Sleep Apnea Success: What Does It Mean?

October 20, 2009

If you have sleep apnea, success has many meanings. In the ideal situation, it means that you feel great, you don’t have to use any gadget or device when you go to bed, and your sleep apnea score (AHI) is 0.

Unfortunately, the definition of success in the sleep apnea research fields keeps changing depending on who’s reporting it. In general, the surgical definition of success is a drop in the final AHI (apnea hypopnea index) of greater than 50%, and the final number is less than 20. Some use an AI (apnea index) being less than 10. Rarely, some people use 5. Some studies report two or three definitions simultaneously. Studies report anything from 40% to 95%, depending on different types and combinations of procedures.

For CPAP users, there are multiple definitions of success. One common definition is when CPAP is used at least 50% of each night for at least 4 out of 7 nights. Actually, this is a measure of compliance, meaning, how well did the patient stick to using the machine? Reported compliance rates using different criteria range widely from 20% to 90%.

Surgical success and CPAP compliance doesn’t measure the effectiveness of the form of therapy. In other words, do you actually feel much better? Is it lowering your blood pressure, or are you feeling less depressed? You can be using CPAP 100% of the time 7 days a week, or your AHI after surgery can drop from 45 to 3, and you may not feel any better. These same concepts apply to oral appliances as well.

What you may find is that although you’re using CPAP every night, your "effective" AHI each night is still relatively high, and not anywhere near the near 0 levels that were obtained during the CPAP titration study. Since the vast majority of CPAP machines that are prescribed will only measure "compliance" data, you’ll never actually know how effective the treatment is when you’re actually using it. Some of the more advanced models are able to tell you what the effective AHI is every night. For only a few hundred dollars more, it’s probably worth giving every patient models with these features.

Even if you’re "successful" in the beginning, how will you feel 20 to 30 years from now? Will you still be using your CPAP machine 100% of the time, or will your AHI remain at the same levels just after surgery? Probably not.

As I’ve describe with my sleep-breathing paradigm, all modern humans are susceptible to sleep-breathing problems to various degrees. It’s a normal part of being human, mainly due to our ability to talk. So thinking of any of these treatment options as a cure is a mistake, since the forces that create collapses in your throat will only get worse as you get older. (Find out more about these important concepts in my book, Sleep, Interrupted.)

Just like any chronic condition, managing sleep apnea has to be considered a life-long process of constant adjusting and fine-tuning, rather than thinking of these treatments as a one time "cure."

Are you a successful sleep apnea patent? How has your mindset changed regarding "success" since you first started treatment? Please enter your responses below in the comments box.

Written by Steven Park · Filed Under Blog | Leave a Comment