[CPAP] 1st time APAP user. Lots of Clear Airway events? Anyway to improve without ASV?

[SarcasticDave94]

I'm seeing a higher CA and Mixed Apnea count than Obstructive Apnea on the sleep study info. If I recall correctly, somewhere it said the sleep study was a short duration. If so, that might be why event counts are somewhat low. I think I saw where it said CA events were 6 to an OA count of 1.

If true, this still can indicate to me an ASV is the best choice. It is going to take lots of complaining to get the ASV no matter what.

[wwsleep]

last couple of nights (ahi 5.48 and 6.08).  Still lots of CAs.  Not getting up in the middle of the night, so that's great.

But, I had set up a camera overnight, and when I checked out some of the clusters of CAs, they were mainly when I'm on my back!

(I'm actually surprised I sleep on my back, I never can if I try).

Is that a thing?  OAs I'd understand.  

I think I'll try pinning a tennis ball in a sock on my back to prevent rollovers.  Or are there better tricks to avoid back sleeping?

[Gideon]

I would like to see a couple of CA events on a 2-minute zoom to see what they look like. Want to see if they look like they are CO2 induced.
Then I would like you to turn off EPR and see what happens. This is to attempt to reduce the centrals.

[SarcasticDave94]

I agree with bonjour. It'd be good to look at zoomed in sections of the flow rate.

[Sleeprider]

Bonjour is on the right track, and I think implementing EPR off will help. I'm also thinking using a single fixed pressure of 9.0 might further reduce events.

[wwsleep]

Here's a whole screen and a two minute zoom of a few of the CAs.  Let me know if more are needed.

I'll try turning off the EPR tonight.

thanks!

   

   

[Sleeprider]

I may have missed it but do you have a sleep study that can help us see if the centrals were present before treatment?

Edit; i see you posted some results but they are not useful in the format you posted.

Apnea Index: 3.50 Total Apneas: 13 Respiration: ? Hypopnea Index: 6.73 Hypopneas: 25 TST with pCO2>/=50 0.0 Apneas+Hypopneas:38.0 Sleep Mean O2 Sat REM: 97.0 AHI: 10.22 AHI in REM: 13.17 Sleep Mean O2 Sat NREM: 94.0 AHI supine: 15.65 AHI in REM supine:0.0 AHI lateral: 9.93 AHI in REM lateral:13.2 AHI Prone: 0.0 AHI in REM prone:0.0 RERA Index: 0.0 Baseline Heart Rate awake: 65 RDI: X ECG Sleep Average: 60 Min: 57 Max: 71 Bradycardia: NO Asystole: NO Number of Arousals: 65.0 Sinus tachycardia during sleep: NO Arousal Index: 17.5 Narrow complex tachycardia: NO Spontaneous Arousal Index: 5.7 Wide Complex Tachycardia: NO PLMS Arousal Index: 0.3 Atrial Fibrillation: NO Respiratory Disturbance Index (A+H+RERA) 10.2 Other arrhythmia: NO PLMS: 45 PLMS with arousals: 1 Periodic Limb Movement Index: 12.1 Lowest SaO2 51-60% 61-70% 71-80% 81-90% 91-100% 90.0% 00 minutes 00 minutes 00 minutes 00 minutes 236 minutes Pressure IPAP/EPAP 00 05 06 07 08 09 10 11 O2 Vol 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Time TRT 194.5m 38.0m 30.5m 27.0m 36.5m 53.5m 9.5m 41.5m TST 134.5m 32.5m 30.5m 25.5m 33.5m 52.0m 9.5m 39.5mSleep Stage % Wake 22.7 14.5 0.0 5.6 8.2 2.8 0.0 4.8 % REM 0.0 14.5 100.0 55.6 0.0 55.1 0.0 3.6

Maybe if you can post this as an image we can make some sense of whether centrals are a component of sleep architecture before therapy or if they are likely therapy onset. The text copy doesn't cut it. This has to be tabular. Do a screen shot.

[wwsleep]

Maybe if you can post this as an image we can make some sense of whether centrals are a component of sleep architecture before therapy or if they are likely therapy onset.  The text copy doesn't cut it.  This has to be tabular.  Do a screen shot.

Unfortunately the PDF I posted is exactly how they sent it to me.  No tables, no graphics, etc.   Must be the basic text dump so they can post it to their online system.   I'll see if I can have them send me a formatted version.

thanks

[Sleeprider]

We can go with what we have then. Your AHI with CPAP therapy is entirely made up of CA and H events. With a CPAP pressure range of 8 to 15 and EPR at 1, the events have no correlation to pressure. I will assume this is mainly therapy onset complex apnea, and would resolve fully with ASV. In order to try to minimize these events, I'd like to try moving to a fixed pressure mode and turn off EPR. I would set the minimum and maximum pressure to 8.0 and start there. If we see obstruction, we will increase pressure manually. The purpose of this is mainly to see if fixed pressure without EPR can resolve the CA events, and if so we will titrate for obstruction. Of course if we can't reduce centrals an hypopnea using fixed pressure, the next stop is talking with your doctor to request ASV titration.

[Mogy]

Hi wwsleep,
One thing that I don't see mentioned here is that during studies they have found that the majority of treatment emergent central apneas(complex apnea) resolve with time. They usually say that by about 3 months after the start of xPAP treatment many(most) of people with treatment emergent apnea will see it diminish to a significantly lower level.
That is what happened to me. I was diagnosed with moderate OSA, but my first week with my machine my CAI was very high, approx. 25. A month later it was much lower, approx 3-4. It continued to go lower and settled at about 1 after 3-4 months.