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What is "Clear Airway" it's not in the sleep disorder glossery
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Tiercel Offline

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Posts: 16
Joined: Jun 2016

Machine: Resmed Airsense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Resmed AirFit 10 nasal pillows
Humidifier: Integrated w/ ClimateLine hose
CPAP Pressure: 6 -12 auto
CPAP Software: SleepyHead

Other Comments: Setup w/ CPAP 17 June 2016 - w/ 40 events per hour on home sleep study

Sex: Male
Location: Pennsylvania

Post: #1
What is "Clear Airway" it's not in the sleep disorder glossery
In trying to understand my stats and get the most out of this long resisted solution I downloaded SleepyHead.

There is far more that I don't understand than that I do understand. One of the most confusing is that it lists clear airway like it is an "event". Does it mean all is well, or is it some classification of an AHI?

Here are a few stats from last night. I am still having 8 - 10 events per hour which is better than 40 during the home sleep study
Thanks!

Large Leak 29.91%
Clear Airway 8.81
Obstructive 0.84
Unclassified Apnea 0.42
Hypopnea 0.21
RERA 0.42
(This post was last modified: 06-22-2016 07:16 AM by Tiercel.)
06-22-2016 07:12 AM
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Crimson Nape Offline

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Posts: 1,327
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Machine: ResMed S9 Autoset
Mask Type: Other
Mask Make & Model: P-10 / F&P Simplus / DreamWear
Humidifier: H5i w/Climateline
CPAP Pressure: 8 - EPR 3
CPAP Software: SleepyHead

Other Comments: CMS-50F & 50IW

Sex: Male
Location: Georgia

Post: #2
RE: What is "Clear Airway" it's not in the sleep disorder glossery
Clear Airway is when your brain forgets to tell your body to breathe. Causes for a CA can range from recording data while you're still awake or while you're waking up, the body not being accustomed to the higher inhale pressure or using the EPR that can washout your CO2 levels. . . on up to more complex reasons.

I have included links that provide more information about apneas and the reporting of events.

Sleepyhead Beginner's Guide:
http://www.apneaboard.com/forums/Thread-...s-Answers-
Discussion?pid=73182#pid73182

Wiki (link at the top of the page):
http://www.apneaboard.com/wiki/index.php?title=Wiki_Home

I hope you will find these useful.

Statistics prove that people who have more birthdays live longer.
06-22-2016 08:05 AM
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Tiercel Offline

Members

Posts: 16
Joined: Jun 2016

Machine: Resmed Airsense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Resmed AirFit 10 nasal pillows
Humidifier: Integrated w/ ClimateLine hose
CPAP Pressure: 6 -12 auto
CPAP Software: SleepyHead

Other Comments: Setup w/ CPAP 17 June 2016 - w/ 40 events per hour on home sleep study

Sex: Male
Location: Pennsylvania

Post: #3
RE: What is "Clear Airway" it's not in the sleep disorder glossery
I just did some digging to see if I can answer my own question and it "seems" that Clear Airway (CA) means I am not breathing but the AirSens 10 Auto is somehow able to sense that my airway is open. It also seems that since during my 5 nights the CA events were from about 45% to 80% of my events that I might have some Central apnea going on.

Hmmm,.... You know, it is strange. on several occasions even when getting sleepy watching TV with the CPAP on I noticed it was almost like I would forget to breathe WHEN I WAS STILL AWAKE ! I would breathe and wonder why I did that an how it was affecting my stats

Weird ????
(This post was last modified: 06-22-2016 08:16 AM by Tiercel.)
06-22-2016 08:11 AM
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Sleeprider Online
Wiki Editor
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Posts: 3,342
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #4
RE: What is "Clear Airway" it's not in the sleep disorder glossery
CA events are about all I have...in moderation. Any 10-second cessation of breathing can be scored, so while some may indeed be central apnea, they can also be just changing position in bed, swallowing and other junk that is meaningless. For most of us being treated for obstructive sleep apnea they are benign and may not even be disruptive to sleep. Many times CA is scored at the beginning and end of the sleep session when we're not really sleeping, and we will often refer to this as "sleep-wake-junk" (SWJ).

To know the difference between benign incidental CA and the type that is disruptive, you need to look at duration, and zoom in on the respiratory flow chart. If you see a flat line of breathing followed by a good spike of recovery breathing, then it's more likely that was a real central that you needed to arouse from sleep to resolve. CA in low numbers is really not a problem, but when it becomes clustered in the middle of the night it might be complex apnea that is the real deal.

We see a lot more CA in new users, people adapting to higher pressure, and the use of EPR or pressure support that can wash-out CO2 and cause centrals. There is a lot to learn to try to decide if it's something to actually try to minimize, or ignore. For the most part CA under 3.0 per hour is probably fine. Over that, it might be worth looking into why it is happening and try to minimize it. For new users, it's important to realize, it often goes away in a few weeks without intervention.

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06-22-2016 08:29 AM
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richb Online

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Posts: 528
Joined: Jun 2015

Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: Built in
CPAP Pressure: Epap 6 Ipap 8 Auto ASV
CPAP Software: ResScan SleepyHead

Other Comments: Idiopathic Central Apnea

Sex: Male
Location: Vermont

Post: #5
RE: What is "Clear Airway" it's not in the sleep disorder glossery
(06-22-2016 08:11 AM)Tiercel Wrote:  I just did some digging to see if I can answer my own question and it "seems" that Clear Airway (CA) means I am not breathing but the AirSens 10 Auto is somehow able to sense that my airway is open. It also seems that since during my 5 nights the CA events were from about 45% to 80% of my events that I might have some Central apnea going on.

