am I getting effective therapy?

[jefe2018]

Hi,

I've been using Airsense 10 for 6 months with all-night use. Pugsy and others have helped me tremendously to dial in the pressure range that seems to help me without pushing into Aerophagia, which I get badly at high pressure levels. I'm running EPR with low at 8.4 and high at 10.4. If I go higher, I get stomach aches that last for hours after I wake up. I'm definitely choking off therapy at times but I feel if I dial up the pressure, I can't use the therapy.

I've had two ablations for AFIB and have medical journal references that suggest apnea has to be controlled in order to have the ablation work. My 2nd one was back in Dec., about two months after I started using my CPAP. So far, so good. I am fit and don't drink too much and don't know what else I can do to maximize things.

My 6 month AHI now is 1.3. Components of it are .8 Clear Airway, .4 Hypopnea and .1 obstructive. Two thirds of it is central. Most of those events are 10 seconds or a bit more. My total time in apnea averages about 2 minutes to 2 1/2 minutes. I doubt my oxygen saturation is crashing with this kind of data.

I occasionally get accumulated AHI up to 5 for 30 to 60 minutes if I get a cluster of events, but most often not.

I don't know how to achieve better equipment performance without increasing the pressure, and I feel like I am optimized now without getting back into trouble with the stomach aches, etc. I am using a chin strap and sleeping on my side, which both help with the mouth breathing already. They also cut down on obstructive events.

Should I consider this about as good as I can do, and does this feel like effective therapy? I know clinically 5 is considered "effective", but I'm way under that and I know that most folks get under 2 with good equipment use. I'm not looking for a pat on the back, just some perspective from some of you more-experienced folks. Should I work harder than this to optimize, or am I "there"?

You guys are awesome. I never would have gotten this far without your help! I would have trashed my CPAP 30 days into it.

thanks!

[Pugsy]

You are pretty much where I am at now with my own therapy after 9 years.
I sometimes get those little clusters that you talk about but like you it's rare and I sleep right through them.
Overall my AHI runs less than 2.0 consistently and often less than 1.0 but I don't worry too much about the AHI variances or even those little clusters as long as I am sleeping decently and feeling decently....and I don't have aerophagia issues causing me to limit anything.

Even without the belly issues limiting things if you are sleeping decently and feeling decent then I would just sit back and ride with the flow. The daytime belly pain...that's part of the feeling decent and if killing all the apnea events ends up meaning you have belly pain every day I don't think it is worth it myself.

I am where you are at now...and I am happy with where I am at. The rare nights with a higher AHI or a little cluster I just laugh, shrug my shoulders and move on.

[Scluvsrain]

Your numbers seem great to me. A little off topic question though - how do you know your centrals? I don’t see that on my Sleepyhead report?


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[Pugsy]

how do you know your centrals? I don’t see that on my Sleepyhead report?

The CAs/Clear Airway flags you might see are centrals.
Respironics calls it clear airway apnea event. ResMed calls it central apnea event.
SleepyHead was originally designed for the Respironics machines so there was the Clear Airway label.
ResMed compatibility as added later but still kept the CA name.
So if you use a ResMed machine and were to use ResScan software from ResMed...the CAs that SH might flag would be labeled centrals in ResScan. It's the machine doing the naming...SleepyHead just reports whatever the machine calls them.
It was just easier to keep the CA label.

[Scluvsrain]

Oh thank you!! That clears up the mystery!!


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[jefe2018]

Thanks Pugsy,
That's what it felt like, but I wanted to check in.
Your help has been awesome. I really struggled at the beginning, and you helped dial me in with higher lower pressure, lower high pressure, EPR and a higher ramp. That all helped get me where I can sleep 8 hours and keep the AHI down. I feel like I'm as high as I can go with 10.4 without getting back into long morning stomach aches, so I'll roll from here.
Best to you!