Mostly Clear Airways

[Snorky]

I was diagnosed with severe OSA about 5 years ago following an overnight in-clinic sleep test. The results indicated that I didn’t have any events when I was sleeping on my side so I used a tennis ball in my pyjamas to stop me sleeping on my back. However, after 5 years of not sleeping that well I gave up the tennis ball and finally decided to try using APAP.

I am much happier with this treatment and my AHI is pretty low (1.70) over the last month. However, I am still waking up in the night and not getting enough sleep and I am concerned that this is due to Clear Airway events, which can be quite severe on some nights.

I asked my doctor about these CA events about a month ago but he was not concerned and said that I do not have CSA and that I should continue with my therapy at the current settings. However, I would like a second opinion.

I have attached graphs from a particularly bad night and some summary stats. Please could you have a look at them, in particular the CAs, and let me have your views about what these are and what I can to do to reduce them?

[Pugsy]

Go here and watch the videos especially the last one.
http://freecpapadvice.com/sleepyhead-free-software

You weren't asleep when those CAs/Centrals were flagged in that zoomed in section. If you aren't asleep they aren't real and they don't count. You have to be asleep before we worry about them and you have to have more of them than you are having to earn the CSA diagnosis.
It is normal to have a random real asleep central every now and then.

Your central flags are a symptom of your poor sleep but not the cause of your poor sleep.
You woke up....had irregular awake/arousal breathing and all those flags don't count. You didn't go back to sleep until about 01:45:00.
You can have false positives arousal related events in any category...not just centrals.

Now what caused you to wake up....million dollar question.

[mper!?]

hi,
_good analysis, Pugsy, as usual; totally agree......._charts are rather similar to mine, as of my early days on APAP......arousals to wake ups could have, indeed, many causes; whatever be them, however, to clear up eventual solution, in my modest opinion, it would depend on better respiration, first of all. High FL suggest to me, things are not doing well (I suspect, in larger scale, flatted top inspiration would be present). And, you know, so many people, like me (an UARS'), have a very sensitive sleep to respiratory effort, leading to arousals/wakeups. After 2.5 years I am still struggling with my BPAP to battle the deleterious constriction effects of minor constrictions on my respiration.

Good luck

[Pugsy]

High FL suggest to me, things are not doing well (I suspect, in larger scale, flatted top inspiration would be present).

While the OP's FL graph is a bit active. I have seen much worse. See below for a real ugly one.
I tend to try to answer questions as presented and not go speculating without more information. Obviously can't see the shape of the breaths in this zoomed in screen shot to evaluate accurately for FLs and we don't know if the FLs are responsible for the poor sleep.
Could be any number of things...like medication side effects or pain or whatever. Might be the FLs. Until someone wants to attempt to dig deeper into the "why" behind the poor sleep I tend to just answer the primary question.
And the link to the videos shows how to zoom in on the breaths themselves and we could then use that tool to evaluate the FLs should the OP wish to go down that road. So before I would go down that road I would gather more information....like is there any nasal congestion going on because nasal congestion can cause more activity on the FL graph. Along with the usual additional information needed to help establish a good history like meds, other health issues, etc.

ugly fl graph.JPG (194.23 KiB) Viewed 1190 times

[Snorky]

Hi Pugsy,

Thanks for the advice. I have viewed the video about CAs and although I can see that a number of my lone CAs do look like SWJ, I sometimes have breathing patterns that wax and wane and seem to have apneas or near apneas in them (see attached). I would appreciate your advice on these.

[Pugsy]

In your last posted image above it's a bit difficult because I can't see enough of the flow rate prior to the first flagged event but the breathing prior to the first flag is obviously arousal/awake breathing and to my eye you never went back to sleep at all during the segment above and all that waxing and waning I would classify as SWJ if it were my report.

[Snorky]

Hi Pugsy,

Here are a couple of additional screenshots - one zoomed out over the whole apnea period and the other showing the flow rate prior to the first apnea. Does this look all look like arousal and SWJ or could this be something else?

[Pugsy]

If that were my report...that obvious arousal breathing prior to the flagging of the first OA flag makes me suspect SWJ first.

approx 6:50 to 7:00....I am betting half awake...half dozing kind of thing. Was this close to your normal wake up and get up time?
I would shrug my shoulders and move on. I don't see where you actually ever went back to solid sleep until maybe 07:01:00 ish time frame.

[Snorky]

Yes, this was just before I woke up. Thanks for your analysis.