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Still tired - too many clear airway events
#1
Still tired - too many clear airway events
I have been using CPAP for about 8 months now and my results vary lately from about 1.5 AHI to 7 AHI per night.  (Some of the variance is due to leaks which I have moderate sucess controlling.)  I was close to giving up on CPAP a number of times, but I stuck with it and I am glad that I have.  I use the Airsense 10 machine and have settled on the Phillips Dreamwear full mask after trying 6 or 7 others.  I also use a neck collar to prevent my chin from dropping during sleep.

My frustration is that even if I control the leaks, I still have a large number of clear airway events every night.  My guess is that they are related to pressure settings or EPAP settings, which I am able to change on the Airsense 10, but I am at a loss as to what to change them to.  After all, I have achieved an AHI 1.5 with these settings, so my assumption is that I can't be that far from the ideal for me.

I appreciate the time that you are taking to read this and any advice that you give me.  I am including two Oscar screenshots from this week.

Thanks


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#2
RE: Still tired - too many clear airway events
Welcome to the forum!

You have come to the right place.


I don't have the skill to help you. However, there are experts here who will surely be of help.
DaveL
compliant for 35 years /// Still learning!



I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#3
RE: Still tired - too many clear airway events
I would move the EPR setting from 3 down to 2 and see if the helps. Repost after a night or two.
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
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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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#4
RE: Still tired - too many clear airway events
Several problems here.

Are you having problems falling asleep? Your flow rate curve looks very grassy hinting at this. See the flow rate chart at around 2am? This smoothness usually indicates normal restful sleep. Search the Wiki for Sleep Hygiene, most of us could use some help in this area.
Your flow limits are high with the 05% value at 0.17, we like to see less than 0.10. The flow limit chart chows clumps of flow limits which are increasing your pressure, I believe these are positional and based on your head tucking to your chest. You fully awakened after two of these clusters so they are significant. Tell us about your pillows, wedges, etc. And do you sleep on your back or side. Try 1 pillow vs 2, a flatter, less firm pillow in an attempt to minimize or eliminate these flow limits. The next step would be to use a cervical collar, see my signature for a link to a wiki on it.

Central Apneas. The first approach is always to lower EPR as Opal has suggested. Many of these a occuring at a pressure of around 11, when the flow limits increase pressure to about 13 you have few to none. Also most of your centrals are occuring during what looks like disturbed breathing the grassy breathing indicating they may be a result of you holding your breath while changing position, in other words they may be misclassified. This is not uncommon.

Bottom line is I feel the Positional aspect is your main problem and no amount of pressure will correct that.

Please post a couple 4 minute views of random central apnea events so we can better see what is going on
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#5
RE: Still tired - too many clear airway events
Thanks.  I'll give it a try.
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#6
RE: Still tired - too many clear airway events
I would start with these 2 questions:

1. Do you have your copy of the detailed PSG Diagnosic Sleep Study?

2. What did that study say about event type and count?

If you don't have this call the doctor and request it. You need it for yourself and to pay a redacted copy here. Dave's fishing for the Central Apnea type FWIW.
Dave

OSCAR
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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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#7
RE: Still tired - too many clear airway events
I didn't think I had a hard time falling asleep, but maybe.   My preference would be to sleep all night on my back, but neck pain prevents me from doing this, so I sleep on my sides.  

Per the advice, I will reduce the pillow thickness, wear the collar consistently, reduce EPR from 3 to 2 and post my detailed sleep study.

Thank you all very much.
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#8
RE: Still tired - too many clear airway events
Two screen shots from my sleep study.  At the time of the sleep study, I was suffering from Atrial Fibrulation, but I am not in Afib at this time.
Thanks.

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#9
RE: Still tired - too many clear airway events
Two screen shots from my sleep study.  At the time of the sleep study, I was suffering from Atrial Fibrulation, but I am not in Afib at this time.
Thanks.


Attached Files
.pdf   SleepStugyPage 2.pdf (Size: 585.22 KB / Downloads: 10)
.pdf   SleepStudyPage 1.pdf (Size: 489.98 KB / Downloads: 12)
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