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[Treatment] New to APAP. High number of "Clear Airway events". Not sure what to do.
#1
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New to APAP. High number of "Clear Airway events". Not sure what to do.
Hello everyone! I am brand new to the CPAP. After the last few years of horrible sleep and feeling tired all the time, I got diagnosed with OSA with an AHI of 69.8 using Lofta's home study.

I got the Airsense 10 a couple of days ago, yesterday I felt very tired still, using OSCAR I saw I had an AHI of 7.55 and many "Clear Airway" events, which after googling I learned are moments where I did not breathe. Last night I had an even higher AHI with 15 and more clear airway events.

The sleep study did not indicate any of these.

I do know that both nights I woke up 3-4 times that I was aware I woke up, not too sure why. Last night I also applied mouth tape to try not to breathe through my mouth (using nasal pillow, which has made my nose very tender).

Some of the CA events seem to cluster together, so I wonder if that's related to times when I woke up and then went to sleep.

Pressure settings the first night, 7 to 16 and no EPR. Pressure last night was 8 to 15.4 and no EPR.

Any thoughts/tips?

Thank you all so much!

Here is my sleep study summary.


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#2
RE: New to APAP. High number of "Clear Airway events". Not sure what to do.
Did your sleep study show any clear airway/central events?
Paula

"If I quit now, I will soon be back to where I started. And when I started I was desperately wishing to be where I am now."
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#3
RE: New to APAP. High number of "Clear Airway events". Not sure what to do.
No, it did not. It was diagnosed as "Severe Obstructiev Sleep Apnea, G47.33"

I shared the summary of the sleep study report above.
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#4
RE: New to APAP. High number of "Clear Airway events". Not sure what to do.
Welcome to Apnea Board,

The study results do indicate CA in the form of the pAHIc 3% line at 140 Central events.

Did the test involve an effort belt you wore across your chest? That's an input device to help differentiate Central vs Obstructive.

You already have EPR off, however you'll need to remove other items like Ramp that induced pressure swings. If these are real bonafide CA, they're not liking Ramp much. Even though there's a need to have the pressure you've got setup, it may need to be reduced in spread between low and high. Be aware though, you do have Obstructive Apnea as well, which will likely increase if you reduce things to affect the Central. You may need to try straight 10 cmH2O or pull down the higher number closer to 12. Unfortunate you'll need to endure trial and error to see what helps or doesn't.

You can edit pressures yourself. Holding Home button and click the dial at the same time for 5 or so seconds to enter clinical menu where you can edit.

I'm not certain these follow a pattern like Positional Apnea otherwise I think flow limits may be higher as well.

Was there any other data involving this test you can provide? Diagnosis or doctor comments?

Other things: you may need to approach the doctor, stressing that this therapy isn't doing you much good. You may want to request an in lab diagnostic to confirm these test results. You also may want to request going to BPAP/ bilevel, specifically ResMed AirCurve 10 VAuto. It has a trigger control that may help with the CA component. If that doesn't help, ASV is your best bet then. ASV specifically treats CA.

CA can be predominant in some small percentage of patients, most have a few, but those with higher counts they can be an aspect needing addressed. The word idiopathic may apply here but not certain. Idiopathic meaning unknown medical reason.

Here's the order I'd consider, edit current machine to avoid CA but note it will affect obstructive negatively. If you can get decent balance you're good with, end of story. You may need to include a lab titration involving bilevel and ASV to help give the need for those machines. Even if you get VAuto it may not be enough. Central Apnea are extra tricky to treat, it may involve ASV, but that's not determined just yet.

PS here's what I'm guessing is happening, your CA from that sleep study is made worse by the CPAP treatment. This places you where you need to avoid CA.
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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#5
RE: New to APAP. High number of "Clear Airway events". Not sure what to do.
Thank you!

The test did make me put a device at the top of my sternum. But it did not all across my chest.

I will play with the settings to see how it goes. I've read that CA events can also be more severe when first starting out, is that the case?

The diagnosis just mentioned obstructive sleep apnea, nothing else. I did take it as a take-home sleep study, so it probably isn't as detailed as the in-clinic. The sleep study found that I slept on my back almost all the time, I believe these past couple of days I've slept on my back also.

Although my sleep hasn't been great for some time. I used a mouth guard that made sleep much bearable. However, my sleep became significantly worse recently, after I got sick with covid. 

I do know that I am overweight, my symptoms definitely started to show and worsen after I gained ~20lbs.

I will play around with the settings and see how it goes.
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#6
RE: New to APAP. High number of "Clear Airway events". Not sure what to do.
I agree with Dave that your central apneas are your biggest concern.  From your sleep study, it appears you had a very high number of them.  Hopefully, SuperSleeper will come along to advise, but I think you likely need a different type of machine called an ASV.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#7
RE: New to APAP. High number of "Clear Airway events". Not sure what to do.
Try an edit tonight if possible, note how it changes things (positive, negative no change), post those thoughts and a standard view OSCAR chart tomorrow if you can. CA may be hard to work with, so maybe nothing changes, but it's worth trying.
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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#8
RE: New to APAP. High number of "Clear Airway events". Not sure what to do.
Your sleep study indicated 18.8 events per hour classified as central, and enough to get you a moderate sleep apnea diagnosis by itself. Keep an eye on it, but you should go back to whomever wrote that prescription for an APAP machine and tell them that you have complex apnea (mix of obstructive and central) to get a machine that can treat both. That's actually more than you are seeing in OSCAR, so I don't know that you can blame the machine for these.
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
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#9
RE: New to APAP. High number of "Clear Airway events". Not sure what to do.
I changed the pressure settings to a range of 10 to 12, I also tried to sleep on my side this time. AHI lowered to 5, still had multiple CA events

It seems events I did have large leaks multiple times. I do not know how to interpret the OSCAR/event charts very well, but it seems to me that most CA events happened after the leaks?

Something else to note, is that I woke up a few times (2-3) during the night (That I could tell) feeling like I could not exhale (It seems I had difficulty exhaling out of my mouth as I woke up) and my throat felt very rough for a bit each time I woke up, until I swallowed a few times, then it felt more normal.

I do appreciate everyone helping out!

P.D. I posted chart images below and a zoomed in CA event that happened after a large leakage.


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#10
RE: New to APAP. High number of "Clear Airway events". Not sure what to do.
Today seemed to be a lot better regarding CA events, although AHI stayed about the same.

I bought a CPAP pillow and a cervical collar, which I used.

I attached the OSCAR images. Any thoughts?


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