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Clear Airway Clusters
#1
Brick 
Hello all. I've read a bit about CA events and know they're not enough to know what's going on by themselves (could be false flags, etc.). I was hoping I could get some help looking at my other data from Sleepyhead. Here's my overview. I've been on the road to compliance since I got a full face mask in mid February. You can see my AHI is generally pretty low except for the CA events.
imgur.com/neX9gdv.png (sorry, first post. can't post images, etc)

Usually it's just a few in a night but occasionally I get a whole lot in a row. The last 3 nights I/ve had around 30 in an hour. All around 4 am. Here's the data from the first night. Overall:
imgur.com/f7HI7hc.png
imgur.com/nKVXCqv.png

Zoomed in:
imgur.com/KU6rc7c.png
imgur.com/j1FCYeN.png

I'd appreciate any help I could get. I tried asked my doctor about these events but they only had access to my AHI and compliance time. Is that normal? Those two pieces seem pretty rudimentary. I figured the doctor software would have everything Sleepyhead gives. Anyway, appreciate any help. I don't understand what most of the data means.
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#2
I can't see the images from work.

I can tell you that mine tend to cluster. Fairly consistently a batch shortly after sleep onset, and I suspect the other clusters are around partial waking during the night. I've had as many as 200 CA's in one night. Sometimes a cluster just before waking.

There is something about the CO2 crossover point changing, during the transition from wake to sleep, that can trigger these events. The specifics of how it worked were a little technical for me... Mainly I got the sense that if that is mainly where they are happening, it's to be expected.
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#3
(03-25-2015, 11:05 AM)CPApnea Wrote: I'd appreciate any help I could get. I tried asked my doctor about these events but they only had access to my AHI and compliance time. Is that normal? Those two pieces seem pretty rudimentary. I figured the doctor software would have everything Sleepyhead gives. Anyway, appreciate any help. I don't understand what most of the data means.

The machine is pretty good at guessing whether the CAs are real or not. I'd expect that they are.

Your doctor should have the manufacturer's software and should be able to see everything that you can. The fact that s/he can't or won't means you might want to change doctors.

The CAs can be induced by the high pressure, but you apparently need the pressure to control you OAs. You may end up needing an auto SV machine that can handle the OAs, but also knows how to handle the CAs by alternating pressure levels to keep you breathing.

In any case, if the best you're getting from your doc is confirmation that you're using your machine, you should get a different doc before you do too much else. Even though 4.3 is technically "treated", if you can find a good doc, you should be able to get it a lot lower.

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#4
Thanks for the replies. I've been thinking about switching doctors anyway. Haven't been too impressed with this one for other reasons. I should also mention I had zero or one central apneas during my sleep study. I'm realizing I haven't saved a copy yet so I can't check til later.
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#5
(03-25-2015, 11:31 AM)CPApnea Wrote: Thanks for the replies. I've been thinking about switching doctors anyway. Haven't been too impressed with this one for other reasons. I should also mention I had zero or one central apneas during my sleep study. I'm realizing I haven't saved a copy yet so I can't check til later.

The CAs are probably from the pressure you're running. sometimes they just go away after a little while. How long have you been running at close to 20?

It's possible you didn't have any during your study because they didn't get the pressure that high.

Terry
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#6
I've been at 20 since I got this machine in January (though I wasn't able to sleep with it on til I got a full face mask in February). So really about a month and a half. And only recently have I been able to sleep through the whole night, so I think I am still adjusting. But the CAs are getting more frequent.

They got the sleep study pressure up high by the end of it, but I can't remember the specific of that and when the central apneas did or didn't happen. Really I just need to get my copy when I get home later.
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#7
(03-25-2015, 11:45 AM)CPApnea Wrote: But the CAs are getting more frequent.

You need to find a good doc and probably get a new machine designed to handle CAs.

Terry


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#8
Best guess -- pressure induced central apnea.

You might need to max IPAP limited to about 16. Also you have variable PS of 4 to 8. Your CA cluster is happening at high IPAP plus a wide split in PS.
The high split in PS may be permitting to to exhale too much CO2 upsetting the brains trigger.

It's a bit complex, so, I'd consult a sleep doc who knows their stuff.
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#9
Alright, I have an appointment with a new doc set for next week. I'm also not completely sure my pressures need to be so high. I had a hell of a time acclimating to the CPAP machine and only became compliant after I gave up on nasal masks. I'm not sure if earlier fixes would have been necessary if I was using a ffm. But I'll see what this new doctor says. Thanks for yall's help.
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#10
For me, there's no way I could run the same pressures on a nasal pillow that I did on an ffm. I needed 10-15 on the FFM, and tested even higher to find the ceiling. I couldn't breathe at those levels when I switched to a nasal pillow and had to drop it to 6-9.

Good luck on your appointment with the new doc. Smile
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