[Treatment] Optimize beyond/other than AHI?

[sndraco]

Hi all

I was diagnosed with moderate sleep apnea in September of 2019 after a home sleep study (report attached), been using a Resmed 10 Autosense since December of that year. I have noticed that compared to before CPAP my energy levels, ability to get out of bed, and also most surprisingly mental mood are much better. My AHI numbers are very good, almost always under 1 and in majority of days under 0.5 with a few at zero. 

However I do find a wide variability in how I feel after a night's sleep, that doesn't correlate with AHI numbers and trying to figure out what's happening and if further optimization/reducing variability is possible. I find that my sleep generally falls into one of 3 categories

A. Great sleep, when I get up, I feel quite refreshed, ready to get out of bed right away, lots of energy. This happens quite rarely, less than 10% of the time. 

B. Decent sleep, when I get up, feel like not quite ready to jump out of bed, however can get up within 5-10 minutes, energy is all right. Probably 75+% of the time.

C. Not great sleep, even after 8-9 hours of sleep, feel that I need to sleep another 30 mins to an hour, and feel tired/sluggish when getting out of bed. About 10+% of the time. 

I have attached reports from one of the better days, an 8 out of 10 though AHI was higher (Aug 10th), and also a worse day about a 2 or 3 out of 10 (June 21st 2021) though AHI was lower. My current AHI numbers are consistently less than they were in 2020 once I switched to nasal pillows. I will post a good day report also from a lower AHI day in my reply to this post. 

I started off with a full face mask (Dr, didn't really try several masks, which sucked), and over time, tried several masks, and currently using N30i which I like mainly as find pillows reduce leaks a lot for me, and also the hose on the top helps with sleeping on my side, and also with turning. I have only tried Resmed masks. I also did try a soft cervical collar and that didn't seem to make a difference. 

I also got an in lab study while I was in India, unfortunately I had not stopped using my CPAP for a week, which would give more accurate results, but... And will attach that report as well in my reply to this post. 

I have tried to talk to my sleep consultant/Dr., and they say one has to expect lots of variability, and could be due to delayed sleep syndrome and prescribed Modafinil to try, which has an effect but it doesn't change my sleep quality and a bit frustrating as they say AHI under 5 so job accomplished. I do suffer from allergies that causes stuffiness/nasal congestion and take Allegra or a nasal spray when its really bad. In fact prior to my sleep study, tried allegra for my allergies and the first couple of days, sleep quality improved a lot, though currently taking the sprays/allegra don't seem to be correlated with my sleep quality/how I feel when I wake up. 

My questions are is it worth it to try and AHI down below the 1 or 1.5 stage and could it be counterproductive, and also what other variables/data should I be looking at to optimize my sleep quality. 

I am also going to try and lose about 10 lbs, my age is 51, male about 5'8.5" tall, and 158lbs. I do have a slightly deviated septum, per ENT not recommended to have surgery for that, they did say I could try surgery to reduce my turbinate size if I want. 

My max pressure is 13, EPR 2. (past it was different settings however those don't seem to correlate with issue I am describing either). 

Thanks a lot for all your help. 

Shri

[sndraco]

Here is my in lab sleep study, and also a good day recent 8 out of 10 sleep quality with lower AHI. 

Glad to share other data, or zoomed in views of specific times. 

Thanks

S

Without knowing much, from my reading on this site, it seems like one goal should be to normalize as much as possible the waveform of the inspiration and expiration to match normal waveforms, and also flow limits (though the Barry Krakow artice seemed to indicate need bilevel for that)

[SleepyCPAP]

Hi sndraco,

I am so glad you’ve dialed in a way to get good AHI.

If you are not feeling rested sometimes, it might be other disturbances in the night. For instance, maybe your tiny leaks are nudging you out of sleep briefly, etc. Or you ate something that upsets your stomach and it disturbs you. Or you are getting some unmarked (perhaps too short) Apneas, Hypopneas or RERA’s that disturb your sleep pattern briefly (look in the wave-by-wave zoom and scroll through) but don’t meet the machine’s criteria. It isn’t all about AHI.

I found it was worth it to stay <1 AHI. That eliminates all those sleep disturbances.

I’ll let others weigh in on your lab report and other questions.

[sndraco]

Thanks SleepyCPAP

Yeah the switch to pillows totally helped with AHI and rarely over 1 these days. It would be nice if we had a template to optimize, ie get AHI below x number, post that it doesn't matter, then do y, then do z etc. Or if the machine spotted wave form abnormalities, and tried to fix them. It just seems like there is quite a bit of variability/optimization that could be possible beyond a low AHI and frustrating right now medical establishment and technology doesn't go that far.

Thx.

This is the progression of my AHI and other stats from the beginning. I know my current minimum pressure is too low, Dr in India set it and leaving it like that for a couple of weeks.