Love My AHI Going Down But What About Time in Apnea and sleep quality?

[S. Manz]

I started therapy with the Resmed 10 ASV back in mid July when I retired my Dreamstation Auto SV. At the time I wan't sure how it would affect my AHI because as you can see in the screenshot, my AHI started jumping up in July when I first started using the new machine.
However now after about 4 months of therapy, I'm just beginning to see a slow drop in my AHI over time, which is great but what about my "Total Time In Apnea" ?
This pesky measurement seems to be disappearing off the chart but every now and then it registers again. 
For me my total time in apnea matters because the greater the time I spend in apnea the lower my Oxygen saturation is likely to get and even though Time Spent has an almost direct relationship with AHI , sometimes the machine takes a longer time to breakup a Hypopnea event and therefore the AHI may stay the same as the night before, or even lower, yet Time Spent for that night may go up.
Anyway, I have included a summary graph with this post.
How is your therapy progressing over that last 6 months?
Are you sleeping better?
Do you generally feel better, less tired during the day?
I still get the urge to fall asleep towards late afternoons sometimes and even though it is a big improvement as compared to before therapy, it is still there to a degree.
Do you still get the urge to fall asleep before your regular bed time?
   

[Sleeprider]

Total time in apnea appears to be proportional to your AHI, and is quite low. It appears that as you have made progress reducing events, you have also reduced total time in apnea. I don't see a problem, or anything in this statistic that would suggest a cause for continued tiredness, but I know it is a constant challenge for some members.

BTW, I changed the title of your thread to remove the ampersand dots and make the question specific because our software has issues with the excessive punctuation. Hope I got the question right.

[S. Manz]

BTW, I changed the title of your thread to remove the ampersand dots and make the question specific because our software has issues with the excessive punctuation. Hope I got the question right.

That;'s fine, except that I was placing more questions in my OP than just the time in apnea.
And yes, looking at the graph summary it may appear that the AHI and TIA are proportional but when you zoom in each event on Flow chart and calculate each event timing, they are hardly the same....On average a hypopnea event may take 10 seconds to breakup but the variance in that timing can span anywhere from 5s to 20 s before an event is registered.
So when I manually add these times and compare them with another session with an identical AHI, TIA may be quite different.
OSCAR does a great job of averaging that out though.

[sweetnothings]

How is your therapy progressing over that last 6 months?
Are you sleeping better?
Do you generally feel better, less tired during the day?
I still get the urge to fall asleep towards late afternoons sometimes and even though it is a big improvement as compared to before therapy, it is still there to a degree.
Do you still get the urge to fall asleep before your regular bed time?

Not sure if you intended this for ASV users (I have an Airsense 10 APAP) but I'm happy to add a data point for your questions.

I started in August, so only coming up on month 5 now, but I'd say my therapy hit a plateau nearly on the first week and has stayed there the whole time. AHI bounces around between 2 and 5. Not really trending worse or better. My TIA is almost perfectly in line with the AHI. Looking at your chart I'm kind of jealous, but of course I know AHI is only a number and how you actually feel tells the real story.

Yes, I've been sleeping way better compared to before CPAP. I also feel like nodding off at work in the afternoon sometimes, but it's very rare now (compared to nodding off all day, every day before therapy). I'm honestly not worried about it at this time.

Before therapy, my circadian rhythm seemed out of whack and I could never get to sleep at 'bedtime' despite feeling exhausted all day long. Right after starting CPAP everything clicked back into place. When I put the mask on at bedtime, it's like my body knows its time for sleep and I have no trouble at all drifting right off into sleep. God that's such a great feeling.

Sorry, I'm not a resident expert so I can't tell you what's up with your AHI and TIA, but I will say your session times look very sporadic to me, and often very short (<6 hours most of the time?). Do you think there could be a correlation to how you're feeling next day? Or maybe this is your normal pattern for sleep sessions and not very different from before you switched to the resmed?

