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[Symptoms] high ahi, mostly clear airway
#1
high ahi, mostly clear airway
hey there ! 

ive had my cpap for over a year - diagnosed with very mild apnea, but having the machine helped. 

lately ive been experiencing higher ahi counts - 6, 7, 8, usually. 

i self set my pressure levels ( because my doctor was extremely hard to see and was not helpful ). the pressure ive been using is 7-14, which i tested out my own a while ago and seemed to be working well. 

3/4 of the ahi events ive been experiencing were clear airway - is my pressure too high ? 

im new to the boards and unsure how to send any data with oscar - ill just screenshot last night, but if more info is needed let me know and i can figure out how to send more !


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#2
RE: high ahi, mostly clear airway
Welcome!  Your Oscar chart came through just fine.  Next time, could you squeeze the following graphs into the screen shot:

Events
Flow rate
Pressure
Leaks
Snores
Flow limitations.

You can grab the horizontal gray bars separating the graphs and push them up to fit everything in.

A few questions:

Try zooming in on the CAs, down to about a 5-minute level.  Do you see arousals before the CAs?  Arousal breathing often has higher and lower flow-rate traces and is often more irregular than asleep breathing.  (I've attached an example.)

Has anything changed recently that might affect your AHI?  Different bedding, bedtimes, medications, evening eating/drinking?

Do your obstructive apneas tend to come in clusters?

Do you sleep on your back, sides, or stomach?


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#3
RE: high ahi, mostly clear airway
While I am not an expert, my situation was initially very similar to yours. Given that every case is different, my case is that (after experimenting for several months) going to a low pressure and narrow range (7-7- with EPR=3) really helped with the centrals. May be worth a thought. Is there a reason your pressures are so high?
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#4
RE: high ahi, mostly clear airway
hi there ! sorry for the delayed response been swamped - 

yes i can attach the info you asked for ! its from that same night - 



answering your questions : 

i zoomed in on the CAs and i do see the arousals before the CA ! what does that mean ? 

gosh my healths often a rollercoaster - i got an endoscopy recently and confirmed i have GERD as well as esophagitis. this isnt new to me, i feel like its been happening the entire time ive been on cpap. so ive been taking omeprazole, and generally actually ive been being good about eating earlier and doing all the things for GERD aka elevated head, eating small etc. lately ive actually been feeling pretty good, but i wonder if i could feel better and my ahis seem like theres a lot of room for improvement. 

another important fact i forgot to mention is i live at elevation - 7200 feet. i didnt have this much fatigue when i lived at sea level. so that certainly could be a factor. 

my obstructive apneas definitely do come in clusters towards the end of my sleep before i wake but if they are in the middle or beginning of the night they tend to be more isolated. 

i sleep pretty exclusively on my sides ! never my stomach, and pretty  rarely my back.

hey thanks for responding just got around to replying back - 

hmmmm so you maintain constant pressure at 7 ? 

i wasnt under the impression my pressures were that high - originally my doctor put me on 4-20 just to see how it goes  i guess ? but that was not working well for me, and i narrowed that range down based on where the pressures were consistently staying during the night - that was from around 7-13 or 14. 

do you have thoughts on whether i should switch that up ? and experiment with less of a range and perhaps lower pressure ?


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#5
RE: high ahi, mostly clear airway
The left sidebar is very important for evaluation, otherwise I'll have to spend an hour or so calculating the various stats. They do look actionable
Your CA looks high Your EPR is off, I don't know if that is good or bad. and your flow limits are high and driving your pressure. I'm sure altitude is not helping.
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#6
RE: high ahi, mostly clear airway
If you see arousals before most of the CAs, could you let us know?

The arousals themselves are problematic. Having some is perfectly normal, but having a lot can mess with your sleep "architecture" -- your cyclical progression through all the stages of sleep that you need to feel and be well.

Arousal breathing can wash out some CO2. Your brain needs to detect a certain level of CO2 to trigger its "breathe now" response. If there's not enough CO2, you won't inhale until enough CO2 can pile up. If that takes 10 seconds or more, you get a CA flag.

Breathing at high altitude can be deeper and more rapid than breathing at lower altitudes because there is less oxygen in the air at higher altitudes. This deeper and more rapid breathing can wash out CO2, leading to central apnea. This can occur in a repeating pattern. I hope someone else can chime in on the question whether by now you are probably acclimated to high altitude for the most part.

How much CO2 is enough? This depends on your "apneic threshold." Using PAP can raise that threshold a bit, though the body will often adjust with time.
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#7
RE: high ahi, mostly clear airway
Flow limits are relatively high and OA events are clustered. We see a lot of pressure fluctuation and that may contribute to CA events. I really think you need to look at what might promote chin-tucking and try to deal with excess pillow height or body position. This section of the Optimizing Therapy wiki is important for you to read to understand flow limitations that lead to hypopnea, or positional apnea that causes the clusters of apnea http://www.apneaboard.com/wiki/index.php...ng_Therapy

I'm pretty certain your solution is going to include some EPR as well as positional awareness.
Sleeprider
Apnea Board Moderator
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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#8
RE: high ahi, mostly clear airway
here is the sidebar ! 

yes, the epr has been off. is there any reason i would see a benefit to turning it on ? i mean numbers wise - ive only heard people talking about it for comfort. 

let it be known that i also should probably reevaluate my pressures in general - i decided them on my own when my doctor was no help. all that to say, my pressure levels right now werent clinical choices by a doctor but numbers i determined. im obviously not an expert so they could be very wrong, i mostly just used trial and error.

i do see arousals before most of the CAs. 

mmm i see what youre saying about arousals being probelmatic. what causes arousals ? 

ive been living here for 2 years now, so i think its safe to say ive acclimated.


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#9
RE: high ahi, mostly clear airway
why do you say EPR ? 

what kind of positional therapy could i do ? id rather not wear a cervical collar, but is that the only way ?
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#10
RE: high ahi, mostly clear airway
EPR is the same as bilevel pressure support. As inspiration begins, additional pressure comes in behind your spontaneous effort and offsets flow limitation with a mechanical assist. Flow limitation is simply a resistance in the airway to a peak flow rate, and it varies individually. This is seen in the flow rate chart as a flattening of the peak flow. With pressure support or EPR, that limitation, if any, is generally at a higher flow rate than without pressure support. This reduces arousals from respiratory effort and has a direct effect on obstructive hypopnea. If pressure support is triggered by spontaneous effort, it can help to stimulate more spontaneous effort in individuals that have very low effort CA. This is why the Vauto bilevel is so valuable in having an adjustment for trigger sensitivity.

Your episodes of obstructive clusters are few and far between, so I would not suggest a collar. My suggestion was to be aware that the pattern exists, and to look for what may contribute to that. I find my airway can stay clear by just pulling a corner of my down pillow between my shoulder and jaw, especially on side-sleeping. The answer is simply to be aware and make any adjustments that make sense, increase comfort and help avoid chin-tucking.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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