This is my sleep study report (a re titration).  I was diagnosed 6 years ago and was on straight cpap (pressure 10cm)until last fall.  I was feeling more fatigued that before.  Had a 5 night in home sleep study which said my 90% pressure was 11cm.
I saw a sleep specialist (wanted to check out anything that might be going on in my sleep. I had the study in April.  The room was freezing.  I did not sleep well.  Had my own mask.  The sleep tech said she only had to raise the pressure to 9 cm!  I did lose about 12 lbs in weight last summer.  I should say that I have an auto pap now and have the pressure set at 10.5 to 13cm and a very good leak rate.  I have an AHI of under 1 almost every morning.  I sleep well at home, retiring around 11 pm and rising at 6 am, falling asleep quickly, waking usually only once a night for a bathroom trip. I always sleep on my back (only pain free position) I have Rheumatoid Arthritis (for 19 years) and am on meds for that - no change in those meds in 2 1/2 years.
Any comments - much appreciated![im

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Did you get a breakdown of events per pressure setting.

In other words, how much time did you sleep on 9cm h20 and did you have any events?

Were you continuing to have spontaneous arousals at 9cm h20? If so, then maybe you have developed UARS and need some added pressure, which wouldnt necessarily be grounds to increase pressure in the lab.

Maybe if your APAP range was lowered to incorporate 9, then you could try it and see how you feel.

Just my opinion.

Thanks so much Ram_Sleep!  So far, I have only been able to get that 2 page summary report.  I am in Canada and the process is slow!   When i call, I get voice mail and no return call!  I will keep trying to get the full report!  I got this summary through my GP.  I see the specialist in late August and am trying to prepare for it by getting questions I want to raise.  You have given me a couple here!!
I have the software and reader so I will try lowering the bottom pressure to 9cm and see how things are after a week or so.
If I have developed UARS, what would you suggest in the way of pressure settings?  Lowering to 9 cm as you suggested here?
Thanks again!

Hawthorne wrote:

Thanks so much Ram_Sleep!  So far, I have only been able to get that 2 page summary report.  I am in Canada and the process is slow!   When i call, I get voice mail and no return call!  I will keep trying to get the full report!  I got this summary through my GP.  I see the specialist in late August and am trying to prepare for it by getting questions I want to raise.  You have given me a couple here!!
I have the software and reader so I will try lowering the bottom pressure to 9cm and see how things are after a week or so.
If I have developed UARS, what would you suggest in the way of pressure settings?  Lowering to 9 cm as you suggested here?
Thanks again!

Id go with the lower range of 9cm h20 for a week and see what happens. If your AHI is satisfactory, and it is, then I would have to go by how you feel. You know your body best and you will know when you are tired and when you are not. Hopefully, you can maintain the low AHI and feel refreshed at 9cm h20. The lower the pressure the better, so long as you are breathing without difficulty.

It will help to have that full report. It sounds like it is a pain in the butt! Good luck!!

The 2 page summary you have is a start, but its quite difficult to read. I cant tell what data is from the baseline portion and what is from the pressurized portion. What we can tell is that the pressure helped you get into Slow Wave Sleep.

Thanks again Ram_Sleep!! I can't tell you how much I appreciate your comments.  While I have been on cpap for 6 years, I had a straight cpap for 5 years which gave only compliance.  For 5 years I was at a set pressure of 10cm.  Seemed to do the job, but then I began to feel the fatiuge increasing.  I bought an Auto online (out of my own pocket) early this year and bought the software and reader.  I began to get serious about my own therapy since I was left to drift, so to speak, 6 years ago and didn't know any better.  Then I found forums like this. I've been doing a lot of research and finding out a lot!  I initiated my re- titration last fall, myself, since I was feeling more fatigue.  If the 9cm ( lower pressure) does not make a difference in a week or so, I will go back to my previous settings I guess.  I am beginning to wonder if you are right about UARS, in my case.  I will check my 90% and the AHI, etc. and how I am feeling daily, as I have been doing and see what results the week brings.
My thanks!

