healthy vs not sick and symptom suppression

[SaldusMiegas]

Happy for you amigo.

Feel better Mark.

Saldus Miegas

[Moriarty]

....That same obsession or hyper-focus as you choose kept me sought after and gainfully employed in automation systems for most of my life. And now I will soon have a new toy to play with ! ....

I can totally relate to that...

My first actions with the new machine were to download daily and try to completely understand each event... As a engineer I found it useful in getting to understand my breathing 'system' but it was starting to become the end in itself. After a month or so of that I had to slap myself about a bit and be prepared to simply enjoy my greatly improved life.

I still watch the global stats on the machine display but I've overcome the desire to micromanage it.

You general point though is well made... I have a relatively simple OSA and I know exactly why I have it. I am overweight and as a result have a general lack of muscle tone. I am gradually addressing that but I don't believe the OSA will ever resolve.

There are others with much more complex Sleep Apnea reasons - and some of them can be quite serious and will never be fully addressed through any of the types of PAP therapy.

What is common across the board though is that xPAP will greatly reduce the stress on an individual's cardiopulmonary system while underlying issues are addressed.

That in itself is a worthy use of resources because not all of the problems caused by lack of high quality sleep affect only the sufferer - there is also the people around them that have to put up with the sufferer's grumpiness and - perhaps even more concerning - the population at large who share the road with sleepy drivers.

All the best

David

[Mark Douglas]

ME? GRUMPY? GRRRRRRRRR

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Happy for you amigo.

Feel better Mark.

Saldus Miegas

Thank you. Tomorrow begins a new dawn.
I hope

[Mark Douglas]

That same obsession or hyper-focus as you choose kept me sought after and gainfully employed in automation systems for most of my life. And now I will soon have a new toy to play with !

Ha ha, I totally appreciate that. I don't know about you but I learned some of the best lessons working all-niters solving technical problems on systems I was developing or debugging.

The CPAP machine is just another computer system to conquer (except the goal is now explicitly to sleep all night). And we are the peripheral systems that get tweaked when we turn the CPAP knobs.

Plus it comes with lots of new data to hyper-focus on.

woot!


Saldus Miegas

Yes indeed. Insights at 0400 after 18 hrs and 20 cups of koffee gnawing at a problem are either brilliant or madness and often both. I had one plant manager bring me a steak dinner and a cot to the test cell that was down and said ask for anything and security would run and get but I wasn't leaving until that !@#$%^ machine was back on line.....

[retired_guy]

Seems if one has an AHI under 5 is considered not to have sleep apnea? Is this not-healthy but less than sick?

By definition... "Less than sick must equal un-sick. Equal to, or greater than sick would equal un-well."

if so is this not like a car dealer telling me since my car engine only misses/stumbles 4 times an hour no maintenance is required?

No. Cars do not have carburetors. Mongo said so.

I certainly would not be happy with an engine that misses "only" 4 times an hour - if I were aware of it. Maybe it does and I just do not sense it? On the other hand does an engine miss or AHI of 4 or less actually cause problems?

Asked and answered.... Still no carburetors..

Now that I am aware of the collateral damage the perfectionist in me wants no stumble no AHI. Can one feel the difference in the morning?

Before, or after coffee?

Will an AHI of 4 reduce ones life span or enjoyment?

No.

Will diddling with the machine to reduce any AHI above zero become an obsession?

Yes. But it's a happy place.... Full of birds and leaves and trees and rocket ships and tall people with funny names.

I have to think anything that adversely effects a steady supply of oxygen and release of waste products is not a good thing.

Is not a cpap machine treating a symptom?

No. A symptom is something like "I want a pickle!" or "I have a headache" or other stuff. Cpap treats a condition which is like ... well,, different.

What would thorough medical RCA tell us if anything if one could afford the cost? Why sleep apena at all?

Just because we can?

Ramble off.

Very nice Saldus. Great commentary. There are those who have been on this forum that due to other limitations can not live with a therapeutic pressure that might get their AHI below 5, who are happy with the results that they are getting.

I have a suspicion that the people who are able to score 0s regularly may have a more stable sleep breathing pattern (aside from the apnea events). My sleep breathing patterns seem to be all over the place and my AHI is normally well below 5 but I have reached 0 only once and I might never do so again. I am happy with where I am. I still experiment with some things in an attempt to improve my therapy but I am definitely not trying to reach 0.

I started with a Resmed S8 VPAP Auto and now on the S9 version of the same machine. I started using it as a straight bilevel machine per my prescription. I tried going to bilevel auto mode several times and my AHI seemed to increase each time. About a month or 2 ago I was able to successfully change to bilevel auto and maintain the same level of AHI with the resulting lower average pressure and I may well try a nasal mask down the road to possibly lower my average pressure some more.

Note to SuperSleeper: Could you please hide this post from Retired_Guy. I don't want him to think that I am going soft(er) in the head.

Best Regards,

PaytonA

Too many big words.............

In that view of things, the CPAP industry has pegged an AHI of 5.0 as the standard to declare the therapy effective across the general population.

The establishment of AHI of 5 as the borderline for clinical Sleep Apnoea was not established by the CPAP industry - they had nothing to do with it - it was established by medical research as the threshold after which disturbance moves beyond a minor every day occurrence in the entire population to a clinical level that may or may not impact on one's health (to be clear, AHI of 5 -7 is not considered high enough to have much in the way of permanent damage to the body, but will cause greater sleep disruption and a loss of quality of life - after 7 it escalates quickly, but but from 5-7 it is at the clinical level where disruption becomes the threshold to greater health problems, but it is just that - a threshold, not a full blown "I'm gonna die in 5 years from a heart attack" type thing. If you are between 5 and 7 you are a lucky person - very minor increases in back pressure will effectively deal with your condition, and that is a wonderful thing - even devices ineffective at higher pressure requirements, like Provent nasal strips, will likely work at those levels if you have simple OSA).

