High Clear Airways during sleep

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Jay Aitchsee
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Re: High Clear Airways during sleep

Post by Jay Aitchsee » Mon Mar 23, 2015 4:44 pm

jimnlacy wrote:Hi Jay, I will make the adjustments to the pressure and EPR. I will also try out a larger size pillow per Pugsy's suggestion. Thanks, Jim
Jim, I think that might be too many changes to make and sort out at one time. How about trying the pillows first, so we can compare them with previous results and just to make sure they fit and are comfortable? Once satisfied with the pillows, depending on the results (could be, they do the trick), if needed, we can do the pressure/EPR changes.

If you try the pillows and it's immediately clear they won't work, you could go ahead with the other changes.

J

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Re: High Clear Airways during sleep

Post by jimnlacy » Mon Mar 23, 2015 6:22 pm

Jay Aitchsee wrote:
jimnlacy wrote:Hi Jay, I will make the adjustments to the pressure and EPR. I will also try out a larger size pillow per Pugsy's suggestion. Thanks, Jim
Jim, I think that might be too many changes to make and sort out at one time. How about trying the pillows first, so we can compare them with previous results and just to make sure they fit and are comfortable? Once satisfied with the pillows, depending on the results (could be, they do the trick), if needed, we can do the pressure/EPR changes.

If you try the pillows and it's immediately clear they won't work, you could go ahead with the other changes.

J
Jay,

Will do. Thanks for the feedback and help.

Jim

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Re: High Clear Airways during sleep

Post by jimnlacy » Tue Mar 24, 2015 7:41 am

My data from last night:

Image

I tried the larger pillows and feel asleep wearing them. When I woke up to go to bed I changed the pressure to 8.6 and the EPR to 1. I did not have any feeling of air starvation last night. But my AHIs climbed.

What are your thoughts?

Thanks,

Jim

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Jay Aitchsee
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Re: High Clear Airways during sleep

Post by Jay Aitchsee » Tue Mar 24, 2015 9:07 am

Well, Jim, I don't see any improvement. In fact, it looks like everything got worse. Fl's and Hypopneas increased quite a bit and so did the CA's. The leak line looks about the same and I don't see any clear indication the CA's are associated with the leaks.

At this point, I think going back to 9.0 and watching the CA's is the best that can be done. You have only been on therapy about a month, perhaps, over time, the CA's will diminish. If they are a result of disturbance, perhaps the origin can be determined. If the CA's get worse, to the point the index is consistently over 5.O, you should see your doctor.

Your AHI is relatively low and as long as it stays under 5, don't worry about it. If your results mimic those of last Saturday, that will be good. Don't fall into the trap of obsessing over your results. A handful of CA's over night isn't really anything to worry about. Don't chase your AHI with frequent changes as we have been doing. It's not likely to get you anywhere.

Relax and be comfortable with your therapy, know that your obstructive apneas are being controlled and it's doing good things for your body. Give it time to work. Stay at the last setting, 9.0, for at least two weeks to see if a trend develops and try not to obsess.
J

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Last edited by Jay Aitchsee on Tue Mar 24, 2015 9:42 am, edited 1 time in total.

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Pugsy
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Re: High Clear Airways during sleep

Post by Pugsy » Tue Mar 24, 2015 9:15 am

Are you comfortable with EPR turned off? If so, try turning off EPR.
There's a small percentage of people who find that EPR (which is essentially bilevel therapy) causes centrals....but you are only using EPR set to 1 do I don't know if that is what is going on here or not.

Otherwise in an effort to see if the centrals are related to pressure you could reduce the pressure again but much reduction is going to probably allow more OA and hyponeas to appear.

Do you have a follow up visit scheduled with your sleep doc? or any doc? If not, maybe you should make one. You are having enough centrals (or at least the machine thinks they are centrals) that aren't reducing with time or commonly used methods to reduce them...that I think a discussion with the doctor is probably in order. At least get doc's input and see if he has other ideas or wants to use the "wait and see" approach.

I actually would back down on the pressure if it were me just to see if the Centrals reduce or not..because there is some wiggle room in terms of the obstructive events.
My gut says that the centrals won't change though...but my gut isn't always right.

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Re: High Clear Airways during sleep

Post by Jay Aitchsee » Tue Mar 24, 2015 12:20 pm

I don't know, Pugsy. We've brought his P down from 16 to 8.6 without a reduction in CA. But I'm like you, I sure thought we'd see a reduction in CA along with the reduction in pressure.

Jim, if you want too rule the pressure out for sure, you could try to decrease again, maybe down to 8.0. What do you think Pugsy, 8.0, or something lower, like 7.6? I'm afraid, though, at 8.6 we're pretty much at the lower limit for FL, hypopneas, and OA's, but one night wouldn't hurt.

I think turning the EPR off is worth a try, though reducing from 3 to 1 didn't seem to have much effect.

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Re: High Clear Airways during sleep

Post by Pugsy » Tue Mar 24, 2015 12:53 pm

Jay Aitchsee wrote:What do you think Pugsy, 8.0, or something lower, like 7.6? I'm afraid, though, at 8.6 we're pretty much at the lower limit for FL, hypopneas, and OA's, but one night wouldn't hurt.
I don't think the centrals are pressure related but just thought a reduction in pressure might be worth a try since there is a little wiggle room available in the obstructive component events.....and I would put the FLs on the back burner for now.
Just to see if the centrals will reduce at all....I don't think they will but there's a part of me that says "they might" and I would want to know what was causing the centrals if at all possible.

He's having enough centrals that we can't explain away to cause me to have concerns now. He didn't have a formal titration sleep study so we are really doing a lot of "what iffing" and there's just a lot of different "what ifs" to consider....
Like what if they are pressure related or what if they are arousal related meaning maybe a post arousal central (and the arousal may not be remembered).

