2nd night on CPAP: CA's through the roof

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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iCePAP
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2nd night on CPAP: CA's through the roof

Post by iCePAP » Fri May 15, 2015 8:33 am

I just had my second night on CPAP. For some reason the central apnea count is at 24%, bringing my AHI up to over 28. Cheyenne Stokes at 47,6%.
The first night these numbers were 11%, 13.5 and 15%, all in SleepyHead.
During the treatment analysis portion of sleep test, my AHI was at 7.8, 100% caused by CA's.

I understand from earlier posts there could be different reasons for this.
Is a high CA also associated with the initial struggle with the mask etc.? I do wake up a lot, lie awake and experience some breathing issues, trying to adjust.
Thanks!

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Re: 2nd night on CPAP: CA's through the roof

Post by Julie » Fri May 15, 2015 8:55 am

What are the chances you're mouth is open when asleep to any extent for some time?

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Re: 2nd night on CPAP: CA's through the roof

Post by Pugsy » Fri May 15, 2015 9:13 am

It's possible that awake/semi awake breathing is being flagged as centrals...so it might explain some of the centrals but I don't know that it would explain that many.

Did you have any centrals noted in either your diagnostic sleep study or the titration sleep study?
If you don't have copies of those studies...get them.
If you didn't have any centrals to speak of in the diagnostic sleep study...and you are having a truck load of them now and we can't explain them away with awake/semi awake flagging...you may be one of the small % of people who start cpap therapy and develop centrals which means complex sleep apnea and that gives you a different discussion.
So for right now let's try to figure out if the centrals are real and did you have them before.

The AHI is an hourly index or average per hour and not reported as %.
Could you post an image of the detailed report you are seeing?
If you don't know how are what to post read this thread to see examples as well as a link for how to post the images.
viewtopic/t103468/Need-help-with-screen-shots.html
https://sleep.tnet.com/reference/tips/imgur

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Re: 2nd night on CPAP: CA's through the roof

Post by iCePAP » Fri May 15, 2015 10:42 am

Quite possible I'm breathing through my mouth - although I'd think the resulting air flow would wake me up. I could ask my wife to check I guess...

I do have a copy of the sleep study:
Centrals noted in diagnostic part of the sleep study contributed only 4.2 points to the overall AHI of 50.1 events/hr. (20.6 points came from obstructive apnea's, 8.8 from mixed and 16.4 from hypopneas).
Centrals during the 'treatment analysis' contributed 100% to the AHI of 7.8 (no more obstructive or mixed apnea's or hypopnea's)
The diagnosis was therefore 'severe obstructive sleep apnea'.

You're right of course that the use % was incorrect.

I attach the screen shot of the graphs you have indicated earlier you need to see.

Image

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Re: 2nd night on CPAP: CA's through the roof

Post by Pugsy » Fri May 15, 2015 11:21 am

Holy crap....much uglier than I anticipated.
How much sleep or non sleep do you think was going on last night?
When is your follow up visit scheduled for to see your doctor about how things are going? If you don't have that appointment scheduled....I suggest that you schedule one. I have a sneaking suspicion that you are going to need it.

For right now just concentrate on doing what you need to do to get comfortable with the mask and machine so that you can actually get some for sure solid blocks of sleep to evaluate.
BTW...none of this is related to mouth breathing leaks....you either have a problem with centrals or you are doing an awful lot of awake/semi awake breathing that the machine is flagging by mistake.

It's too soon to worry about pushing the central panic button though...let's get you sleeping halfway decently and then see what that does to the centrals.

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Re: 2nd night on CPAP: CA's through the roof

Post by iCePAP » Fri May 15, 2015 12:54 pm

It felt as if I spent quite a bit of time either awake or just dozing. Not too tired though.

Just talked to my pulmonologist's office. I asked them to review the stats as well and their comment was 'just keep doing what you're doing and try to get used to it. Everything is all right.'
That's one way of looking at it, I suppose. Not that I have great confidence in the medical profession.
I'll see them on June 12. Or sooner if this stuff keeps showing up. I'm leaving on a two week+ business trip to Europe soon; that should be fun.

