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Is AHI really the "gold standard" for apnea treatment ?

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dmypub +0 points · 3 months ago Original Poster

Reading in this and other cpap forums has lead me to believe that it's all about AHI.

Really ?

I've struggled as most have, and have tested 4 different masks, tweaking my cpap pressure. I've been able to get my AHI down to 2.1 . Alas, I really felt like shit the whole day after. Which leads me to question if I should be chasing AHI so rigorously ? Last night I decided to give myself a break from this chase - backed off my pressure. Much easier night, and my resulting AHI was 3.3 . As expected, moving backwards. Yet I feel sooo much better today.

So I ask - is getting my AHI down to 1 really worth it ? Am I really going to feel more energetic and less lethargic ?

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Sierra +0 points · 3 months ago Sleep Innovater

The official target is to get under 5 for AHI. Getting down to 1 is nice but not essential in my opinion. I know I can't get there. It has to be a balance between AHI and comfort. With more comfort one should get a better sleep.

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bonjour +0 points · 3 months ago Sleep Commentator

As Sierra said it is a balancing act. You need enough "comfort" to sleep with this contraption on your face, then you need to get your Apnea under control (<5) then comfort again tales over. Keep in mind that apnea is only one cause of sleep disruptions, there are many others. Look at Sleep Hygiene, the meds you take and other factors. On all the apnea forums there is focus on apnea, go figure.

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CharmingSalmonSeaLion +0 points · 3 months ago

With my old gen 8 RESMED machine I had a residual AHI of 3.0. When I upgraded to the Gen 10 Airsense for Her, it decreased to a residual AHI of under 0.3 and I noticed a significant improvement in how I felt. Notwithstanding that under 5.0 is considered the goal.

Since my problem is that I desat pretty drastically, even a few apneas during the night can make me feel miserable the next day. So, don't look only at your residual AHI numbers, but also consider your O2 desat levels. To do that you will need an overnight recording oximeter, but they are available online.

Net/net, for those who DO desat badly, if may be important to get the residual AHIs down as low as possible.

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Sierra +0 points · 3 months ago Sleep Innovater

Watching Minute Ventilation in SleepyHead is a good proxy for O2 desaturation.

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sleeptech +0 points · 3 months ago Sleep Enthusiast

Many people will never have an AHI of 1 or less. 3 or 4 will be as good as they will every get. If you feel much better and your AHI is 3 instead of 2, then go with it. Especially if your other medical parameters are good.

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thegreatgrampa +0 points · 2 months ago

First post here. Two year Cpap user. The AHI sure seems to be the gold standard especially at the doctors office. It should be everyone's desire to achieve the lowest number possible, but not at the expense of sleeping well or feeling better. I have used 10 different masks in my short 2 year usage, full face, nasal & nasal pillows. I presently use pillows but in the beginning I had a difficult time with a pillow because I was a mouth breather. With continued practice I learned to keep my tongue at the top of my mouth and learned to breath solely out of my nose. I have seen my AHI remain consistently <1.00. I truly feel the first place to start is a proper, comfortable fitting mask. For some of us it takes a long time and sometimes it doesn't hurt to go back and try previously used masks you didn't care for.

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Biguglygremlin +0 points · 2 months ago Sleep Commentator

Revisiting the ghosts of past masks is a very good suggestion, because we make a lot of desperate decisions early in the piece, and have a powerful reluctance to go back there, but they weren't always the best decisions, and our attitude and goals can change over time.

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Sierra +0 points · 2 months ago Sleep Innovater

Using mouth taping was the breakthrough for me in using a nasal pillow mask.

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Sherry +0 points · 2 months ago

KEY PHRASE: "With continued practice I learned to keep my tongue at the top of my mouth and learned to breath solely out of my nose." I have always been a mouth breather but I am amazed how easy it has been to train myself to place my tongue at the top of my mouth. I am even more amazed at how much difference that has made in switching from life long mouth breather to a nasal breather. And it happened pretty quickly!

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Sierra +0 points · 2 months ago Sleep Innovater

My wife said the same thing. The ResMed and I suspect the DreamStation machines set a very low bar in reporting leaks. It is not until you use SleepyHead to graphically see the leaks during the night that you become aware when you open your mouth. When I showed her SleepyHead graphs with and without mouth taping then she became a believer. Before that she was an equally firm believer that she never opened her mouth in sleep.

I also find that when I use mouth taping there is no room for my tongue anywhere else but at the top of my mouth behind my teeth. I think the unfortunate reality is that some people open their mouth when they sleep and others do not. I remain skeptical that it is a learned practice. I have a hard time learning how to do things when I am awake, let alone learning when I am asleep!

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