clearairway apneas...lots of them

[sleepsurfer]

finally got my encore pro 2 working....which is nice, however my results after a 3 days show lots of clear airway apneas! isn't that nice. i've been using a pressure of 7 to 10. in a-flex, c-flex, and no flex. in auto and cpap mode. the ca are going up with increased pressure. i'm having like 4 to 10 ca per hour. by the way, my diagnosis is UARS. my ahi in my sleep studies(4) were something like 1 or 2. my reras were 20. with this machine my ahi is 10!!!!! (80 percent clearairway apneas......i got to believe that it is scoring reras as ca's.....right? or i just developed central apneas?

[Julie]

How about "Maybe I should try out a full face mask in case I'm leaking like mad out of my mouth all night"? That seems a lot more likely than having central apneas, especially as you're running a fairly low pressure set. Have you considered that?

[sleepsurfer]

How about "Maybe I should try out a full face mask in case I'm leaking like mad out of my mouth all night"? That seems a lot more likely than having central apneas, especially as you're running a fairly low pressure set. Have you considered that?

i use a chin strap and tape my mouth shut. i also used a FFM last night. no leaks are detected on my apap.

[barry15]

You say you have Encore Pro 2 working. Have you looked at your Waveform Report? It shows every breath, all night long, marking every "event", and you can clearly see what is going on with that report. I have a fair number of Clear Airway Apneas, too, on the same machine, but most of them are when I am awake, trying to fall asleep, so I am not worried about them. I think they are higher with higher pressure, too. And, I also have a fairly low pressure - currently I am using 6 to 7.5, although it should probably go a little higher on the high end. One reason I lowered it is because of the Clear Airway Apneas. The machine sends out a little puff of air (used to detect if it is a Clear Airway Apnea or an Obstructive Apnea, they say), and that puff of air annoys me and wakes me up again, just as I am dozing off. What I don't know, of course, is - would I have awakened anyway, in order to breathe, or would I have started breathing again and then gone off to sleep, if the puff of air hadn't annoyed me? I wish I could turn off that puff of air, even if it meant that the machine couldn't distinguish between CA's and OA's.

Take a look at your Waveform Report. The Smart Card only saves the last night's report, then writes over it the next night, so if you want them all in your database on your computer, you have to download the card every day. I not only download the card every day (which puts it in the Encore Pro database on your computer), I also save each day's Waveform Report as a pdf file. The Waveform Report is accessed by clicking the little dark blue icon on the right side of the page, when you are on the Therapy Data page. It is not obvious that it is there, and they don't tell you that it will be written over every night, but it is the most useful data provided, in my opinion. After you look at your Waveform Report for a night, post more here, or PM me. I am quite interested in this whole Clear Airway Apnea thing that Respironics seems to have invented with this machine. RERA's are another story, and they are also interesting, in the Waveform Report. As is Periodic Breathing. It is a fascinating report, and I wish I knew how accurate it really is. I pore over mine every day.

Barry

[sleepsurfer]

You say you have Encore Pro 2 working. Have you looked at your Waveform Report? It shows every breath, all night long, marking every "event", and you can clearly see what is going on with that report. I have a fair number of Clear Airway Apneas, too, on the same machine, but most of them are when I am awake, trying to fall asleep, so I am not worried about them. I think they are higher with higher pressure, too. And, I also have a fairly low pressure - currently I am using 6 to 7.5, although it should probably go a little higher on the high end. One reason I lowered it is because of the Clear Airway Apneas. The machine sends out a little puff of air (used to detect if it is a Clear Airway Apnea or an Obstructive Apnea, they say), and that puff of air annoys me and wakes me up again, just as I am dozing off. What I don't know, of course, is - would I have awakened anyway, in order to breathe, or would I have started breathing again and then gone off to sleep, if the puff of air hadn't annoyed me? I wish I could turn off that puff of air, even if it meant that the machine couldn't distinguish between CA's and OA's.