[S. Manz]

Before therapy, my circadian rhythm seemed out of whack and I could never get to sleep at 'bedtime' despite feeling exhausted all day long. Right after starting CPAP everything clicked back into place. When I put the mask on at bedtime, it's like my body knows its time for sleep and I have no trouble at all drifting right off into sleep. God that's such a great feeling.

I know EXACTLY what you are talking about. Since I started therapy, I honestly can't recall a single time that I may have had any trouble drifting into sleep right away after putting on the mask.  It is as if my mind has established a firm relationship between the mask and falling asleep. It is great, isn't it?
As for AHI , I am not too worried about it either. I just wanted to gauge what others have to say about it and it appears that a few seconds discrepancy here and there can't have a great impact on oxygen saturation....not at any level that I can see in my graphs anyway, but I am still somewhat curious.

As for the difference between ASV and airsense, the only thing that stands out is the algorithm and some electronics, used in each machine. The ASV mode uses feedback from your breathing patterns and adjusts its ventilation timing accordingly whereas with non-ASV machines there's no servo monitoring of breathing feedback on a breath by breath basis. 
ASV machines are most effective for people with Central apnea and as well people with complex apnea because if the patient suffers from both Central and Obstructive apnea, then the Auto ASV mode not only monitors and adjusts IPAP pressures on a breath by breath basis, but also the EPAP pressures too. This is very effective at breaking up the upper airway obstructive events with EPAP adjustment, while taking care of Centrals by adjustment of the IPAP pressure, breath by breath.

However if you only have Obstructive apnea then ASV would be a waste of money, as an auto machine will just be as effective.

[Geer1]

Based on all the data you have posted neither your time in apnea nor mild oxygen desaturations appear to be an issue. If you have some serious desaturations you need to post examples of them so we can give further direction.

[harrywr2]

I subscribe to 4-5 approximately 90 minute(in a perfect world) sleep cycles are required per night theory.
I myself feel well rested after 4 sleep cycles(approximately 6 hours) but have learned that if I get up I will be in need of a nap by lunchtime.
If I stay in bed and force myself to get another sleep cycle I can manage to go until late evening the next day without feeling the need for a nap.

[sweetnothings]

I subscribe to 4-5 approximately 90 minute(in a perfect world) sleep cycles are required per night theory.
I myself feel well rested after 4 sleep cycles(approximately 6 hours) but have learned that if I get up I will be in need of a nap by lunchtime.
If I stay in bed and force myself to get another sleep cycle I can manage to go until late evening the next day without feeling the need for a nap.

That's an interesting viewpoint that I haven't heard about before. A normal night of sleep for me is about 6 hours, then I tend to wake in the early morning wanting to get more sleep because it's not the "recommended 8 hours". So I'll lay there tossing and turning for a while, trying to get back to sleep, sometimes drifting back into some kind of half-sleep, but I almost always get into this pattern of interrupted breathing even with the CPAP going where it shows up as a bunch of CA's. I guess we call that sleep wake junk?? It seems like a waste of time to me. I could have just gotten up super early and gotten productive things done.

I'm the same way though, if I get up early after only 6 hours of sleep I find myself nodding off at my desk by noon.

[S. Manz]

Yesterday I finally stopped using my Resmed ASV and went back to my Dreamstation ASV. Predictably the DS reports my AHI at over 7 this morning, while Resmed has me down to an average of less than 1. This is because Resmed algorithm does not precisely follow every breath and monitoring of Hypopnea events.
Anyway, I am hoping that I can breakup my "nodding off" routine in mid afternoons because it really pisses me off when I have to struggle with yawning in the middle o a business meeting (or whenwhen my wife is trying to tell me something "really important", like everything else):-)
I will post a comparision chart between the two machines and definately discuss how each machine affects my wakefulness during the day.

[S. Manz]

Based on all the data you have posted neither your time in apnea nor mild oxygen desaturations appear to be an issue. If you have some serious desaturations you need to post examples of them so we can give further direction.

You are right. That's why I am suspecting something not bing right here.
Going back on my DS1 ASV for a few weeks and monitoring the results to see if I can make a comparison deduction.