Thanks in advance
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[Symptoms] clear airway
05-24-2016, 08:45 AM
What are CLEAR AIRWAY EVENTS and how do I reduce them?
Thanks in advance
05-24-2016, 09:01 AM
Central Sleep Apnea - A period of at least 10 seconds without airflow, during which no respiratory effort is evident. Synonym for Clear Airway.
CA can occur as a result of excessive pressure support (IPAP/EPAP), that can cause a drop in CO2 levels. It may be possible to reduce CA by reducing pressure or pressure support. The need to reduce CA depends on how prevalent it is. Treatment of CA is generally by use of a bilevel ASV machine. This is a broad area that is widely discussed on the forums. You will need to provide more information, or do some research.
05-24-2016, 09:01 AM
WELCOME! to the forum.!
Hang in there for answers to your question and much success to you with your CPAP therapy.
05-24-2016, 12:30 PM
How do you know they need to be reduced? Your machine reports a CA index, what is it? And what are your OA (obstructive apnea) and H (hypopnea) indices? The sum of these three indices is the AHI.
Were you originally diagnosed with just obstructive sleep apnea, or did it also include central sleep apnea?
Do you know why you were prescribed the VPAP Auto instead of just a regular CPAP machine?
Which mode is your machine set to? It's either VAuto or CPAP? If it's VAuto there are three pressure seetings: Maximum IPAP, Minimum EPAP, and Pressure Support. We need to know all three numbers.
This may seem like too much information, but it's all needed.
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05-24-2016, 01:14 PM
last night readings| CA=6.06 OA=0.48 H=1.07
originally diag with obstructive apnea with some central apnea
not sure but understood that the CPAP did not work as well as BIPAP
(my Dr was not very cordial, even wrote in her report that I asked too
my machine is set on mode S-IPAP 13.4 EPAP 9.4 EASYBREATH ON TIMAX 2.0
TIMIN 0.3 RISETIME 300
hope this is the info you needed
Hey 67badger, the numbers are not too bad for someone early in their therapy. Let me explain your settings. You have an auto bilevel machine and are using it in a fixed pressure mode. The TiMAX of 2, TiMIN of 3 and rise time are defaults. You are using IPAP at 13.4 and EPAP at 9.4 which means you have a pressure support of 4.0 cm.
Your OA+H are pretty acceptable, but you have somewhat excessive CA. It's not enough to justify ASV, so we will not go there for now. The CA may go away without any changes or intervention, but I know it could be reduced with slightly modified settings. If I was setting it up, I'd recommend mode Vauto, IPAPmax 15, EPAPmin 8.4 and pressure support 3.0. This would start your therapy at 11.4/8.4 (IPAP/EPAP) and would allow it to go as high as 15.4/12.4. So the starting pressure is only 1-cm lower than your current prescription, but the Vauto mode will increase pressure as needed to respond to obstructive events. This lower pressure and pressure support should reduce CA events, but may slightly increase OA. If we find OA is unacceptable, the next step would be to increase EPAPmin by 0.6 to 9.0. If H is too high, we might go back to pressure support of 4.0. It will take some time, and trial and error to fine-tune.
This is nearly the same as your prescription, but lowers pressure and allows the machine's auto algorithm to respond to OA and will reduce the stimulation from pressure support that is the likely cause of CA. Feel free to run that idea by your doctor, or just try it out. You can always go back.
05-24-2016, 04:52 PM
SleepyHead will allow you to see how long these clear airway (central) events last. Knowing that they're of short duration is helpful information.
Note to Sleeprider: I was not aware that the S9 VPAP Auto could be set in fixed bi-level pressure mode. I would think that to accomplish that the OP would have to set the PS at 4.0 given his current IPAP and EPAP settings. Lowering the pressure, not just the pressure support, might lower the CA index.
Apnea Board Moderator
05-24-2016, 05:11 PM
Welcome to the Forum. Sleepster and Sleeprider have some pretty good advice for you. Many of us have had to deal with uncooperative sleep Docs. Continue to educate yourself and install the Sleepyhead software. It is very likely that some minor adjustments to your pressures will reduce those CAs. In any event this is the place to ask questions.
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
05-24-2016, 05:34 PM
The S9 VPAP Auto has 3 modes: CPAP, S mode, and Auto.
The rise time setting of 300 msec indicates that you are not using Easy Breathe which in S mode is selectable. In Auto mode Easy Breathe is automatically invoked. I like the feature a lot. It makes the EPAP-IPAP transitions very comfortable.
05-24-2016, 07:45 PM
What determines need to consider ASV?
Percentage CA or number of CA per night.
I took an Echo Cardiogram in preparation of upcoming titration for ASV. Want to make sure I am moving in right direction.
Last night readings:
AHIApnea Hypopnea Index 11.38
ResMed AirSense 10
PAP Mode: APAP
Min 8.2 Max 13.4 (cmH2O)
Clear Airway 7.36
Unclassified Apnea 0.09
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