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Clear Airway definition
#1
After appx 2 months of treatment, my average AHI numbers are 2.8 with all being "Clear Airway" apneas. What exactly is a clear airway apnea? Does this mean that my normal breathing is being interrupted while I clear my airway? Is this a neurological problem that can be corrected?

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#2
(03-22-2012, 08:34 AM)spiral_15 Wrote: After appx 2 months of treatment, my average AHI numbers are 2.8 with all being "Clear Airway" apneas. What exactly is a clear airway apnea? Does this mean that my normal breathing is being interrupted while I clear my airway? Is this a neurological problem that can be corrected?

Welcome to Apnea Board, spiral_15!

"Clear Airway Event" is another way of saying "Central Apnea Event". More on central apnea events on our Wiki, here. There is a slight difference, and maybe someone else can expand on this, but they're basically the same. There is no real true way to determine a Central Apnea event using today's CPAPs (you need a sleep study for that), so to play it safe, the manufacturers sometimes use the term "clear airway event" instead of central apnea event to indicate that it's not an obstructive event, but most likely is a central event.



SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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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#3
It has to be a reason why you've been prescribed Bi-level
usually Bi-level prescribed to treat wide range of respiratory disorders other than simple OSA.

A diagnosis of central sleep apnea (CSA) requires all of the following:
An apnea index > 5
Central apneas/hypopneas > 50% of total apneas/hypopneas
Central apneas or hypopneas occurring at least 5 times per hour
Symptoms of either excessive sleepiness or disrupted sleep
http://www.resmed.com/us/clinicians/abou...clinicians
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#4
(03-22-2012, 08:34 AM)spiral_15 Wrote: After appx 2 months of treatment, my average AHI numbers are 2.8 with all being "Clear Airway" apneas. What exactly is a clear airway apnea? Does this mean that my normal breathing is being interrupted while I clear my airway? Is this a neurological problem that can be corrected?

I have similar results with only a few OSA events, and this is what motivated my question yesterday about "shouldn't the goal of PAP therapy be control of OSA?".

I doubt the neurological problem can be corrected short of a brain transplant or Borg-style bionic implants, so No, or not yet since this is undoubtedly being researched.

The wiki entry suggested by Supersleeper suggests that treating atrial fibrillation (AF) might decrease central apneas.

The wiki says "There is an association between atrial fibrillation (AF) and central sleep apnea. A study found that the prevalence of atrial fibrillation among patients with idiopathic central sleep apnea was significantly higher than the prevalence among patients with obstructive sleep apnea or no sleep apnea (27%, 1.7%, and 3.3%, respectively). There was a total of 180 subjects with 60 people in each of the 3 groups. Possible explanations for the association between CSA and AF are a causal relationship between the two conditions, or an abnormality of central cardiorespiratory regulation.".

This last phrase suggests to me that reducing AF might reduce CSA through a feedback mechanism. Plus reducing AF is desirable itself.

AF seems to be fairly intractable short of extremely invasive heart surgery, but I have met one person who used Laminine to completely suppress his AF, plus there are reports in the Alternative Medicine literature of various plant extracts that suppress AF, particularly abroad. I did locate one person who claimed to have totally cured his AF with the aid of a USC cardiologist, but I don't think his method would work until hypertension were eliminated, because I think that hypertension causes AF, so the AF would just recur after being cured.
My age is none of my mind's business. --- Netskier
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#5
(03-22-2012, 03:10 PM)zonk Wrote: It has to be a reason why you've been prescribed Bi-level
usually Bi-level prescribed to treat wide range of respiratory disorders other than simple OSA.

A diagnosis of central sleep apnea (CSA) requires all of the following:
An apnea index > 5
Central apneas/hypopneas > 50% of total apneas/hypopneas
Central apneas or hypopneas occurring at least 5 times per hour
Symptoms of either excessive sleepiness or disrupted sleep
http://www.resmed.com/us/clinicians/abou...clinicians

holy moly.

last night sleepyhead:
ahi 9.09
oa .15 (1 event)
ca 5.66 (38 events)
hypo 3.28 (22 events)
disrupted sleep, wake several times.

i could have central apnea? the numbers are different every night and usually between 5 and 10 ahi but the percentages are kinda the same.

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#6
Bill, what pressure range do you currently have your auto set for. still at 8-12? Also, are you using A-flex, if so what setting? Using the ramp feature also?

What was your last sleep study titrated pressure? What's your 90% pressure?

