AHI question for first 2 nights

[grannyt]

Night 1
AHI= 6
Total clear airway apneas = 9
Total Obstructive apneas = 11
Totsl Hypopneas =35

Night 2
AHI = 4.5
Total Clear airway apneas = 9
Total Obstructive apneas = 8
Total Hypopneas = 20

Min purssure = 5
Max pressure = 20
90% pressure = 13 and 12.9 respectively

My main question is about the "clear airway apneas." Is this common to have clear airway apneas when diagnosed with OSA?
Should I be concerned?
Will my AHI decrease over time with my therapy?

Thank you!

[D.H.]

Very high pressure could cause Clear Airway (a.k.a. "Central") events, but there are other reasons you could be having these.

You might want to turn the min up at least to 7, and see if that helps lower your AHI further. While they say under 5 is acceptable, lower is better.

Last, use sleepyhead to see if your Clear Airway events are more prevalent at higher pressures. If not, then it's probably not the reason. If so, then it could be (but this is not certain).

[grannyt]

Thank you.

I will download SleepyHead.

And raise my min presssure.

[LSAT]

Thank you.

I will download SleepyHead.

And raise my min presssure.

At this point, don't be concerned with the CAs. There are not enough to be concerned about. Continue trying to reduce the AHI

[Pugsy]

A few clear airway/central apnea events are normal even for those only diagnosed with plain OSA.
So an occasional "real" central isn't cause for alarm. Like it's normal to have what is called a sleep onset central when transitioning to sleep stages.

Also it is normal for the machine to sometimes flag some sort of awake/semi awake breathing irregularity as a central apnea.
Remember these machines don't/can't tell if we are asleep or not. They only measure air flow and our awake breathing can often cause the machine to flag events that aren't "real". If we aren't asleep they simply don't count.

When new to cpap therapy we often wake up during the night if for no other reason than the newness of everything and with each wake up there's the increased chance of another normal sleep onset central when we go back to sleep.
So some of the centrals might be real and some of the centrals might be what we call SWJ or sleep/wake/junk awake breathing irregularities getting flagged.

Central apneas/Clear Airway (Respironics term) aren't a problem unless present in really large numbers.
You aren't having enough of them to be a problem even if every one of them was "real".
How many is considered large??? ... average of 5 or more per hour...every night for the bulk of the night that are real.

You are new to therapy and I usually tell people to just worry about getting the sleep first unless the results are horrible and yours aren't.
Use available software to see when those events are getting flagged. See if there is any clustering of events.
You may need a small adjustment in that minimum pressure upwards to better hold the airway open in the first place and thus prevent some of the obstructive apneas and hyponeas.
https://sleep.tnet.com/equipment

Give yourself a week to get adjusted to just using all this stuff and then look at maybe doing something if it looks like some adjustments are needed.
If you are waking often or spending much time awake/semi awake with mask and machine on....there's a good chance that the AHI you see isn't all real and awake stuff doesn't count in the final evaluation as to pressure needs.

I wouldn't go changing that minimum pressure until I knew for sure what was going on and why...2 nights of therapy and not knowing what is going on or when...not a good idea in my book. Especially if I wasn't sleeping soundly.
If you want to share what you see in SleepyHead..
See this thread.
viewtopic/t158560/How-to-post-images-for-review.html
You've got available data...use it to determine if you need to change anything or not.
Right now for all we know the bulk of that AHI could be happening at the beginning of the night while awake and no pressure changes are really needed.

[grannyt]

A few clear airway/central apnea events are normal even for those only diagnosed with plain OSA.
So an occasional "real" central isn't cause for alarm. Like it's normal to have what is called a sleep onset central when transitioning to sleep stages.

Also it is normal for the machine to sometimes flag some sort of awake/semi awake breathing irregularity as a central apnea.
Remember these machines don't/can't tell if we are asleep or not. They only measure air flow and our awake breathing can often cause the machine to flag events that aren't "real". If we aren't asleep they simply don't count.

When new to cpap therapy we often wake up during the night if for no other reason than the newness of everything and with each wake up there's the increased chance of another normal sleep onset central when we go back to sleep.
So some of the centrals might be real and some of the centrals might be what we call SWJ or sleep/wake/junk awake breathing irregularities getting flagged.

