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How To Adjust Pressure For Clear Airway Apneas
#1
How To Adjust Pressure For Clear Airway Apneas
I am 78M who has been diagnosed with mild-to-moderate sleep apnea and has been wearing a mask for five months.  Within the first month, most of my OSA apneas were gone, but CA apneas have come to dominate my events.  I’m used to sleeping with the mask now (Air Fit F30I, Air Sense 11 Auto set) and sleep well the 1H of the night, but less so during the 2H with frequent, very poor sleeping during the last two hours.  At the suggestion of my sleep doctor, I reduced my time in bed from 8.25 to 7.25 hrs. to lesson my bad sleep time.  I get clusters of CA apneas, often in the last two hours of my sleep time.  I use Flonase and, in the middle of the night, a saline solution to eliminate congestion.  I also tape my mouth to eliminate mouth breathing.  Someone on the Reddit Sleep Apnea forum suggested that a pressure change might eliminate these CA apneas.  I am hoping to get advice here (get me started).  This is my first time on this forum.  Thanks in advance.


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#2
RE: How To Adjust Pressure For Clear Airway Apneas
The cluster of CA's could be from movement, turning over, and simply holding your breath. There's not that many to worry over unless you see an increase.

What I do see is that you have some Flow Limitations which cause the pressure to rise. You may be waking up when the pressure rises.

What I would try is to lower the maximin pressure. Move it down to 10cm.
Keep EPR set at 3 for now because you need EPR to help with FL. Try that for a day or two and see how it goes.

If the CA's were to increase, then we can take another look and lower the EPR a bit.
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
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Soft Cervical Collar
Optimizing therapy
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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: How To Adjust Pressure For Clear Airway Apneas
Thanks for the prompt response.  Will adjust max pressure to 10 tonight.
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#4
RE: How To Adjust Pressure For Clear Airway Apneas
First the CA clusters. Almost always, when one sees a cluster like that, at the beginning of a sleep session, and not sustained, its cause is sleep onset and sometimes even wide awake breathing. And given how few there are, I wouldn't even concern myself over them.

Although you mentioned they occur in the last few hours, check to see if they are occuring at the beginning of a break in sleep. You also might want to zoom in, if the breathing pattern before during and after are uneven and volatile you may still be awake. If the breathing pattern before and during, is erratic then it may be sleep onset.

I disagree with the advice about capping your maximum pressure.

You're awakenings are not following a pressure increase, and often well after an increase and during a decrease.

Yes the pressure is increasing because of flow limitations, but the solution is not to cap the max pressure. Lowering the maximum may sustain them more and allow them to develop into full fledge obstructive events.

Your graphs, with the volatile pressure swings and somewhat active (but not horrible) flow limitations, suggests your minimum is too low.

I would:
  • Increase the minimum pressure, say 8 and then re-evaluate after a few days
  • leave the maximum at 11, or perhaps increase it by 1 to 12, to stop the flat lining at the top. 
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#5
RE: How To Adjust Pressure For Clear Airway Apneas
The night I posted wasn't the best case:  I was anxious to get an example on the forum and get some advice.  Last night I had an AHI of 2.24, which is high for me (majority are under 1.0), which consisted of CA = 16 and H = 3.  The CA's started at 3:15 and became heavier after 4:30, which corresponds with my "bad" sleep period.  I think I will up the minimum pressure to 8 and see what happens.  A second change would be to increase the max. to 12, but I will wait to see effects of min. change first.  Thanks for your help.
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#6
RE: How To Adjust Pressure For Clear Airway Apneas
ICE MAN,
I would like to see a couple more charts.  Just to be clear, my advice was not given based on the cluster of CA's shown, but based on the Flow Limitations.  

Look at your 95% FL reading of 0.12, we like to see that below .10.

I'm not too concerned over one clump of CA's.  If this isn't typical, and you have other charts showing CA's more often during the night or other apnea's, please post those charts, so that more accurate advice is given. You can zoom in a little in the clusters of CA's and see if they lean toward Obstructive.

Line up the flow limitation graph with the pressure increases.  You don't need pressure swings during the night disrupting sleep.

I will suggest, however not to make more than one change at a time, as you won't know what's working.
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
OSCAR Chart Organization
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines




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
RE: How To Adjust Pressure For Clear Airway Apneas
It would be helpful to see that worst case CA chart and then others that are more typical. Even so it doesn't sound like the CA are bad enough to make adjustments.
Dave

OSCAR
Standard OSCAR Chart Order
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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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#8
RE: How To Adjust Pressure For Clear Airway Apneas
Here is my chart for last night (3/22/22), which I referenced in my last post.  Should have posted with the text.  I knew to this!


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#9
RE: How To Adjust Pressure For Clear Airway Apneas
Despite the CA being flagged, which I still think are of secondary concern to better sleep in your case. It appears there's a Ramp that's active which is robbing therapy time, 5 sessions during that night didn't help. These last 2 are more important to address than that cluster of CA.
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: How To Adjust Pressure For Clear Airway Apneas
I don't think ramp is on.

In both graphs you see pressure increases and Flow Limits flagged within minutes of a session start. It's possible he's in auto-ramp, but the flowrate doesn't look like it combined with the almost instantaneous flagging of FLs, isn't consistent with Auto-ramp stopping because of sleep onset or events.
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