If the pressure range has been set between 8-12 for a while now... what's your current average number of ca events?




SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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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#7
Keep in mind that no modern CPAP machine can be completely accurate when determining centrals - you need a sleep study for that. When CPAP machine data lists central events, it's really saying that "most likely" these are centrals, since there is no way for the machine to determine with absolute certainty that you're experiencing centrals. That's one of the reasons why PR lists them as "Clear Airway" events, instead of the more definitive term of "central events".
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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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#8
(03-22-2012, 05:14 PM)SuperSleeper Wrote: Bill, what pressure range do you currently have your auto set for. still at 8-12? Also, are you using A-flex, if so what setting? Using the ramp feature also?

What was your last sleep study titrated pressure? What's your 90% pressure?

If the pressure range has been set between 8-12 for a while now... what's your current average number of ca events?

-----------------------------------------------------------------------------------------------------------------------------

high pressure is currently 12.5 because i bumped up against 12, 3 or 4 times since december when i bought the apap.

low pressure is 8.5 because i felt i could deal with it. 9 hurt my numbers and was a little much. 8.5 seemed to be the best.

with my straight cpap even with c-flex i couldn't blow against the 12 pressure.

ramp is 5 because 4 seemed low. not using ramp is too high.

a-flex is 3 because i feel i need it.

last titrated pressure was 2 yrs ago at 12.

last nite 95% pressure was 10, max was 11.

from sleepyhead overview
ahi 8.56
ca 4.07
0a .75
h 3.75

averages are shakey because i was alternating 2 and 4 yr old masks until a week ago when i bought a new cushion.

2 yrs ago at age 60 i was first diagnosed with adult onset asthma. this year at age 62 the pulmonologist told me i have asthma and copd. he said i have some of asthmatic bronchitis and emphysema. copd is generally one or the other. so i have asthma, asthmatic bronchitis and emphysema. along with this i have a paralyzed vocal chord. one side only. 10 yrs ago i had a vocal chord implant put in to push the paralyzed vocal chord permanently to midline so the good side would close properly. so i have this air blowing in and i'm breathing out thru a voicebox that has one side permanently blocked.

the answer to my problem may not be a straight forward cpap adjustment answer. i probably need to leave things alone until i see the sleep doc to discuss all of these numbers. i was waiting to see him til i got the new mask cushion to have some reliable data. i don't know how these lung conditions and the vocal chord play into the numbers. the lung condition seems to be changing, from first getting asthma 2 yrs ago to asthma and copd now.

-----------------------------------------------
from encore:
therapy data summary all data 86 days
mean pressure 8.7
average peak pressure 10.5
90% average pressure 10.0
average time large leak per day 31 minutes
average ahi 8.5

last nite
90% pressure 10.0
average pressurs 9.1

indices
ca 5.7
oa .1
h 3.3
fl .6
vs .3
re .6
ahi 9.1

min in larg leak 0.0
% night in large leak 0.0%
average leak 29.0

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#9
Bill, reducing or turning off A-Flex is going to decrease AHI, generally... same thing with reducing the amount of time for ramp period. Not much, but it should help to a degree. If not possible for comfort or tolerability reasons, I understand.

Not sure if you tried this, but if your average 95% pressure is 11.0, I'd be willing to bet good money that your pressure needs go up above 12.0 at certain times during the night (on some nights), and your current upper restriction of 12.0 might be hampering you from obtaining the best possible pressure during those times to punch through a particularly stubborn event. Have you tried increasing the upper pressure limit to say, 15 or 16 for one night and seeing the effect upon overall AHI?

In any case, good idea to discuss with the doc, considering the other issues.

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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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#10
(03-22-2012, 07:18 PM)SuperSleeper Wrote: Bill, reducing or turning off A-Flex is going to decrease AHI, generally... same thing with reducing the amount of time for ramp period. Not much, but it should help to a degree. If not possible for comfort or tolerability reasons, I understand.

Not sure if you tried this, but if your average 95% pressure is 11.0, I'd be willing to bet good money that your pressure needs go up above 12.0 at certain times during the night (on some nights), and your current upper restriction of 12.0 might be hampering you from obtaining the best possible pressure during those times to punch through a particularly stubborn event. Have you tried increasing the upper pressure limit to say, 15 or 16 for one night and seeing the effect upon overall AHI?

In any case, good idea to discuss with the doc, considering the other issues.

Is there evidence that higher max pressures reduce central events?
My age is none of my mind's business. --- Netskier
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