Take a look at your Waveform Report. The Smart Card only saves the last night's report, then writes over it the next night, so if you want them all in your database on your computer, you have to download the card every day. I not only download the card every day (which puts it in the Encore Pro database on your computer), I also save each day's Waveform Report as a pdf file. The Waveform Report is accessed by clicking the little dark blue icon on the right side of the page, when you are on the Therapy Data page. It is not obvious that it is there, and they don't tell you that it will be written over every night, but it is the most useful data provided, in my opinion. After you look at your Waveform Report for a night, post more here, or PM me. I am quite interested in this whole Clear Airway Apnea thing that Respironics seems to have invented with this machine. RERA's are another story, and they are also interesting, in the Waveform Report. As is Periodic Breathing. It is a fascinating report, and I wish I knew how accurate it really is. I pore over mine every day.

Barry

oh man i wish i could turn off the puffs too!!! yes, i have been studying my waveform reports too. fascinating isn't it! i just noticed on my trend sheet that as i have raised the pressure from 7 to 10, my oa index and hypopnia index have dropped off to almost nothing(oa was 2.0 and now 0. h was 3.5, now 0.5), while my clearairway apneas have gone up from 3 to 10 per hour. i have hypothesized that the machine is not sensitive enough to detect that there is still an obstruction when it indicates a CA. i thought it would indicate a flow limitation or RERA as they are what predominantly cause UARS(what i have) tonight i am going to try a pressure of 11cm to see if the CA's go up or down. right now i am using c-flex+.

[timbalionguy]

If you cannot for sure determine what might be causing an indication of a clear airway apnea, or if your CAA rate goes up when you increase pressure, the rate is definitely high enough to bring to your doctor's attention. If it is consistently above 5, I would do that sooner rather then later.

That said, a certain small percentage of CAA's is normal in most people.

[sleepsurfer]

If you cannot for sure determine what might be causing an indication of a clear airway apnea, or if your CAA rate goes up when you increase pressure, the rate is definitely high enough to bring to your doctor's attention. If it is consistently above 5, I would do that sooner rather then later.

That said, a certain small percentage of CAA's is normal in most people.

my sleep doctor said the couple centrals that i had on my 4 sleep studies with and without cpap were normal. the fact that this machine is telling me i am having 10 per hour might be an indication as to why they call it a clearway apnea and not central apnea.

[timbalionguy]

Only a PSG can tell for certain whether a given apnea is central or not. That is why I suggested that you make sure you eliminate other causes if you can. From what I understand, a central AHI of more than 5 (and you said you have been seeing as high as 10) will result in a diagnosis of Complex Sleep Apnea Syndrome (CompSAS). The treatment for this condition is a very advanced machine called a 'servo ventilator'. The two most common examples, both heavily discussed here, are the Resmed VPAP Adapt SV and the Respironics BiPAP auto SV (and their newer variants). They may first try a more 'normal' bilevel machine with you first to see if they can control your apnea at a lower, but bilevel pressure. Generally the lower the pressure, the less severe compSAS is.

As a benchmark, my IntelliPAP autoadjust (which has a suspect algorithm for reporting 'centrals') reports an 'NRI' (basically the same as 'clear airway apnea') of about 0.2 most nights. The highest I have ever seen is 1.6.

[fadedgirl]

Take a look at your Waveform Report. The Smart Card only saves the last night's report, then writes over it the next night, so if you want them all in your database on your computer, you have to download the card every day. I not only download the card every day (which puts it in the Encore Pro database on your computer), I also save each day's Waveform Report as a pdf file. The Waveform Report is accessed by clicking the little dark blue icon on the right side of the page, when you are on the Therapy Data page. It is not obvious that it is there, and they don't tell you that it will be written over every night, but it is the most useful data provided, in my opinion. After you look at your Waveform Report for a night, post more here, or PM me. I am quite interested in this whole Clear Airway Apnea thing that Respironics seems to have invented with this machine. RERA's are another story, and they are also interesting, in the Waveform Report. As is Periodic Breathing. It is a fascinating report, and I wish I knew how accurate it really is. I pore over mine every day.

Barry

WOW I had no idea this Waveform report existed and I cannot believe that it gets written over every day. ARGHGHGH. Why would they do that?

Thanks so much for the info Barry, I can't wait to check this report out tomorrow!

