Are these CA's any concern?

[Baby's Daddy]

Good afternoon kind cpap talkers,
As Columbo said, "Just one more question". From this "Newbie".
I've managed to get my AHI's down to an average of 3.5 per night from 7.5, six weeks ago. (30 before cpap).
Of that 3.5 average, 2.5 is clear airway indices. (CA). Is that CA number fairly normal or too high compared to OA's ?
I'm titrated at 12 cm. Machine set at 12 min, 20 max.
Thank you, and I do truly appreciate the kindness of this group.

B.D.

[JohnBFisher]

Unless the clear airway apneas (CA) are causing you problems, then I would say "Nope! Don't worry!"

Why? Well, one reason the machines score items as "central apneas" that are not in fact a central apnea. It's perfectly normal for us to awaken slightly during sleep. For example, I might awaken from being stiff and decide to turn over in my sleep. Now, while I don't remember that the next morning, my wife occassionaly says we talked ... and I have no CLUE about it. Of course, she tends to think (rightfully) that I don't have any clue, anyway!

My point is that we all occassionally awaken, just enough to toss and turn, then fall back to sleep. This is completely normal.

But here's the "catch". It is perfectly normal when we fall asleep to have these "central apneas". That is there is NO effort to breathe. Why? Well our bodies transition from one mechanism to control sleep to another. During that transition our sleep becomes slightly unstable. And those "central apneas" occur. However, when they occur, it is perfectly normal.

Here's an article that discusses this transition and the impact on sleep:

Ventilation is unstable during drowsiness before sleep onset
http://jap.physiology.org/cgi/reprint/99/5/2036

On a sleep study those apneas during sleep onset are NOT scored as central apneas. After all, it's a prefectly normal for them to occur. So, unless it causes poor sleep, I would not worry about them.

[Hawthorne]

A friend of mine asked his RT and was told that anything under 5 CAs, on that machine, is no problem.

I had wondered, like you, what would be normal or okay, since my last machine did not report CAs in the software. I found it helpful to know this. I am assuming we can count on that "professional" opinion!

[JohnBFisher]

As my neurologist explained to me, whether it is central, obstructive or both, the effort is made to keep the apneas below 5. Above that, if they result in symptomatic sleep issues, then it should be addressed. If there are obstructive apneas should they be addressed? If it is mostly central apneas, then perhaps supplemental O2 will help reduce those numbers.

In this case the AHI value (including the hypopneas) is well below 5. So, unless it leads to symptoms, it's not something to worry about.

Of course, when in doubt, discuss it with your doctor.

[chunkyfrog]

I, too am wondering about centrals:
I had none in sleep study. (13 AHI before CPAP --down to under 2 now); BUT
half or better of my remaining apneas are centrals.
I know the number is still low--but, at what point SHOULD I be concerned?

[Baby's Daddy]

JohnB,
Thank you so much for the information and link to a very good article. At the end of the article I checked the footnotes/references
to see if I found your name. It was well written and very informative as all of your posts!
Thank you again,
B.D.

[FlyingB]

My stats are really strange with CA's also. I now have my OA's down to under 1. But the machine records CA's ranging from 6-40. Usually they are under 10 for a few weeks, then all of a sudden they'll climb up to 40 and back down again during a week. The high CA's are usually accompanied by greater than normal headaches. Since it seems to be fairly regular, my wife just calls it my "period" (when my head is pounding, I'm not the nicest person). I've been wondering if it is something I should be worried about, or simply miss-readings on the machine. However, looking at it through the software, the apnea marker seems to coincide with little to no air flow.

[JohnBFisher]

My stats are really strange with CA's also. I now have my OA's down to under 1. But the machine records CA's ranging from 6-40. Usually they are under 10 for a few weeks, then all of a sudden they'll climb up to 40 and back down again during a week. The high CA's are usually accompanied by greater than normal headaches. Since it seems to be fairly regular, my wife just calls it my "period" (when my head is pounding, I'm not the nicest person). I've been wondering if it is something I should be worried about, or simply miss-readings on the machine. However, looking at it through the software, the apnea marker seems to coincide with little to no air flow.

FlyingB, I never say "don't worry about it". You have done exactly the right thing to start to get it under control. It is clearly impacting you (and your family and friends), so it's quite real and something you should address.

First, you note that when the number climbs you also seem to suffer from severe headaches. Sure sounds as if the one triggers the other. That was part of my symptom set prior to getting it under control. Central apneas cause a drop in oxygen to the brain just as obstructive apneas do.

Second, a word of warning. Don't use Ibuprofen for those headaches (in any form). Too much Ibuprofen can damage your kidneys, especially if you have high blood pressure. I am speaking from personal experience.

Third, since you have massive headaches that impact your quality of life, I highly recommend looking into purchasing a pulse oximeter. Why? You have information from your machine that you can show what appear to be central apneas. If you also show pulse oximeter data from the same time, it will be clear it is impacting you.

By the way, some doctors will take that as you obsessing about it. Be clear that you were trying to better describe the situation. Sure you could say you had headaches that seem to be connected to the information on the machine. But you wanted to see if it resulted in lower O2 levels.

Even if you don't use a pulse oximeter, you should discuss the pattern and the impact with your sleep doctor. It might be that something as simple as supplemental O2 will help you on those nights when you have heightened central apneas.

Anyway, good luck with working through this.

[JohnBFisher]

... Thank you so much for the information and link to a very good article. ... It was well written and very informative as all of your posts! ...

Why thank you! With my 20 years of experience with xPAP therapy. I try to help others along their journey. It takes quite a bit to adjust to using CPAP/BiPAP/ASV. I figure if my experience can help someone else, then we all benefit.

And I certainly want to help others avoid some of the pitfalls I encountered over the years. I know what it's like to be not believed when I note that I have problems with central apneas. Fortunately, I finally found a doctor who would test and show that I need an ASV unit. It's made a world of difference. I was getting very desperate for sleep a year ago. My blood pressure was out of control. And i was barely functioning. If I can help others avoid that type of situation, I feel I've made my own experience wothwhile.