Cheers, thanks for your time!

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Re: 2nd night on CPAP: CA's through the roof

Post by CPAP Master » Fri May 15, 2015 1:32 pm

CA is Clear Airway not central Apnea.

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Re: 2nd night on CPAP: CA's through the roof

Post by LSAT » Fri May 15, 2015 1:39 pm

CPAP Master wrote:CA is Clear Airway not central Apnea.
The OPs could be Central Apnea

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Re: 2nd night on CPAP: CA's through the roof

Post by iCePAP » Fri May 15, 2015 4:50 pm

If I understand it correctly, my machine can't distinguish between central apnea and clear airway and therefore marks both as 'clear airway'. The latter is not a category discussed in the sleep study.

I'm beginning to wonder if it wouldn't be a good idea to change the fixed setting of 8cm H2O to Auto, find out if this will make things more comfortable and perhaps thus reduce the occurrence of clear airway events.

Any thoughts on this?

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Re: 2nd night on CPAP: CA's through the roof

Post by palerider » Fri May 15, 2015 5:06 pm

CPAP Master wrote:CA is Clear Airway not central Apnea.
this is *wrong*.

CA== central apnea == clear airway.

it's the same thing, you're having an apena, when the airway is clear, not obstructed.

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Re: 2nd night on CPAP: CA's through the roof

Post by palerider » Fri May 15, 2015 5:09 pm

iCePAP wrote:If I understand it correctly, my machine can't distinguish between central apnea and clear airway and therefore marks both as 'clear airway'. The latter is not a category discussed in the sleep study.
as I said above, but to direct it to you specifically, clear airway is respironics way of saying 'central apnea', no t because they are talking about anything different.

it's like some people call the meal you eat towards the end of the day "dinner" and some call it "supper".

same thing here... same thing, different terms.

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Re: 2nd night on CPAP: CA's through the roof

Post by robysue » Fri May 15, 2015 9:21 pm

palerider wrote:
CPAP Master wrote:CA is Clear Airway not central Apnea.
this is *wrong*.

CA== central apnea == clear airway.
It's a bit more subtle than this.

When you're talking about central apneas scored on an in-lab sleep test. On a PSG, they make no effort to determine the patency of the airway. Apneas are scored on whether the data shows an effort to breathe or not.

If no air is getting in or out of the lungs, you continue to try to breathe, the assumption is that the upper airway has collapsed and the event is scored as an OA.

If no air is getting in or out of the lungs and you are NOT making an effort to breathe, the assumption is that the problem likes in the central nervous system and its "control" of the breathing and a CA (central apnea) is scored. It could be that the airway has collapsed or it could be that the airway is clear (open). But the problem is that the brain is not telling the diaphragm and lungs to "inhale NOW".

In a sleep lab, the tech may also score an apnea as a "mixed apnea". These start out looking like central apneas: There is no effort to breath at the start of the apnea. But while the apnea is occuring, the patient starts attempting to breath, but no air continues to get through to the lungs; in other words a mixed apnea ends by looking like an obstructive apnea. The general hypothesis is that a mixed apnea is initially caused by the same central nervous system problems that underlie a central apnea. But during the time when the patient is making no effort to breath, the upper airway collapses, and hence once the brain starts sending the signal to "Breath Now", no air can get into the lungs.

Our machines have no way of measuring whether we are making an effort to breathe. So they use proprietary algorithms designed to test the "patency" of the upper airway. If the algorithm's analysis of the data indicates that the airway is blocked, the machine manufacturers assume that the patient is trying to breath and can't; hence they score the apnea as an OA. If the algorithm's analysis of the data indicates that the airway is not blocked, the machine manufactures call the apnea a Clear airway apnea (PR) or a Central Apnea (Resmed) and the assumption is that the apnea is most likely a central apnea.

