What's with the CAs?

[clenchingtobreathe]

My sleep test in June (2018) showed 2 apneas and 28 hypopneas. Nothing indicated CA's unless those were included in the hypopnea count. Nothing shown as centrals. 51 spontaneous arousals were noted...whatever that means.

I have been slowly lowering my max pressure and slowly raising my low pressure to try to reduce the high pressure spikes that woke me up repeatedly during the night. (started at 5 -15...now at 5.6-9.6). Also changed to the Dream wear nasal cushion which has not kept me awake like my first 2 masks. I have slept a bit better the last 4 days but am concerned about the number of CAs and AHI rising a bit. Here is last night. Four nights previously on same pressure were AHIs of 1.91, .87, .96 & 1.19
I don't feel sleepy during the day...just fatigued...which, in large part, I believe is caused by my continued teeth clenching (the better I sleep, the harder I clench) and that strain on my facial, neck and shoulder muscles.
Looking at last night's SH report, do you see any significant tweaks I should make?

[Julie]

What CA's? Your report looks great!

Very many of us will have a few clear airway events on falling asleep and just before waking... called 'sleep-wake junk' but they're nothing at all to worry about. If you start having big bunches of them throughout the night, that would be a different story, but what you have is nothing to speak of at all.

[Pugsy]

Watch all the videos here to help you figure out if the flagged event is real (as in you were asleep) vs not real and often called SWJ/sleep/wake/junk or post arousal breathing flagged by mistake.

http://freecpapadvice.com/sleepyhead-free-software

These machines only measure air flow and they can't tell the difference between awake/irregular breathing and asleep breathing.

Even if all those centrals were real...not enough of them to worry about.
It's normal to have a few real centrals anyway...like sleep onset centrals.

[zonker]

have slept a bit better the last 4 days but am concerned about the number of CAs and AHI rising a bit. Here is last night. Four nights previously on same pressure were AHIs of 1.91, .87, .96 & 1.19

one of the hardest things for me to get accustomed to was the fact that we can sleep differently each night. i think this might just be a case of that.

see what you get tomorrow morning. it may change back to what it was.

i had something similar happen to me friday night. after having three days at my more typical 2-3, sleepyhead reported i had an AHI of 5.23! with WAY too many obstructives, hypopneas and rera. the only thing different i'd done was raise my minimum pressure from 7 to 7.2. pretty sure that wasn't enough to warrant that result!

sure enough, last night was very pleasant 0.94!

so maybe the machine had to go stupid high before it went stupid low?


perhaps a similar thing will happen for you.

[clenchingtobreathe]

Watch all the videos here to help you figure out if the flagged event is real (as in you were asleep) vs not real and often called SWJ/sleep/wake/junk or post arousal breathing flagged by mistake.

http://freecpapadvice.com/sleepyhead-free-software

These machines only measure air flow and they can't tell the difference between awake/irregular breathing and asleep breathing.

Even if all those centrals were real...not enough of them to worry about.
It's normal to have a few real centrals anyway...like sleep onset centrals.

Wow! I watched those videos carefully several times and pulled up my own charts to compare! Very interesting. I suspect that (to my untrained eye) only one of the CAs last night happened while asleep....and only 2 of the apneas were actual OAs. I roll over and change positions a lot at night as a result of joint issues and now I can pretty clearly see those arousals! Thanks a million for suggesting the videos!

[clenchingtobreathe]

have slept a bit better the last 4 days but am concerned about the number of CAs and AHI rising a bit. Here is last night. Four nights previously on same pressure were AHIs of 1.91, .87, .96 & 1.19

one of the hardest things for me to get accustomed to was the fact that we can sleep differently each night. i think this might just be a case of that.

so maybe the machine had to go stupid high before it went stupid low?


perhaps a similar thing will happen for you.

I know you are right! And I'm trying to learn to focus on how I feel during the day more than the numbers on SH. But as I noted the stress on my body from teeth clenching makes it more difficult for me to recognize feeling better as a result of CPAP. My "doctor" has completely ignored that my fatigue and the clenching started at the same time....so I am probably going to get my primary doctor to refer me to a dentist who specializes in sleep issues to discuss custom oral appliances in hopes of controlling the clenching. I wore a regular teeth guard for awhile last night and clenched even harder as a result. Getting old is DEFINITELY not for sissies!

[Midwest_non_sleeper]

I run into this alot on my own SH reports. At first, I was worried about them, but through the assistance of Pugsy and several others here, as well as my own reading, I'm not concerned about them anymore.

When I drilled down into each one, I could only find at the most, one or two a night that appeared to be the real deal, and that's not enough to get bend into a twist over. Just keep checking your reports and taking a look at them, most of the time you'll see some abnormal breathing patterns just before the event, indicating that it was connected to an arousal event and not from actual sleep.

[clenchingtobreathe]

What CA's? Your report looks great!

Very many of us will have a few clear airway events on falling asleep and just before waking... called 'sleep-wake junk' but they're nothing at all to worry about. If you start having big bunches of them throughout the night, that would be a different story, but what you have is nothing to speak of at all.

Comforting to hear! Thanks for the encouragement!

[Sleeprider]

Clenching, your therapy looks great, and the only thing that stands out is that you are using EPR at 3 for very low pressures. At 5.6 to 9.6 your EPAP pressure does not go higher than 4.0 cm until pressure is over 7.0. It may be a coincidence but it seems like the relatively few CA events you have is when your pressure is above that threshold and full EPR is being felt (equivalent to PS 3.0). You might try a EPR of 2, or 1 and see if that reduces the incidental CA events.

[palerider]

Clenching, your therapy looks great, and the only thing that stands out is that you are using EPR at 3 for very low pressures. At 5.6 to 9.6 your EPAP pressure does not go higher than 4.0 cm until pressure is over 7.0. It may be a coincidence but it seems like the relatively few CA events you have is when your pressure is above that threshold and full EPR is being felt (equivalent to PS 3.0). You might try a EPR of 2, or 1 and see if that reduces the incidental CA events.

The centrals are totally insignificant.

[Sleeprider]

Clenching, your therapy looks great, and the only thing that stands out is that you are using EPR at 3 for very low pressures. At 5.6 to 9.6 your EPAP pressure does not go higher than 4.0 cm until pressure is over 7.0. It may be a coincidence but it seems like the relatively few CA events you have is when your pressure is above that threshold and full EPR is being felt (equivalent to PS 3.0). You might try a EPR of 2, or 1 and see if that reduces the incidental CA events.

The centrals are totally insignificant.

That's fine, and they might be less significant with my suggestion. YMMV

[Julie]

And the higher you set EPR, the higher your AHI's will be (by 1-2 cms) - just a trade-off where you need to find your own balance.

[palerider]

The centrals are totally insignificant.

That's fine, and they might be less significant with my suggestion. YMMV

They cannot be less significant. Your suggestion may eliminate a few, but it's totally unnecessary, because those few centrals are harmless.