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[CAs] How long Before CAs Diminish?
#21
RE: [CAs] How long Before CAs Diminish?
(03-30-2018, 10:51 PM)Ron AKA Wrote: On the other hand, I looked at your results and I don't think you have a real significant CA issue. It starts to be a greater concern when the CA component of AHI is 5 or more, and you appear to be well below that.
I agree with this. I've been on CPAP now for two years and still have CA events every single night, they make up the bulk of my events. My AHI is usually under 2 so in 7 hours of sleep I often have 13 CAs over a night and the vast majority are not "real" but Sleep wake junk events.
My advice is to be concerned if you are seeing large numbers of CAs back to back, not 3 to 6 over a whole night's sleep (i.e. over 7 hours which is less than 1 per hour). I doubt any doctor would take that seriously.
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#22
RE: [CAs] How long Before CAs Diminish?
(03-30-2018, 11:59 PM)Doza Wrote: It really is quite confusing.   Especially since there wasn't one CA event recorded during my initial sleep or titration studies.  I can only presume it has something to do with how Sleepyhead picks up events.

I don't recall having turned my EPR to less than 2. I'll try turning it off just to see what happens, then back on again at 1, and so on, to see if there's a difference.

I don't think it is an issue with SleepyHead as it just displays the data it gets from the AirSense 10. There certainly could be a difference in how the AirSense 10 identifies a CA vs how sleep study equipment does it. 

My view is that a lot of the rules of thumb that suggest how to adjust your CPAP pressures do not consider the fact that prior to CPAP treatment a person's automatic nervous system that controls breathing during our sleep adapts to abnormally high CO2 in the blood. The more pre treatment apnea events the poorer the CO2 levels. Then we hit our bodies all of a sudden with a CPAP that significantly improves breathing efficiency. The higher pressure air has more oxygen, and the EPR reduces exhale pressure to allow more volume of air to exchange with the lungs on each in out breathing cycle. CO2 levels are suddenly reduced. The body reacts to the lower CO2 levels by reducing the strength of the breathing signals. And at some points it reduces the signal so much it causes a CA event. 

Then over time, like 8 weeks or so, your automatic control system adapts to the lower CO2 levels. Or, at least it does in about 75% of people. 

So when there is no longer any benefit from body adaption to the CO2 about the only option to reduce CA events if they are really high is to compromise the breathing efficiency effect of the CPAP. This in effect increases CO2 levels and forces the body to react sooner and stronger to the CO2. This can reduce CA. The two obvious ways to reduce breathing efficiency is to reduce the maximum pressure the CPAP uses, and reduce the efficiency of the air exchange on each breath (reduce EPR). This obviously can compromise the CPAP's ability to reduce OA and H events. This where it becomes a tradeoff. 

But try turning EPR off. If you make no change to the pressure setting, you may see everything improve. The tradeoff in doing that is in comfort.
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#23
RE: [CAs] How long Before CAs Diminish?
Thanks, all Smile  
Yeah, I certainly can't claim to know anything about how all this works, and fully admit to having some difficulty with much of it sinking in, to be honest. Brain fog rules, I'm afraid. One day it might all click into place Wink

Well, I didn't end up turning EPR right off, but I dialled it down to 1 from 2 to start with.  Early days, but a definite improvement in CA.  Comfort-wise, no discernable change, so I'll try out 0 tonight.

As for last night's pie graph, it's as colourful as many others, so not really a big deal in terms of results.  One CA is not unheard of in my Sleepyhead stuff, so it will be interesting to see how it goes over a period of time, especially once EPR is off..  

I've been having a fair bit of trouble with leaks over the summer (it's still yukky here well into autumn), but I won't get too concerned about that until some cooler weather tells me different.  The nice hard venting of the Swift FX is an advantage on those nights because as a tummy sleeper, it cools my arms down Big Grin 

[Image: 5tuqJVPl.png]
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#24
RE: [CAs] How long Before CAs Diminish?
Hello again Doza

The numbers are getting better but I could not help but notice a few small clusters. You noted some leaks too. Have you considered a soft neck collar to deal with those clusters due to chin tuck which would also help to keep our mouth shut and help to prevent leaks as you use nasal pillows?
Sleepyhead in 5 easy steps
Beginner's Guide to SleepyHead

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#25
RE: [CAs] How long Before CAs Diminish?
Hiya Smile
Yes, I tried a collar, but it's definitely not a summer thing, unfortunately. I'll know more about what the leaks are most likely due to when the cooler weather kicks in.
The cluster thing is pretty normal for me it would seem. I don't have any cause for concern about my health in general. I'm very healthy and fit, especially for someone my size.

I'm not 'with' a sleep clinic at all and sourced the machine independently. I was under the impression my GP was au fait with sleepyhead etc (he did say that at the outset which influenced my decision to go it alone), which turned out to be a pile of BS. The hassle of having to have my drivers license adjusted with all the paperwork by a doctor without a clue made that clear. But the cursory examination for that medical certificate showed no issues at all in general. Plus the sleep study data didn't show up anything untoward except for obstructive apnoea, so it's as much about getting a nice set of graphs as anything else at this point.
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#26
RE: [CAs] How long Before CAs Diminish?
Bug-eyed  Horrors!  The last two nights I've woken with the most godawful dry mouth.  Huh   I guess mouth breathing would account for the progressively worsening leaks, then.  I don't get it. Doing some more reading it would seem this might happen more than I thought. 
I've dug the dreaded collar out to try again. 
I also ordered a dreamwear with cushions because I've also been having trouble with the P10 AND the Swift pillows not fitting properly; and hurting in recent weeks, thus having to swap sizes a bit.  
I'm perplexed as well as disappointed after what had been a relatively easy intro to this hosenose bizzo. While  AHI has been acceptable, it all seems to be turning to custard. 
  Bugger.  Sad
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#27
RE: [CAs] How long Before CAs Diminish?
No large leaks, no CAs, no dry mouth. Win.  But still a lot of snores despite the collar. WTH?

[Image: EmJ25c8l.png]
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#28
RE: [CAs] How long Before CAs Diminish?
(04-04-2018, 03:12 PM)Doza Wrote: No large leaks, no CAs, no dry mouth. Win.  But still a lot of snores despite the collar. WTH?

Looks good. Your snores start at 3:30, and your machine is responding with more pressure. However, it is maxed out at 16 cm. You may want to try increasing your max pressure to 17 cm.
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#29
RE: [CAs] How long Before CAs Diminish?
Yeah I was wondering about that. I wonder how high I'll end up having to go if this keeps up though. There seems to be more need for adjustment as time has gone on than when I started.
One thing I also wonder about is that because my masks came via a US seller, that they're made to the quick-change DME model of replacement, thus less durable. Even whether the masks are included in the whole US insurance system market like the machines are (apparently).
That might explain a bit in relation to why they are hurting my nose, when they didn't before.
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#30
RE: [CAs] How long Before CAs Diminish?
You see I don't think upping pressures will be the answer. Cos this may lead to leaks returning and dry mouth yada yada.

You just have a few clusters and I wager those are with chin tucking comfortably as you drift into deep cosy slumber.

If you feel good currently, perhaps just wait for cooler climate to try to use the collar to knock off those clusters.
Sleepyhead in 5 easy steps
Beginner's Guide to SleepyHead

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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