This idea that an AHI of 0 every night is a sort of holy grail is utter rubbish. One thing that years and years of sleep studies and sO2sat recordings has told us white coat types is that no one in nature consistently has no AHI score night after night. The healthiest person doesn't. It simply is not the nature of the beast, human or otherwise (yep, it was also tested on a wide variety of animals. Yay, veterinary medicine!). We are not built that way, just as the wonderful diagrams of a perfect EKG don't actually exist in nature very often - the heart is messy and the signal is inconsistent - out of every 30 beats, at least two will show some sort of irregularity, minor though they be, and you shouldn't run screaming to the cardiologist for it. We are not perfect machines, and even in as near perfect condition as our bodies can get, AHI scores of 0-4.5 will show up with regularity. Nature of the beast. Don't obsess about the numbers, just get effective therapy and if you stay consistently below clinical levels, then breath a sigh of relief. To go further, these scores include a lot of things that don't actually necessarily desaturate your O2 levels, and that is actually more important to consider, since it is the desaturations that remain the greater danger, but since machines score AHI based on "events" as a gestalt, including events that do not create clinical level desats, like periodic breathing and flow limitations, still count in the score. In short, it can be deceiving - that is why you look over the graph and not just the numbers, and why you spot check it every now and again with a recording pulse oximeter. 93% does not equal a clinical desat and is normal both in sleeping and at rest while awake(although not ideal). There is a good reason why we set the upper threshold of sO2desats at 88%, just as we set the lower threshold for clinical apnoea at AHI5. That is where we have observed that things start to lean toward dicey but are not absolutely dicey yet (although the number is far more critical in sO2saturation than in apnoea definitions).

And yes, well said - once therapy has begun one will feel much better and well done. i support your statement not to obsess about the numbers, just accept that it is working and work with the therapy, don't treat it like an Olympic sport.

Speaking of big words. Wow. But as usual the good Doc lends much to the discussion. I'm not sure what any of it has to do with carburetors which is what the o/p was concerned about as I recall. But that's fine.

My AHI is zero currently around 3 out of 4 nights. I really didn't try to do anything to achieve that. It just happened. I did focus on tweaking my therapy as close as possible to achieve what I felt were the best results for me. Then I paid attention to how I slept. Head elevation, good pillow but not one of those goofy cpap pillows, no meds other than my regular bp meds and inhalers I do at night. Certainly no sleeping aids.

I also believe that using the pillows mask allows me, and perhaps many people, to use a lower pressure, and achieve a lower ahi result. But there again I did not become the poster child for the P10 mask because of that. I did it for comfort and effectiveness.

I have emphysema. My normal sit around during the day O2 is 93%, which I think is pretty good considering. I do not allow O2 in the house. Maybe that will change someday. But not today. When I walk around the O2 will come down. When I exert myself it will come down substantially. But I have learned to manage that. For me, one of the most wonderful things about cpap therapy is that at night, when I'm not managing my own O2, my O2 level stays perking along at 93 all night long. I would use cpap no matter what any sleep study or doc said to do at this point.

So in sum: I do not believe you should obsess over the "numbers." But I do believe you should obsess over making sure that you are doing everything in your power to have a wonderful, positive sleep experience and a wonderful, positive wake-time experience as well. If you do that, your numbers might be zero or 2 or 3 or 4, but it will not matter.

[Mark Douglas]

I do not allow O2 in the house.

So are you one of those tall people with funny names in a happy place or do you breath through a carburetor?

[Mosquitobait]

Seems if one has an AHI under 5 is considered not to have sleep apnea? Is this not-healthy but less than sick?

You can certainly rag on your doctor for a cpap, but your INSURANCE won't pay for it. If your AHI is low, there are other, less expensive solutions, is their motto, unless you have other issues or are physically unable to use other options (due to disability). You can lose weight. You can sleep on your side. You can get a dental appliance. It's not that you don't have sleep apnea, but it hasn't reached a need to actually treat. However, if you think your numbers are wrong, then ask for a home sleep test to see if the results are much different that in the sleep lab.

Not much different from diabetes. Even though someone is pre-diabetic doesn't mean that they don't have early stages of diabetes, but they aren't at a point yet where it is causing damage. Treatments can cause side effects, remember, not to mention cost $$. In fact, the current levels that define diabetes are the point where retinopathy may begin.

[Mark Douglas]

Well I paid cash for it. It is mine. I do not have to prove to anyone I am in compliance. This makes me happy

[DocWils]

Mark,

Showing compliance is not only an insurance issue - it is also a way for your docs to make sure you are getting the needed treatment - if you cannot be in compliance, then other methods have to be found to help you. Insurance is just one part of the equation.

[Mark Douglas]

Understood.
I would love to have had some quality hand holding.* I did document my experience with the schade insurance "process". Ultimately I am better off without them. Fortunately I found an awesome PCP and will email him the data card files biweekly for his review. As his income stream is not dependent upon CPAP patients I am confident I will receive good advice.

This experience has made me a lot more humble. When I see overweight and miserable people I now wonder do they have OSA and do they have the slightest idea there are possibly alternatives to dying miserable - and way too soon.


*Doc I am getting quality hand holding right here and you are certainly a big part of it!