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Still confused, and I feel terrible!
#1
Still confused, and I feel terrible!
Hi Guys,

I finally made the switch to a full-face mask. I had tried everything to keep my mouth closed at night (chin-strap, taping) and always managed to have leaks. With a well-fitting full-face mask I seem to have tamped down my leak rate, however; I now seem to be experiencing a lot of Clear Airway (CA) events. Are these central apneas? Do I need to reduce my pressure? Narrow the range? Run in straight CPAP mode? Reduce my EPR? Any advice would be greatly appreciated. I feel like absolute trash today. 

Best,

Justin


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#2
RE: Still confused, and I feel terrible!
Have you tried going without the EPR? Turn it off and see if that helps with the CA’s.
OpalRose
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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: Still confused, and I feel terrible!
They are central Apneas, most likely caused by the fact that your machine has improved the efficiency of your breathing.  This has likely resulted in an increased reduction of CO2 from your blood.  As good as that sounds, that actually depresses the drive to breathe and causes "Treatment-Emergent Central Apnea" 

Let's cut your EPR and that should decrease your Central Apneas.  

Set EPR = 1 and let's see what happens.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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#4
RE: Still confused, and I feel terrible!
Hi Everybody,

I dropped my baseline pressure to 7 and set my EPR to 1. I feel okay today, not great, but not terrible. What is my next move? Drop the baseline pressure again? Turn the EPR off? Once I am asleep, I do not wake up or feel disturbed by the machine. When I first put on the machine, I do feel like my breathing is unnatural, and I continually need to take massive, gaspy breaths to feel at ease. Am I a candidate for a bi-level device? If so, what is the best way to get my hands on one for a trial period? Thank you all for the advice! I appreciate you all so much. 

Best,

Justin


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#5
RE: Still confused, and I feel terrible!
Stay the same. The CA events are low enough now they are not a problem. We are starting to see some flow limitation creep in and some hypopnea, and your pressure went up for that. This has the appearance of good therapy and the CA will diminish from here if you give it time. We don't want to further reduce minimum pressure to where OA is an issue and turning off EPR will be less comfortable and allow more flow limitation or hypopnea. I'd give this some time to settle in before reacting with setting changes.
Sleeprider
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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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#6
RE: Still confused, and I feel terrible!
A small amount of CA's can be attributed to 'sleep-wake-junk'. The body isn't particularly graceful about handing off respiration when you change from a sleeping state to awake state. A normal sleep cycle lasts about 90 minutes(give or take), your first 3 CA's appear to me to be 'sleep-wake-junk'. Your tidal between 5 AM and 6:30 looks like you may be awake.
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#7
RE: Still confused, and I feel terrible!
Also, the duration counts.  Are these CAs in the 10+ second range?  If so, and they persist and happen in groups, they should be addressed.  If they are 'junk' CAs around the 10 second mark, or less, then I have learned not to give them much credence.

So, I would agree that staying the course for now is the wisest approach. Let's see where you settle down.  It isn't likely that two nights of data will be the final answer.
Serial Tapist
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#8
RE: Still confused, and I feel terrible!
Hi Guys,

All of the CA events are in excess of 10 seconds; the average duration is 16.23 seconds.


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#9
RE: Still confused, and I feel terrible!
with all the concern about referring to 'fake' ca's voiced here recently...

duration isn't the issue. events are flagged only if they are at least 10 seconds long so being 10 seconds long does not make them discountable. it goes without saying that the longer any event occurs, the more the potential damage. shorter pauses, less than 10 seconds, can be seriously disruptive too. so duration isn't useful in determining whether a ca can be ignored. the only determinant is whether we're awake or not. waking events can be ignored. while we may choose to ignore a few events because it's the best we can eke out of the machine, &/or we feel good, ignoring sleeping events of any duration isn't particularly prudent, especially if we're still not feeling well.
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#10
RE: Still confused, and I feel terrible!
I tend to agree; ignoring these events feels imprudent. My charts have been littered with CA events since I started APAP over a year ago. It feels like I have traded RERAs - at a rate of 18/hour - for less frequent central apneas with the same net result of being exhausted every day.
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