I tried a pressure range of 9cm -13cm for 5 nights, as you suggested Ram_Sleep.  My AHI rose slightly each night (got to 2.7 one night).  I know that is not bad but, since I was having an AHI of under 1 most nights with a pressure of 10.5 cm-13 cm, I didn't like the direction I was heading.  I was also beginning to be more fatigued again.  In addition, I found breathing a little bit of a problem when the machine started at 9 cm.  It seemed more difficult -not a lot but noticeable.
I still cannot get anyone to try to get the complete sleep study (voice mail and no returns).  I see the sleep specialist next month.
In the meantime, 2 nights ago, I decided to re set my pressure to 10 cm -13 cm.  Results - AHI 1.1 on the 16th and AHI 0.3 last night.  I felt quite a bit more rested today.  Initial breathing when I am falling asleep is easier. I have the software and noted that I am having way fewer events at this pressure.  With a minimum of 9cm they were happening regularly through the night.  Last night there were 2 events just as I was going to sleep.  The rest of the night - no events.
I'm thinking the best move is to stay at this range until I have my appointment with the specialist and TRY to get my full study and discuss it with him.
Ram_Sleep, what are your comments about what I have done and the results?  
I know this is not specifically about my sleep study but, just added it to the thread since it is related.
Hey, I guess your 5 night experiment gave me a mini sleep study!  Is that assumption right?

Hawthorne wrote:

I tried a pressure range of 9cm -13cm for 5 nights, as you suggested Ram_Sleep.  My AHI rose slightly each night (got to 2.7 one night).  I know that is not bad but, since I was having an AHI of under 1 most nights with a pressure of 10.5 cm-13 cm, I didn't like the direction I was heading.  I was also beginning to be more fatigued again.  In addition, I found breathing a little bit of a problem when the machine started at 9 cm.  It seemed more difficult -not a lot but noticeable.
I still cannot get anyone to try to get the complete sleep study (voice mail and no returns).  I see the sleep specialist next month.
In the meantime, 2 nights ago, I decided to re set my pressure to 10 cm -13 cm.  Results - AHI 1.1 on the 16th and AHI 0.3 last night.  I felt quite a bit more rested today.  Initial breathing when I am falling asleep is easier. I have the software and noted that I am having way fewer events at this pressure.  With a minimum of 9cm they were happening regularly through the night.  Last night there were 2 events just as I was going to sleep.  The rest of the night - no events.
I'm thinking the best move is to stay at this range until I have my appointment with the specialist and TRY to get my full study and discuss it with him.
Ram_Sleep, what are your comments about what I have done and the results?  
I know this is not specifically about my sleep study but, just added it to the thread since it is related.
Hey, I guess your 5 night experiment gave me a mini sleep study!  Is that assumption right?

Yea, it might be best to stay about the 10-12 range. It all depends on how you feel. If 9cm h20 is leaving you feeling awful, then there isnt a good reason to continue on. The AHI was acceptable, so it should boil down to your sleepiness level.

As always, the titration data is usually a good starting point, but its not always concrete. It may be that the pressure of 9cm h20 eliminated your OSA, but exposed UARS. We cant tell from the limited data that you were given. You could always up the range just to be sure. Try 11-13 for a week and see what happens. m not advocating ever changing pressures, but while you are at it, you might as well get your optimal level. ;)

Thanks Ram_Sleep.  I appreciate your input.  The sleep study was an awful night.  I am surprised they got anything of use at all!  Since I seem to be doing a small "sleep study", I may try that 11 cm-13 cm for a week and see.  At the moment I am getting a 90% at 11 cm.  I know that means that I spend 90% of the night at 11 or lower.  Not sure if I mentioned that I had an "in home" auto  5 night study last November.  It showed my 90% to be 11 cm so I was really surprised when the sleep tech, at the study, said she didn't have to put me above 9 cm.  I think they were just aiming for below 5 AHI.  That's fine but I feel better with a lower AHI.  I will finally get my follow up with the specialist next month.  That will be almost a year since I initiated this last fall.  The waiting times are long in Canada!
Thanks again, Ram_Sleep!