The algorithms are good, but not perfect. Things scored as a CA do have a high probability of being central events. Things scored as an OA have a high probability of being obstructive events for most people. However, mixed apneas are more likely to be classified by our machines as OAs, even though they have a lot in common with central apneas. Finally there are certain circumstances where a string of genuine central apneas can be misscored as OAs. Morbius has commented on this issue in previous incarnations.
it's the same thing, you're having an apena, when the airway is clear, not obstructed.
Yeah, a CA is the same thing as an OA in terms of "no air is getting into the lungs for at least 10 seconds"

But the causes of CAs and OAs are quite different, and our machines react to them differently when running in APAP mode. And if someone is having serious issues with CAs being scored on the machine, the answer is NOT "increase the pressure."

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Re: 2nd night on CPAP: CA's through the roof

Post by palerider » Fri May 15, 2015 10:19 pm

robysue wrote:
palerider wrote:
CPAP Master wrote:CA is Clear Airway not central Apnea.
this is *wrong*.

CA== central apnea == clear airway.
It's a bit more subtle than this. ... When you're talking about central apneas scored on an in-lab sleep test.
yes, if you're talking about in lab sleep tests, however, from the point of view of the machines that we sleep with, if it detects an open airway, then it scores a CA, which is called different things by different manufacturers, but is the same effect, you're not breathing, and your airway is not blocked, and the pressure won't increase.

respironics: "Obstructed Airway Apnea / Clear Airway Apnea Detection"
resmed: "The device detects both obstructive and central sleep apneas (CSA)."

quotes from the manuals of both.

same thing, different words.
robysue wrote:
it's the same thing, you're having an apena, when the airway is clear, not obstructed.
Yeah, a CA is the same thing as an OA in terms of "no air is getting into the lungs for at least 10 seconds"

But the causes of CAs and OAs are quite different, and our machines react to them differently when running in APAP mode. And if someone is having serious issues with CAs being scored on the machine, the answer is NOT "increase the pressure."
I never said, nor implied that a CA was the same as an OA, I said that what respironics calls a "clear airway apnea" and what resmed calls a "central apnea" were the same thing.

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Re: 2nd night on CPAP: CA's through the roof

Post by Pugsy » Fri May 15, 2015 10:46 pm

Respironics has elected to call their open airway cessation of breathing as Clear Airway apnea event.
I don't know why they elected to do that...but that did.

ResMed has elected to call their open airway cessation of breathing as a Central apnea event.

SleepyHead was originally designed for Respironics machine software reports....so Clear Airway stayed as the term used.

ResMed calls them centrals and if you were to use ResMed's ResScan software these same events that are called clear airway on the SleepyHead reports will be called "centrals" on the ResScan software reports.

Sleepyhead isn't making the calling...SleepyHead is just reporting what the machine called them.

Now sometimes both machines can be fooled by awake breathing irregularities and call some pauses in breathing a "central/clear airway apnea" because it measures air flow and not wake status. They don't know if we are awake or not but they know if the air flow stops or is reduced so they just call them like they see them.
We pause/hold our breath often while awake and don't ever even notice it....but these machines notice it.
For this reason when we see someone who says they are having a lot of awake time on the machine and they aren't sleeping well...and they see a lot of centrals...we have to wonder if they are awake breathing pauses getting flagged by mistake. We don't panic but we do keep an eye on them while we go through the adjustment process so that a person can honestly say that slept for 2 or 3 or 4 or more hours solidly and then if we see a truckload of centrals then we start to wonder more about the centrals.

In the OPs situation....There's also substantial CSR being reported and the ResMed's call it CSR....and while it wouldn't be impossible for awake breathing to look CSRish...I doubt that all the flagged CSR breathing here is SWJ (sleep/wake/junk). I am concerned but not ready to push the panic button for Complex Sleep Apnea just yet.
Let's give this a bit of time to see what happens once OP can get some for sure solid blocks of sleep...and let's see what shows up in for sure sleep.

And remember...even if it is CompSA...there's always the chance that it will reduce or go away on its own with a bit of time. It's a small chance but it is a chance.

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Re: 2nd night on CPAP: CA's through the roof

Post by iCePAP » Mon May 18, 2015 11:53 am

Sleeping is going very well now; sudden and huge improvement after the first three days.
AHI isn't doing so great at all: 30.6 last night, >28 CA's.

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