besides the waking up)? Or do you see any problems? I was watching LankyLefty and he was causing worry and fear by suggesting that AHI is meaningless and doctors only look at AHI and in reality even if AHI is amazing this can be false and there can be events seen on Oscar graphs that were not flagged in the machine? So I am wondering if you think my latest report is ok?

I am noticing that I seem to have a large leak at the end of the 1st sleep episode. I am wondering if the leak woke me up or the leak is the result of me removing the mask after I woke up? Do you know why I do not see a large leak after the 2nd sleep episode. I thought that when I remove the mask it would only make sense for Oscar to register a large leak?

Of course I think that my biggest problem right now is waking up every hour or so. Please let me know if you see anything in my report that can explain why I am waking up. 

Thanks!

[SarcasticDave94]

In my opinion your FL didn't look bad until the area marked with RERA about 5:10 -5:35. I can only go by the graph as the calendar pushed the numerical stats off.

As for what to do, you are likely at the area you set the machine for best feel when you wake up.

Not much thought on what Lefty Lanky has to offer. I guess it somewhat comes down to everyone has an opinion. AHI can be a gauge to indicate how therapy is going, but it's not everything. What you're stating he said sounds kinda like the respiratory doctor I consulted that told me looking at a pulse oximeter caused artifacts of false readings or some other off the wall sounding stuff. He also indicated I lack the medical training to read an oximeter. FWIW I can tell without looking at an oximeter when my SpO2 drops to 92 or less.

However AHI does count with doctors as the criteria to hand you a CPAP, so it does mean something.

[newtothis1]

Sorry. I will make sure to remove the calendar and include the left panel from now on. I attached the left panel. Please let me know if you think flow limitations are ok or is there a problem? 

Thanks!

[Crimson Nape]

newtothis1  -  Here are the steps to organize the Daily screen and take a screenshot.  I hope it will help.

1. Make sure that your display is set to the Standard view, your graphs are in the default order, and all graphs are of the same size.
    If not:
   • To reset the Default Graph Order:  Go to (View > Reset Graphs > Standard)
     
   • To reset Graph Heights:  Go to (View > Reset Graphs Heights)
     
   
   
2. Resize the Daily screen's left panel's width, so each channel parameter only uses one line and does not wrap the data.  This allows more information to be displayed.
   
   
3. Make sure you are at the top of the Daily screen and have not scrolled down.  Also, make sure you are displaying the complete day's data, and not zoomed in to any specific time range. (Take a guess as to why we mention all this. . .)
   
   
4. To take a screenshot of your Daily screen, select one of the following:
   • For Windows or Linux: Use the F12 key
     
   • For a Mac: While holding down the Fn key, press the F12 key.
     
   
   
5.  Follow the steps here to post an image: https://www.apneaboard.com/forums/Thread...ttachments
   

- Red