Hawthorne wrote:

Thanks Ram_Sleep.  I appreciate your input.  The sleep study was an awful night.  I am surprised they got anything of use at all!  Since I seem to be doing a small "sleep study", I may try that 11 cm-13 cm for a week and see.  At the moment I am getting a 90% at 11 cm.  I know that means that I spend 90% of the night at 11 or lower.  Not sure if I mentioned that I had an "in home" auto  5 night study last November.  It showed my 90% to be 11 cm so I was really surprised when the sleep tech, at the study, said she didn't have to put me above 9 cm.  I think they were just aiming for below 5 AHI.  That's fine but I feel better with a lower AHI.  I will finally get my follow up with the specialist next month.  That will be almost a year since I initiated this last fall.  The waiting times are long in Canada!
Thanks again, Ram_Sleep!

Here is another thought, although I do not believe that this happened to you:

Our physicians write for the lowest pressure possible, so if we titrated to 8, then 9, and finally 10, the physician will choose the lowest pressure with an AHI under 5. Even if at 10 there are no events, if 9 has an AHI under 5, then the script will get written for that. I do not always agree with their philosophy, but they have the Md (phD) whereas I do not.

Plus added pressure is not always a good idea, but it beats no pressure at all (combined with loads of events).

Ram_Sleep - Actually I do believe that the sleep tech got my pressure to 9 and it brought my AHI below 5 so she did not go higher.  I asked her what my pressure was when I left the study that morning.  She said - we didn't have to go above 9".  I don't think a doctor had seen the results at all yet.  
I have a covering letter from the specialist that came with my 2 page report.  That was a couple of months later.   I got this letter and the 2 page report from my GP.

The letter said-
"This patient with known sleep disordered breathing is being reevaluated because of some concerns about ongoing tiredness and whether or not CPAP is set effectively or other factors have come into play.
Because of the patient's arthritis she was not comepletly comfortable in the strange environment.  Latency to consistent sleep is long and there's a couple of periods of wakefulness after sleep onset.  In total four hours and 18 minutes of sleep were achieved although adequate amounts of REM sleep and slow wave sleep were noted.  The patient started with CPAP at 7 cmH20 and with some transitional events, pressures were increased to 9 and the majority of the recording from midnight on was at 9 cmH20.  No snoring, flow limitations, or obstructive sleep apnea were seen and oxygen saturation was stable at 98%  The patient was not restless and there were no periodic movements.  Cardiac arryrhymias are not seen apart from sinus bradycardia.

IMPRESSION   Sleep apnea was controlled with nasal cpap at 9cmH20.  This is slightly lower that the patient's original titration in 2002 and, in fact weight is down 7 kg from that time.  We will be seeing her in clinic to follow up."

I don't know if adding this letter gives you much more info to go on but when I had my auto set at 10.5 to 13 I was getting, consistently below an AHI of 1 and had 3 0r 4 AHI of 0.0 during those 3 months.  I was feeling more rested after a time at this pressure.  The sleep study made me rethink and so I posted to get some comments.
Am I right in my assupmtion that a higher pressure, and probably a tight range, in auto is better for me given all this?  
Should a person try to get close to AHI 0.0 or at that most of the time?  I feel better when I am getting those low AHIs but is it psychological?  I don't really want a high pressure but my goal is to eliminate as many events as possible and feel more rested!  
Sorry for this long post but I do appreciate what you have told me! I also attempting to get some idea of what I should be asking the specialist when I finally see him.  Thanks so much for helping me to interpret somewhat and attempt to get to my optimal level.

An AHI of 0 is a remarkable task. In my opinion, it isn't realistic. A lot of"normal" sleepers have AHIs of great than 0. In fact, I bet some of those same sleepers have AHIs of 4 or 5.

This next set of comments may upset you, but they are not intended to do so. The AHI value from that machine is important, but be careful when putting so much faith in it. I am not accusing you of doing so, but I have met patients that use the value as a guide to how well they slept. It isnt really the case. Sure, if the AHI is 50 compared to 3, then yes, but between 2 and 1? Some people get fixated on the value and mentally convince themselves of the day ahead. Just watch out for that trap. Data can be good, but too much data can be bad, at the same time.

