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[Diagnosis] Clear airway questions
#1
Clear airway questions
I am a long time CPAP user.  Recently have had some challenges, so I purchased a new Resmed Aircurve 10 and down loaded OSCAR to see my results.
To my surprise the report is showing a number of "Clear Airway" events, with very low AHI.

My questions -

1.  Are Clear Airway events always central apneas?  More than half of my Clear Airway events seem to be in the last hour of sleep (not even sure I was asleep).
2.  Should I be more concerned since they are Clear Airway events?
3.  If they are not central apnea events, what could they be?


Stats -   S mode (bilevel)  20 in/ 20 ex pressure.  No mask leaks.

Thanks for any help or comments......

Tried to attach copy of my OSCAR results from last night but had a problem.

About 16 Clear Airway events in eight hours...  ranging from 10 seconds to 23 seconds.
AHI about 2.0 including  Clear Airway events....   no apneas, one hypopnea...
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#2
RE: Clear airway questions
G'day mratliffe. Welcome to Apnea Board.

A low rate of CA events is not at all unusual and most times it's no cause for concern. It's possible they are false alarms, which can be caused by an unrelated arousal or holding your breath (especially when rolling over in bed).

CA events in the first and last periods of sleep may be "sleep-wake junk" which occurs during that transition period. Putting it very simply (coz that's the only way I can Smile ) your waking breathing and sleeping breathing are controlled by different processes in the brain. Sometimes the handover from one process to the other doesn't go smoothly (especially if you're in a prolonged doze) and you can get pauses in your breath.

Instructions for formatting your Oscar data are here: http://www.apneaboard.com/wiki/index.php...ganization

And instructions for uploading are here: http://www.apneaboard.com/wiki/index.php...pnea_Board
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#3
RE: Clear airway questions
CA, Clear Airway, or Central Apnea, yes most times these will indicate a central or not breathing episode. The SWJ or sleep/wake junk thing could be the reason. There's the pre-existing CA events like I've got as well. Sorta in-between is another central apnea, treatment emergent. I think, this of course has the caveat that data evidence is lacking for now, you might have a majority of the SWJ centrals. You might also have a few treatment emergent CA events here as well. Why? New machines may be better at delivering oxygen than the old unit. Your body got used to the slightly less oxygen rich intake and isn't used to getting the boost in efficiency the new machine is bringing to your respiration. IF there are any of this type CA, these will diminish in short order, between 1-3 months, very likely sooner rather than later.

Regardless of any of this, showing us OSCAR data is best case scenario. This has the data evidence to be very accurate in interpreting what's going on with these CA events.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Clear airway questions
Thanks so much for your quick reply.   Makes the situation much clearer to me....

I have tried again to attach screen shots of last nights report.  It is divided on two
pages as I sleep past noon, which seems to be the cutoff....

The second attachment shows nine or more Clear Airway events in the last half
hour.  Your thoughts?  I'm not even sure I was asleep then...

Thanks for your help....


Attached Files Thumbnail(s)
       
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#5
RE: Clear airway questions
Thanks for posting the charts. In general we like to see all the stats and settings in the left side-bar, not just the raw graphs.

Anyhow, looking at the session running from ~19:00 - ~21:00 there are nine mask-off events in the space of two hours. In the session running 05:00 to ~12:00 there are 5 or 6 mask-off events. We need to identify why the mask is coming off so frequently. Each mask-off is accompanied by a big spike in leaks, and then there are CA events either immediately before or immediately after nearly every mask-off. I doubt very much that these are real apneas.

On the other chart, you seem to be doing OK from 12:00 to 13:05, but then there are a further 9 CA events in the space of a half hour. I'd be fairly sure these are all SWJ. Perhaps you could zoom in so that we can see 2 or 3 events in close-up?

You have a bilevel machine but it's running at a fixed 20cm pressure. This is a very non-standard type of setting - were you given this by a doctor or technician? The constant high pressure must be uncomfortable and might account for the highly disrupted sleep. Can you tell us the exact model of machine please? There are several different Aircurves and they all do different things. And could I ask you to update the machine in your profile? Thanks.

So let's see some charts with the left sidebar intact, and a zoom in on some of those CAs around 13:30 or thereabouts. Then we can give you some more targeted advice.
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#6
RE: Clear airway questions
I am just getting used to using the software; please bear with me....
I want to say that my night sleep starts on the first  attachment at around 5:00 am 
and runs through 11:30 am on the first chart and then continues on the second
chart from 12:00 noon to 1:45 pm.  I know this is confusing.

The first session running 19:00 - 21:00 you should just disregard.  This is a nap
and I don't know if I ever went to sleep.  The mask off issues were me getting
up for the phone or the bathroom.....

The other mask off flags were most likely bathroom breaks....  I count four of
them on the first page, which is correct.

I attached two additional shots, I hope this is what you want....

thanks for all your help......

Machine - Aircurve 10 V Auto


Attached Files Thumbnail(s)
       
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#7
RE: Clear airway questions
I think your machine is set wrongly a fixed pressure of 20 is not right. What were the settings of your previous machine, do you have a sleep study we can look at
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#8
RE: Clear airway questions
I have not had a sleep study in many years......  The pressure on my previous machine
was set at 18 by me many years ago.   This setting gave me some relief....  Because of
recent difficulties I changed it to 20.....

Any thoughts on how to proceed?

thanks for  your help.....
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#9
RE: Clear airway questions
If you have the VAuto like you list in your info sidebar, you may want to edit the running Mode of the machine to enable that automatic pressure. It's possibly a VAuto Mode. Here you would enter 2 pressures I'm thinking. I know you have events that show, and yes they will need to be addressed according to their cause. However I would suggest the mode change to greatly increase usage comfort ASAP. It will help you get used to a machine again by boosting mask on comfort.
    A recap on CA events:
  • They can be caused by SWJ sleep/wake junk during transitions in sleep position or literally sleep to wake and vice versa. This type is intermittent and based on breath holds while moving on bed and holding breath or similar. Most definitely you have some; most people do at times.
  • Treatment emergent CA occur when you start therapy and your body is reacting to lower CO2 levels due to it being washed out by the xPAP. Might be your status.
  • If we were to view a predominant CA count on a sleep study, they'd be considered pre-existing like mine. This means that despite xPAP therapy, you will have CA and need an ASV to treat. Very likely NOT you.

PS request the clinician manual from the top banner area CPAP Setup Manual. Look for your exact machine, which should be listed on the front and on an ID label on the bck/bottom of machine. Take the water tub out before flipping over (yeah OK an obvious thing but the reminder is there anyway).
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Clear airway questions - follow up
Hi Dave,

   Two follow up questions for you -

1.  Regarding to your thoughts on treatment related CA, I have been on CPAP therapy at pressure 18 for over
     eight years.   Would this still apply because I got a new machine?  Obviously I'm not just starting therapy...

2.  Do you see anything other than the CA that jumps out?  Upper airway issues (my tonsils have grown back) or
     burping?  would they cause arousals and do they show on the report?  I have been burping now for a couple of
     months and trying to determine if this is why I'm not doing well.....

3.  I am looking into changing the mode; but to let you know I am quite comfortable using the mask...   Now
     if you feel a mode change to lesser pressures will help me sleep better, then I will definitely try that....


Thanks again for all your help.....
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