Central apneas/Clear Airway (Respironics term) aren't a problem unless present in really large numbers.
You aren't having enough of them to be a problem even if every one of them was "real".
How many is considered large??? ... average of 5 or more per hour...every night for the bulk of the night that are real.

You are new to therapy and I usually tell people to just worry about getting the sleep first unless the results are horrible and yours aren't.
Use available software to see when those events are getting flagged. See if there is any clustering of events.
You may need a small adjustment in that minimum pressure upwards to better hold the airway open in the first place and thus prevent some of the obstructive apneas and hyponeas.
https://sleep.tnet.com/equipment

Give yourself a week to get adjusted to just using all this stuff and then look at maybe doing something if it looks like some adjustments are needed.
If you are waking often or spending much time awake/semi awake with mask and machine on....there's a good chance that the AHI you see isn't all real and awake stuff doesn't count in the final evaluation as to pressure needs.

I wouldn't go changing that minimum pressure until I knew for sure what was going on and why...2 nights of therapy and not knowing what is going on or when...not a good idea in my book. Especially if I wasn't sleeping soundly.
If you want to share what you see in SleepyHead..
See this thread.
viewtopic/t158560/How-to-post-images-for-review.html
You've got available data...use it to determine if you need to change anything or not.
Right now for all we know the bulk of that AHI could be happening at the beginning of the night while awake and no pressure changes are really needed.

[Pugsy]

I see at least one break in therapy where you turned the machine off and back on again.

How many awakenings during the night are you having?

Are you spending much time awake with mask and machine on?
Or are you pretty much going right to sleep and staying asleep for the most part?

We don't need the snore graph...snores are easily (at better displayed) on the Events graph.
Next time you post an image make the pressure graph bigger and omit the snore graph. There's no need to redo this image though.
The pressure graph is more important than the snore graph.

[grannyt]

I see at least one break in therapy where you turned the machine off and back on again.

How many awakenings during the night are you having?

Are you spending much time awake with mask and machine on?
Or are you pretty much going right to sleep and staying asleep for the most part?

We don't need the snore graph...snores are easily (at better displayed) on the Events graph.
Next time you post an image make the pressure graph bigger and omit the snore graph. There's no need to redo this image though.
The pressure graph is more important than the snore graph.

I pretty much go right to sleep when I go to bed. Within just a few minutes.
I wake a few times, but usually go right back to sleep.
The break was when I went to bathroom. I didn't mean to turn the machine off... Went right back to sleep.
No, I do not spend wake time with machine on.

Since I am new, I will wait a few days and post results again. Maybe me and my mask just have to get used to each other

Thank you for all your help!!!

[Pugsy]

Since you report sleeping decently for the most part that likely reduces the chances of what we see on your reports as being SWJ clutter and most likely real.

Give yourself a couple more nights and then let's see where that pressure wants to go.
I do think that you probably would benefit from an increase in that minimum pressure but I am unsure just how much of an increase.
I don't like to rely too much on the 90/95% numbers because they are too easily skewed.
I prefer to maybe look at using the median average as a guide line assuming it seems to be fairly stable.
Going from starting 5 to 11 isn't going to be very comfortable...too big of a jump.

Besides...sometimes when the minimum is more optimal those other numbers will actually reduce a bit when the machine can actually prevent instead of trying to fix a problem after the fact.

Are you going to be comfortable making changes yourself over here on the dark side or are you more comfortable leaving things in the hands of your medical care team?

If you are ready to jump over to the dark side I would first try 7 cm minimum for 3 or 4 nights and see how much of that clutter (the AHI plus the stuff not included in the AHI) clears up. Might need around 9 cm starting minimum but I would suggest working up to it.
Adjustments are easier when smaller and you might get lucky and find out you don't need as much of an increase as first thought.

[grannyt]

Since you report sleeping decently for the most part that likely reduces the chances of what we see on your reports as being SWJ clutter and most likely real.

Give yourself a couple more nights and then let's see where that pressure wants to go.
I do think that you probably would benefit from an increase in that minimum pressure but I am unsure just how much of an increase.
I don't like to rely too much on the 90/95% numbers because they are too easily skewed.
I prefer to maybe look at using the median average as a guide line assuming it seems to be fairly stable.
Going from starting 5 to 11 isn't going to be very comfortable...too big of a jump.

