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High "Clear Airway" events
#1
Hello,

I have a Philips Respironics System One 550P RemStar Auto with A-Flex. I have a full face mask. Do I have central sleep apnea, too? Here are my stats in sleepyhead last night:

AHI 14.88
Hypopnea 2.23
Obstructive Apnea 0.70
Clear Airway Apnea 11.95
Resp. Effort Related Arousal 0.70
Flow Limitation 0.00
Vibratory Snore 0.35
PB/CSRPeriodic Breathing 4.49%

Statistics
Channel Min Med 95% Max
PressurePressure (cmH20)
W-Avg: 9.71 9.50 9.80 11.00 11.50
Minute Vent.Minute Ventilation (L/min)
W-Avg: 9.33 0.12 8.62 19.50 36.91
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 16.22 6.89 16.60 21.00 24.80
Total LeaksTotal Leak Rate (L/min)
W-Avg: 29.77 0.00 29.00 32.71 34.00
SnoreSnore (unknown)
W-Avg: 0.18 0.00 0.00 1.00 3.00
Insp TimeInspiratory Time (seconds)
W-Avg: 2.47 0.32 2.20 4.06 6.50
Exp TimeExpiratory Time (seconds)
W-Avg: 1.34 0.06 1.20 2.20 2.66
Tidal VolumeTidal Volume (ml)
W-Avg: 576.02 13.33 500.00 1200.00 2280.00

Machine Settings
Pr. ReliefPressure Relief A-Flex x2
HumidifierHumidifier Setting x5

Session Information
SessionID On Date Start End
CPAP Sessions
00000370PRS1 CPAP 1h, 50m, 23s 9/11/2012 02:09 03:59
00000371PRS1 CPAP 0h, 44m, 58s 9/11/2012 04:05 04:50
00000372PRS1 CPAP 2h, 53m, 20s 9/11/2012 04:53 07:46
00000373PRS1 CPAP 3h, 3m, 20s 9/11/2012 07:47 10:50

Pressure setting is auto; 9.5min and 15 max.

I was able to get my obstructive down, but now my clear airway keeps going up. Many people say don't worry so much about it, but when it is lower, along with hypopnea and obstructive being lower, I feel much better. Any suggestions? If I lower the pressure, my obstrutives go up.

I attached a pdf with more details.
.pdf   zzzzk01.pdf (Size: 171.65 KB / Downloads: 217)

Thank you.

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#2
Hi zzzzk, First, WELCOME! to the forum.! I don't know the answer to your question but hang in there and someone will have suggestions to help you.
trish6hundred
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#3
Does your sleep study reports mention anything about central apnea?
Whats makes you waking up? The machine don,t know if you were awake or asleep so we cannot tell for sure
I wouldn't worry if its only one night but if its a typical night than you need to show those charts to your doctor

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#4
(09-12-2012, 12:16 AM)zonk Wrote: Does your sleep study reports mention anything about central apnea?
Whats makes you waking up? The machine don,t know if you were awake or asleep so we cannot tell for sure
I wouldn't worry if its only one night but if its a typical night than you need to show those charts to your doctor

Hi zonk, the stats are basically the same over 2 months. Only 2 good nights, no idea why. I don't have insurance right now. The latest sleep study I had was about 8 years ago. Did they know about central, then? I don't remember them saying anything about central, then. Also, I don't know what is waking me up. Obstructions, back pain, not sure, both?

Thank you.
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#5
Hi zzzzk

I have no special knowledge and can only speak from my experience but I have found a bit of a connection between the A-Flex / C-Flex / EPR and the reports of CA's. For me I notice that the CA's are more when I have A-Flex turned on - although not as high as your's.

I turned mine off.

Your mileage may vary
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#6
In your profile you list your CPAP pressure at 8, yet you have your APAP set at 9.5 to 15?

CPAP-induced CSA is a known effect. The usual cure is to lower the pressure and hope it doesn't raise the hypopnea or OA indices. Try setting the APAP range to 9.5 - 12 and see what happens to the three indices. You may need to lower it even further.

Have you discussed this with your doctor or DME?
Sleepster
Apnea Board Moderator
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
When the events happen, look to see what the pressure was at those times.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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
(09-12-2012, 06:14 AM)Moriarty Wrote: Hi zzzzk

I have no special knowledge and can only speak from my experience but I have found a bit of a connection between the A-Flex / C-Flex / EPR and the reports of CA's. For me I notice that the CA's are more when I have A-Flex turned on - although not as high as your's.

I turned mine off.

Your mileage may vary

Thank you Moriarty, I'll look into that...
(09-12-2012, 08:14 AM)Sleepster Wrote: In your profile you list your CPAP pressure at 8, yet you have your APAP set at 9.5 to 15?

CPAP-induced CSA is a known effect. The usual cure is to lower the pressure and hope it doesn't raise the hypopnea or OA indices. Try setting the APAP range to 9.5 - 12 and see what happens to the three indices. You may need to lower it even further.

Have you discussed this with your doctor or DME?

Hi Sleepster,

I am testing, that is why it's different in my profile. I can't lower it more because my OA's go up. Or maybe a few more OA's is better if it drops my CA's more?
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#9
(09-12-2012, 11:13 AM)PaulaO2 Wrote: When the events happen, look to see what the pressure was at those times.

OK, thank you. Have you heard if taking naproxin or antihistimines can raise CA's?
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#10
Zzz,

Welcome!

Modern xPAP machines try to differentiate between Central and Obstructive events, but they can only guess. There are various methods, like Resmed's Forced Oscillation Technique (FOT). If you have an apnea event, the machine pulses the pressure. If the flow reacts in one way, it shows the throat is closed and you're having an obstructive event (obstructed airway). If the flow reacts in a different way, it shows that the throat is open and you're having a central event (clear aiway). It's just the best the machines can do. It's not 100% accurate. To really tell if you're having a central event, you've got to be hooked up to wires that monitor your brain, a chest ring to tell if you're actually trying to breath, etc. This is the fully instrumented sleep study.

Now an event is an event. Regardless if the machine is correct that it is OSA or CSA, they are very accurate in saying you've quite breathing for 10 seconds (or more). Your AHI is higher than optimal target (<5), so don't ignore this.

Many people have reported a correlation between higher pressures and machine reports of increased CSAs. I wouldn't ignore it, but I wouldn't take it as "fact."

You said you are currently without insurance, so you're in a tough spot. You've got Sleepyhead figured out. Read the forum Widi article on changing your pressures. If at that point you are comfortable, follow the guidelines and monitor the results. Never take one night as results, you should allow 7-14 days with each change to really see how the change is affecting you. Pay attention to both the high and low APAP pressures. Look at your 95% pressure and, general rule of thumb, about 2 cmH2O above that and about 4 cmH2O below that should get you in the right area. If you're bouncing against the high limit frequently, you may need to push it up. Just keep working at it.

All that said, if and when you can get to a doctor, take the graphs and information you've shown us. We're not professionals, just trying to help.

Sleep-well
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