[montana user]

Complex sleep apnea is a night techs worst nightmare. A true Complex apnea patient is this:

The higher the CPAP pressure the worst the apnea becomes. This can be central or obstructive. As you lower the pressure the apnea gets better, but the hypopneas/apneas are still present. Then you try Bi-level and you will notice the same thing. The higher the pressure, the worst the apneas. We also see central apneas in patients we over titrate. So just central apnea alone, is not usually diagnosed as complex. But you take centrals AND the fact it gets worst with pressure increases and cannot be fixed with CPAP or Bi-level, then we get a diagnosis of Complex. Thank God for the new SV adapt machines!!!! We can finally do something about it!!! This machine also works on straight central apnea patients as well. for most insurance companies, we have to prove that CPAP AND Bi-level will not fix the person, then we can go to the SV adapt. If we don't follow that guideline insurance will usually reject it. It is a spendy machine and insurance does not want to pay for it if they don't have to.

[sleepsurfer]

i have noticed after studying my waveform reports that in most cases of a clear air way apnea being recorded, there is either a rera or hypopnea just before or after. i think the distinctions between these events is so minute that the machine is having trouble classifying them. remember, i do not have sleep apnea(though i had a handful of everything on my PSG's). i have upper air way resistance. so the when my machine starts out with a baseline for what a clear airway is, it is getting a result that is not 100% clear. (be it nasal congestion, etc.) .........i think i will need more data to figure this out completely.

[timbalionguy]

Montana User can correct me if I am wrong, but I kind of suspect that BiPAP would be effective for upper airway resistance. A higher inhale pressure helps get the air in, and a lower exhale pressure helps get the air out.

[montana user]

Montana User can correct me if I am wrong, but I kind of suspect that BiPAP would be effective for upper airway resistance. A higher inhale pressure helps get the air in, and a lower exhale pressure helps get the air out.

you are 100% correct! Hope you didn't think I was arguing with you or saying you were wrong about complex sleep apnea. sometimes I scan the posts and have something to say and type real quick before I forget or get busy with my patient!

[rested gal]

I don't think I'd put a lot of faith in the "clearairway apnea" data from the new Philips Respironics System One machines as showing probable "central apneas." Not yet, anyway.

If a person's sleep study had not shown many central apneas during titration, quite a few -- perhaps even all -- of the "clearairway apneas" reported in Encore Pro 2 data from PR1 machines may not be central apneas at all. Without the additional data provided by effort belts as used in sleep lab PSG (polysomnogam) sleep studies, I wouldn't put much store in the PR1's "clearairway apneas" reporting.

Likewise, I'm pretty skeptical about the PR1's supposed ability to identify "RERAs" (Respiratory Effort Related Arousals) accurately. Without EEG leads (again, like in a sleep lab PSG) to see brain wave wake/sleep data, I don't see that the PR1's so-called RERA data would mean much. I feel the same way about Fisher and Paykel's touting their newest machines as being able to identify when a person is "awake."

I think both those companies (Philips Respironics and Fisher & Paykel) may be overly market-hyping what their machines can identify. But that's just my layperson's opinion. I could be wrong.

[JohnBFisher]

... I think both those companies (Philips Respironics and Fisher & Paykel) may be overly market-hyping what their machines can identify. But that's just my layperson's opinion. I could be wrong. ...

No, I think you are spot on. Though the data is interesting, you can not rely on it. Rather think of it as a windsock at the airport. If the windguage or even a weather vane is broken, that windsock will give you a general idea of the strength and direction of the wind.

These machines are reporting a "clear airway apnea". The manufacturers are VERY careful not to say they are Central Apneas. But they sure do imply it, don't they? It's just this side of deceptive and dishonest.

And it's things like this that often drives doctors and healthcare professionals crazy. They know they need reliable data. Unfortunately, the manufacturers don't what to clearly note what they are measuring. As a result, it's hard for doctors to know for certain what a "clear airway apnea" REALLY means for you, while you are sleeping.

So, use it as a guide. Is it increasing or decreasing. Does it change when you change masks? More or less. If you use it as your windsock you can often get your therapy into the right range for a home run. But these numbers just don't replace the need for a detailed sleep study to sort out some of these problems.