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Having Clear Air Events in Clusters
#1
Having Clear Air Events in Clusters
I’m a new member hoping to find some information.  I used a CPAP for 2 months and was then prescribed a BIPAP - ResMed AirCurve 10S.  The pressure settings are IPAP 14 and EPAP 9.  I’m using a full face mask.  I’ve also installed the sleepyhead software and have been tracking my stats for the last 45 days.

I have a connective tissue disorder and require the higher pressure to keep my airway open and my obstructives down.  However, since using the CPAP and BIPAP, my AHI actually went up.  When I look at the sleepyhead data the obstructives are minimal, but the clear air events are usually between 60 and 90 each night.  When I drill down on the graphs, the clear air events do not look like classic “central” apneas, they look more like sleep/wake/junk.  But these are occurring in clusters, 5 to 7 in the span of a few minutes, and it’s during sleep not going to sleep or waking up.

These events and clusters are causing oxygen desaturation episodes so I’m trying to get to the bottom of this.  My doctor doesn’t seem to have any answers and wants to do more sleep studies. The previous sleep studies don’t seem to match the experience I have outside the lab.

Has anyone experienced nothing like this?  Does anyone have any insights or perspective?
Thanks so much......
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#2
RE: Having Clear Air Events in Clusters
Hello Sleepykiddo

Welcome to the forum. I do not have the wealth of knowledge that the gurus here have to make a opinion and they would be along soon. However in order for meaningful discussion, do publish your sleepyhead stats by posting onto imgur with a space in the link as you do not meet the qualifying 4 posts yet.

You may also be asked for your sleep test results to compare your development to.

The best to you.
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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#3
RE: Having Clear Air Events in Clusters
Thank you so much for the reply.  I’ve posted part of last night’s graphs to imgur.  How do I load it to this thread?  Thx.
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#4
RE: Having Clear Air Events in Clusters
See the link on imgur below. It explains how to copy the address and paste to your thread.
Download SleepyHead
Organize your Sleepyhead Charts
Posting Charts
Beginner's Guide to SleepyHead
Mask Primer
5
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#5
RE: Having Clear Air Events in Clusters
There is a link by the side that you copy (ctrl C) and paste(ctrl V) into a post here.
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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#6
RE: Having Clear Air Events in Clusters
As you have less than 4 posts you will need to break up the url with a space such as htt p://


Jason
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#7
RE: Having Clear Air Events in Clusters
(11-18-2017, 02:19 PM)SleepyKiddo Wrote: I’m a new member hoping to find some information.  I used a CPAP for 2 months and was then prescribed a BIPAP - ResMed AirCurve 10S.  The pressure settings are IPAP 14 and EPAP 9.  I’m using a full face mask.  I’ve also installed the sleepyhead software and have been tracking my stats for the last 45 days.

I have a connective tissue disorder and require the higher pressure to keep my airway open and my obstructives down.  However, since using the CPAP and BIPAP, my AHI actually went up.  When I look at the sleepyhead data the obstructives are minimal, but the clear air events are usually between 60 and 90 each night.  When I drill down on the graphs, the clear air events do not look like classic “central” apneas, they look more like sleep/wake/junk.  But these are occurring in clusters, 5 to 7 in the span of a few minutes, and it’s during sleep not going to sleep or waking up.

These events and clusters are causing oxygen desaturation episodes so I’m trying to get to the bottom of this.  My doctor doesn’t seem to have any answers and wants to do more sleep studies. The previous sleep studies don’t seem to match the experience I have outside the lab.

Has anyone experienced nothing like this?  Does anyone have any insights or perspective?
Thanks so much......

Sleepykiddo, a very common occurrence on bilevel therapy is to for a user to develop central apnea events.  The cause is the pressure support of 5 cm between your IPAP (14.0) and EPAP (9.0) pressures.  This pressure support is also what takes some of the effort out of breathing for you.  The answer to reduce events is to reduce pressure support.  Assuming your central events are under control at EPAP of 9.0, you should consider reducing the IPAP.  I would reduce the IPAP by 1-cm each night until the central events are acceptable. The onset of CPAP or BiPAP induced central apnea is called "complex apnea", and it's more common than you might think.

If this causes you to have such low pressure support that you don't experience the therapeutic benefits of bilevel, then there are two possible solutions that provide a backup breathing rate to overcome the centrals.  By far the better of those two options is the Resmed Aircurve 10 ASV.  The ASV provides a minimum pressure support, for example 5.0 cm, so you can have easier breathing normally, but it provides backup breaths that apply higher pressure support (up to 15 cm) when you have a central apnea or hypopnea.  So it's a very intelligent machine.  By comparison, your Aircurve VPAP S stays at 9 cm EPAP pressure until you initiate a breath, so it does nothing for central apnea.  The second alternative may be a bilevel ST (Spontaneous/Timed) machine.  This machine also provides a backup rate, but the pressure support is fixed.  Not nearly as smart or as good a solution. 

Anyway, my suggestion is that you inform your doctor the bilevel has caused a high number of central apnea events to appear.  You can ask permission, or take the initiative yourself to lower the pressure support by lowering IPAP pressure until those events are under control.  By alerting your doctor he will be made aware of the situation.  He may elect to wait and see if these events reduce on their own before making changes, or he may also suggest you try pressures at 13/9, 12/9, 11/9 before he finally throws in the towel and evaluates you for ASV.  

Best of luck!
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#8
RE: Having Clear Air Events in Clusters
Here are sleepyhead screenshots from last night, and are fairly representative of most nights.  First screenshot is the sleepyhead daily summary and the second screenshot is an expanded view of the graphs during one of the clusters of events during the night.

Daily summary:

ht  tp://i.imgur.com/qhxDSIol.png



Expanded view of events:

ht  tp://i.imgur.com/XWoOKbyl.png
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#9
RE: Having Clear Air Events in Clusters
(11-18-2017, 06:54 PM)SleepyKiddo Wrote: Here are sleepyhead screenshots from last night, and are fairly representative of most nights.  First screenshot is the sleepyhead daily summary and the second screenshot is an expanded view of the graphs during one of the clusters of events during the night.

Daily summary:

http://i.imgur.com/qhxDSIol.png



Expanded view of events:

http://i.imgur.com/XWoOKbyl.png

Something not quite right with the way you are posting your links to your data.
>^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^<
I am NOT a doctor.  I try to help, but do not take what I say as medical advice.

I am just a long term user of c.p.a.p. and therefore I have some experience in using these machines and equipment.

However, I am NOT an expert, so advice given should be taken as given in good faith only and NOT medical advice.

Every journey, however large or small starts with the first step.   Coffee
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#10
RE: Having Clear Air Events in Clusters
Links are fine for a new member, but it would help if they were in original size.  What we have is bilevel therapy at fixed pressures of 14/4 which is a pressure support of 10 cm.  In my opinion, this is an improperly setup machine.  If you have a sleep study or titration study I would really like to see it.  Meanwhile, if you want to sleep, please change pressure to 6.0 EPAP and 10.0 IPAP and call me in the morning.

[Image: qhxDSIol.png]

[Image: XWoOKbyl.png]
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