Am I suggesting that you actually use the 9cm h20 setting? Not really. I'm simply trying to say that it might be satisfactory to do so. Worry about feeling well without ever looking at the AHI value. To be honest, leakage and AHI isnt all that important to you because you have down to a science. Run the machine back on 9 for a few days, IGNORE the ahi value and see how you feel again. If you can honestly say that you are feeling a lot of unnecessary sleepiness, then its time to increase.

Id like to see some studies, from outside the manufacturers of those data machines, about the accuracy of the AHI values. This needs to get done due to how many people are relying on these values. If you find a link, then please send it to me. I am not someone who believes in the overall value that is given, however I do believe that it gives a good ballpark to effective treatment.

I hope this makes sense.

Ram_Sleep - Your comments did NOT upset me!   You are trying to help and that's what I want!   I know that those of us with software, etc especially, can become obsessed with the numbers.  I guess, bottom line, I want to feel good with a reasonable AHI.  That's why I wondered if it was psychological that I felt better when my AHI was very low.  I know that I will not always achieve 0.0 AHI or even below 1.0 AHI all the time, since I have sleep apnea.  I expect you're right that people without sleep apnea , would have an AHI of even up to 5 sometimes, since those of us with sleep apnea are considered "okay" at 5 or under.
I must admit, it is nice to see those low numbers but I hope I can base success on the way I feel - as long as the AHI is consistenly below 5. I do need to make a deliberate effort to assess my sleepiness without a look at that AHI so I will not be unduly influenced!
At the 10.5 to 13 though, I was definitely (after a period of time at that range) able to get more done in a day and required a daily nap less often.  I just kept wondering if I should have the lower setting at least at 9 cm since that's how the sleep study went.  I don't want the pressure to be any higher than I need because that can cause other issues.  That's why I posted here.
Some outside studies on the accuracy of these machine would be excellent.  I think each manufacturer tries to "sell" their machine as the most accurate but it is based on their studies and, therefore, biased.
 You suggested "run the machine back on 9 for a few days and ignore the AHI and see how I feel again". Are you suggesting a straight cpap pressure of 9 cm or that range of 9 cm to 13 cm for a little longer and assessing how I am feeling (without bothering about the AHI numbers)?  Just wanting to clarify your suggestion there.  I do like the auto and I like the A-Flex.  It makes exhaling so natural.  Since I found that I am reluctant to give it up.
Again, many thanks for all your comments and suggestions!  I really appreciate your advice!

Maybe tighten up the window, say 9-11cm h20.

Its just a suggestion. It would be interesting to see how things go.

I completely understand your desire to get a low AHI. And you know your body and how it feels, so take my suggestions with a grain of salt.

just one comment:

 the AHI for mild apnea is 5-15, right?  so an AHI of less than 5= less than mild = clinically insignificant

ex:  my son's AHI was 1.2 and the impression was:  "no evidence for clinically significant apnea"

just throwing that out there

ok---a 2nd comment:

I wonder if your fatigue could have a cause other than the low AHI?  
for example:  you said the 1st study was done 6 yrs ago but your meds started (or changed) 2 1/2 yr ago---could they be influencing your fatigue?

embryopathy wrote:

just one comment:

 the AHI for mild apnea is 5-15, right?  so an AHI of less than 5= less than mild = clinically insignificant

ex:  my son's AHI was 1.2 and the impression was:  "no evidence for clinically significant apnea"

just throwing that out there

ok---a 2nd comment:

I wonder if your fatigue could have a cause other than the low AHI?  
for example:  you said the 1st study was done 6 yrs ago but your meds started (or changed) 2 1/2 yr ago---could they be influencing your fatigue?

Yes, I think that an AHI under 5 is clinically insignificant in adults. 5 and under is normal. The problem is that AHI gets so much focus. It really should be RDI, but thats an entirely different debate.