Hmmm,.... You know, it is strange. on several occasions even when getting sleepy watching TV with the CPAP on I noticed it was almost like I would forget to breathe WHEN I WAS STILL AWAKE ! I would breathe and wonder why I did that an how it was affecting my stats

Weird ????

Hi tiercel,
What you are experiencing is fairly typical of "sleep wake junk". Your body is in a transition stage between being awake and sleep. It is a time when your autonomic nervous system is taking over breathing for you. You can look at your stats and graphs using the Sleepyhead Software to get a better picture of when the CA events are happening and what you can do about them. If most of your events are during transition periods between sleep and wakefulness you can disregard that data as "sleep wake junk". If the CAs are spread out through the night it is more likely that you might need some minor adjustments in pressure support. Specifically you may need to narrow the gap between Inhale IPAP and Exhale EPAP pressures. This kind of adjustment reduces the washout of CO2 from your blood. It is this "washout" which fools your body into thinking you have done enough breathing and that you can take a little break. Your numbers are close to being satisfactory. Therefore, small adjustments may be all that you need. Feel free to post a screenshot of your Sleepyhead charts to get more feedback.

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-22-2016 08:33 AM
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Sn00zeAlarm Offline

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Machine: Resmed A10 autoset
Mask Type: Nasal pillows
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CPAP Software: SleepyHead

Other Comments: Heated hose

Sex: Male
Location: Florida US

Post: #6
RE: What is "Clear Airway" it's not in the sleep disorder glossery
My sleep test had very few Centrals and since starting CPAP I have noticed getting these CA events. Excluding the SWJ, I still sometimes get a cluster of them in the middle of the night. So I suspect it is this washout effect. Would decreasing EPR to 1 be enough to show an improvement if that is it? EPR is currently 3 but as my CPAP is fixed at 6 and the machine will not go below 4, the EPR is effectively 2.
06-22-2016 06:44 PM
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Tiercel Offline

Members

Posts: 16
Joined: Jun 2016

Machine: Resmed Airsense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Resmed AirFit 10 nasal pillows
Humidifier: Integrated w/ ClimateLine hose
CPAP Pressure: 6 -12 auto
CPAP Software: SleepyHead

Other Comments: Setup w/ CPAP 17 June 2016 - w/ 40 events per hour on home sleep study

Sex: Male
Location: Pennsylvania

Post: #7
RE: What is "Clear Airway" it's not in the sleep disorder glossery
I think this is a link to a screenshot of some of my CA events on DropBox

https://dl.dropboxusercontent.com/u/8041....42.42.png

Am I correct that the number in parenthesis after an event indicates the number of seconds of the duration?

Thanks for all the great input.
(This post was last modified: 06-22-2016 07:54 PM by Tiercel.)
06-22-2016 07:47 PM
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richb Online

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Posts: 528
Joined: Jun 2015

Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: Built in
CPAP Pressure: Epap 6 Ipap 8 Auto ASV
CPAP Software: ResScan SleepyHead

Other Comments: Idiopathic Central Apnea

Sex: Male
Location: Vermont

Post: #8
RE: What is "Clear Airway" it's not in the sleep disorder glossery
(06-22-2016 07:47 PM)Tiercel Wrote:  I think this is a link to a screenshot of some of my CA events on DropBox

https://dl.dropboxusercontent.com/u/8041....42.42.png

Am I correct that the number in parenthesis after an event indicates the number of seconds of the duration?

Thanks for all the great input.

Hi Tiercel.

Your leak rate is probably the first thing to correct. Your mask, as do all the others, normally vents a fixed amount of air so that you get a proper mixture of inhaled gasses. Large leaks get rid of some of the CO2 that you would normally re-breathe. Try adjusting your nasal pillows for a better fit and then consider a nasal mask if that doesn't work. Once your leak situation is under control we can re-evaluate.

Rich

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-22-2016 08:23 PM
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richb Online

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Posts: 528
Joined: Jun 2015

Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: Built in
CPAP Pressure: Epap 6 Ipap 8 Auto ASV
CPAP Software: ResScan SleepyHead

Other Comments: Idiopathic Central Apnea

Sex: Male
Location: Vermont

Post: #9
RE: What is "Clear Airway" it's not in the sleep disorder glossery
(06-22-2016 06:44 PM)Sn00zeAlarm Wrote:  My sleep test had very few Centrals and since starting CPAP I have noticed getting these CA events. Excluding the SWJ, I still sometimes get a cluster of them in the middle of the night. So I suspect it is this washout effect. Would decreasing EPR to 1 be enough to show an improvement if that is it? EPR is currently 3 but as my CPAP is fixed at 6 and the machine will not go below 4, the EPR is effectively 2.

Hi Sn00ze Alarm,

Look at my reply to Tiercel. I was looking at data from Sleepyhead and saw that he had a considerable amount of time spent with large leaks. It would help if you posted some more data in a new thread. You will get a lot more people looking at your issues that way. You may also have other issues that could be addresses that way.

Rich

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-22-2016 08:29 PM
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