Besides...sometimes when the minimum is more optimal those other numbers will actually reduce a bit when the machine can actually prevent instead of trying to fix a problem after the fact.

Are you going to be comfortable making changes yourself over here on the dark side or are you more comfortable leaving things in the hands of your medical care team?

If you are ready to jump over to the dark side I would first try 7 cm minimum for 3 or 4 nights and see how much of that clutter (the AHI plus the stuff not included in the AHI) clears up. Might need around 9 cm starting minimum but I would suggest working up to it.
Adjustments are easier when smaller and you might get lucky and find out you don't need as much of an increase as first thought.

Hahaha The dark side. I have no problem making changes. Especially, when I looked through the settings on my machine, nothing was set except the pressure. It even had the wrong hose size selected. I won't see my sleep doc until May...Besides, it's easier to ask forgiveness than permission.

I will change the minimum to 7. Then, I'll run a new report in a few days unless something unusual appears.

[grannyt]

Since you report sleeping decently for the most part that likely reduces the chances of what we see on your reports as being SWJ clutter and most likely real.

Give yourself a couple more nights and then let's see where that pressure wants to go.
I do think that you probably would benefit from an increase in that minimum pressure but I am unsure just how much of an increase.
I don't like to rely too much on the 90/95% numbers because they are too easily skewed.
I prefer to maybe look at using the median average as a guide line assuming it seems to be fairly stable.
Going from starting 5 to 11 isn't going to be very comfortable...too big of a jump.

First week...still lots of events. Still waking a few times throughout the night, but going right back to sleep.
See attached Sleepyhead for last few nights.
Thanks!!

[USMCVet]

Personally I would set minimum to 10. However if you choose to try that I would work up to that pressure over a week or two . Basically as fast as is comfortable for you.

[Pugsy]

I think I would stand by my original thoughts...more minimum pressure...Can you maybe try 8 cm minimum comfortably? If not maybe 7 for 3 or 4 nights and see what happens and then maybe 8 cm....and see what happens and then maybe 9 cm.

The OAs, Hyponeas, Flow limitations, RERAs and snores all point to the pressure being sub optimal and while the machine tries to go higher to prevent them it can't do it fast enough. So the solution is to start with a little pressure right off the bat and give the machine a better head start on getting to where it needs to go.
These machines work best when preventing the airway from trying to collapse in the first place instead of trying to fix it after the fact.

You might end up needing even more minimum than the 9 or 10 I am thinking of but sometimes I have seen some pleasant surprises when the minimum pressure is more optimally set. The maximum actually comes down and the median and 90/95% pressures will also reduce.

So 2 reasons why I suggest going up slowly instead of making a big jump.
1....it's easier adjusting to small incremental increases
2....sometimes we get lucky and we don't need as much as we first thought

I wouldn't advise going from 5 minimum to 9 or 10 in one big jump. It's going to be uncomfortable for one thing and it might not even be needed.

[grannyt]

I think I would stand by my original thoughts...more minimum pressure...Can you maybe try 8 cm minimum comfortably? If not maybe 7 for 3 or 4 nights and see what happens and then maybe 8 cm....and see what happens and then maybe 9 cm.

The OAs, Hyponeas, Flow limitations, RERAs and snores all point to the pressure being sub optimal and while the machine tries to go higher to prevent them it can't do it fast enough. So the solution is to start with a little pressure right off the bat and give the machine a better head start on getting to where it needs to go.
These machines work best when preventing the airway from trying to collapse in the first place instead of trying to fix it after the fact.

You might end up needing even more minimum than the 9 or 10 I am thinking of but sometimes I have seen some pleasant surprises when the minimum pressure is more optimally set. The maximum actually comes down and the median and 90/95% pressures will also reduce.

So 2 reasons why I suggest going up slowly instead of making a big jump.
1....it's easier adjusting to small incremental increases
2....sometimes we get lucky and we don't need as much as we first thought

I wouldn't advise going from 5 minimum to 9 or 10 in one big jump. It's going to be uncomfortable for one thing and it might not even be needed.

Thank you. I will raise slowly.