To be honest I am scratching my head over this one but if it were me I would at least attempt to answer the "what if it is pressure related" question and not worry about what the obstructive side of things do during trying to answer that question. One night won't hurt to use a lower pressure and I was thinking of taking a big jump down to probably 7.

So if this were me...I would first try turning off EPR and no other pressure changes...just to see if EPR itself is the trigger. There is the very remote possibility that it could be a trigger even at 1 cm.

And if no joy there then I would try reducing the pressure to 7 (no EPR) and yes, I know the FLs will go to hell and maybe the OAs and hyponeas will too but my main objective is to see if the centrals will reduce or not.
Eventually I think the doctor needs to be brought into the loop probably no matter what gets figured out.

To Jimnlacy:
Oh...one other thought which I may or may not have addressed elsewhere but question .....are you taking any meds that might suppress respiration? Especially pain control meds?

Oh..one other request...can you zoom in on a central cluster for me? There's one really ugly CA cluster between 00:00 and 00:20...go to the events tab on the daily detailed report from last night...click on the CA group...so that all the CAs are shown with the time they occurred and click on on single event that has other CAs before and after it shown real close in time to that one....then get me a screen shot of the graphs after you do the clicking on the one event. I want that level of zoom and would like to see 3 or 4 centrals (more if you have them) at that level of zooming in. I just want to see the flow pattern up close but not too up close and clicking on just one event in the group will give me the level of up close I want to see.

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Re: High Clear Airways during sleep

Post by Pugsy » Tue Mar 24, 2015 1:08 pm

I have another question for you and it's about the home sleep study that you had.
Can you tell me what all was involved with it? Did you just have a finger tip sensor (like pulse oximeter) and/or maybe a little cannula in your nose...or did you have more elaborate stuff that you had to wear like a belt around your chest and/or little sticky things on your forehead?

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Re: High Clear Airways during sleep

Post by jimnlacy » Tue Mar 24, 2015 4:11 pm

Pugsy,

Here is a detail. I had a heck of a time. Whenever I clicked on the event tab using my Mac, Sleepyhead crashed. Took it over to my PC laptop and it worked like a charm.
Image

Interesting intervals between the CA events. Like clock work really. Interesting.

Jim

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Re: High Clear Airways during sleep

Post by jimnlacy » Tue Mar 24, 2015 4:13 pm

Pugsy wrote:I have another question for you and it's about the home sleep study that you had.
Can you tell me what all was involved with it? Did you just have a finger tip sensor (like pulse oximeter) and/or maybe a little cannula in your nose...or did you have more elaborate stuff that you had to wear like a belt around your chest and/or little sticky things on your forehead?
Pugsy,

The at home sleep study I did had a fingertip monitor, a nasal monitor and a check strap. Great nights sleep for two nights. The blasted thing went off with an alarm about every ten minutes saying something was amiss. Or so it seemed.

Jim

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Re: High Clear Airways during sleep

Post by Pugsy » Tue Mar 24, 2015 4:16 pm

Thank you. That's almost what I would like to see. Can you do it one more time with the exact same events but this time turn off the mask pressure...pressure and leak graphs so that the flow rate graph isn't so tiny.
I am looking for a certain pattern and I can't quite rule it in or out at this scale.

you said
check strap
but I assume you meant chest strap.

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Jay Aitchsee
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Re: High Clear Airways during sleep

Post by Jay Aitchsee » Tue Mar 24, 2015 5:36 pm

Pugsy wrote:I am looking for a certain pattern and I can't quite rule it in or out at this scale.
If you click on the chart, then download "full resolution" and zoom can you see what you need? Or is the original simply not detailed enough?

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Re: High Clear Airways during sleep

Post by Pugsy » Tue Mar 24, 2015 5:52 pm

Jay Aitchsee wrote:If you click on the chart, then download "full resolution" and zoom can you see what you need? Or is the original simply not detailed enough?
I did do that and I think that I am NOT seeing the typical CSR waxing and waning but I wanted to give the vertical scale enough room to allow for any rounding of the air flow pattern...just in case I am missing it.

Does it look CSRish to you? It doesn't to me....looks more like SWJ or arousal stuff to me.

To Jim:
When you have time can you look at the other flow patterns zoomed in when there are Centrals and see if you spot any that look like this below...
I just wanted to make sure that we weren't playing around with a truckload of CSR stuff and if we were I would definitely push for that follow up with the doctor sooner than later.

Image

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Jay Aitchsee
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Re: High Clear Airways during sleep

Post by Jay Aitchsee » Tue Mar 24, 2015 6:56 pm

Pugsy wrote: Does it look CSRish to you? It doesn't to me....looks more like SWJ or arousal stuff to me.
No, they don't look "classic" CSR, could be SWJ, but I would expect maybe a little more exaggerated flow preceding the events with arousals? But I'm not an expert, maybe Morbius will chance by and have a look.

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Re: High Clear Airways during sleep

Post by jimnlacy » Tue Mar 24, 2015 9:18 pm

Pugsy wrote:Thank you. That's almost what I would like to see. Can you do it one more time with the exact same events but this time turn off the mask pressure...pressure and leak graphs so that the flow rate graph isn't so tiny.
I am looking for a certain pattern and I can't quite rule it in or out at this scale.

Here's the detail:

Image

you said
check strap
but I assume you meant chest strap.
Yes "chest strap".

I do not take any medications. I am very active and healthy. My wife just noticed that I stop breathing sometimes. She suggested I get the sleep study. And here we are.

Pugsy,

Thanks for the feedback and interest. I have a meeting tomorrow with my GP and with my Pulminolgist May 11.

Jim