"Cluster" AI's - Cause for concern?

[jonnybee]

Started CPAP about two and a half months ago using S8 series pump. Received S9 series 6 days ago. Pressure set at "5".

After 6 days, AHI is 2.0. Other parameters appear normal.

After the second night on the S9, detailed data showed a "cluster" of 26 AI's in a 25 minute period followed 15 mins later with another group of 5 AI's in 10 mins. Otherwise, just a few scattered AI's with a couple of centrals. Again, all other parameters appeared normal during these periods. Electrical power to the neighborhood was lost for about an hour during the night but not during the period discussed.

Last night, the data showed a group of 10 AI's in a 13 min period. Again, all other parameters appear normal; no leak, no snoring. The remainder of the night, I apparently only experienced a total of 4 AI's which produced an AHI of 1.6.

AHI for the 6 days is 2.0

Three questions:

1. Anyone else experience "cluster" activity?
2. Is this activity cause for concern?
3. Should I be happy with an AHI of 2.0 or should I try bumping the pressure up to "6" and monitor the results?

Thanks in advance.

John

[ozij]

Started CPAP about two and a half months ago using S8 series pump. Received S9 series 6 days ago. Pressure set at "5".

After 6 days, AHI is 2.0. Other parameters appear normal.

After the second night on the S9, detailed data showed a "cluster" of 26 AI's in a 25 minute period followed 15 mins later with another group of 5 AI's in 10 mins. Otherwise, just a few scattered AI's with a couple of centrals. Again, all other parameters appeared normal during these periods. Electrical power to the neighborhood was lost for about an hour during the night but not during the period discussed.

Last night, the data showed a group of 10 AI's in a 13 min period. Again, all other parameters appear normal; no leak, no snoring. The remainder of the night, I apparently only experienced a total of 4 AI's which produced an AHI of 1.6.

AHI for the 6 days is 2.0

Three questions:

1. Anyone else experience "cluster" activity?
2. Is this activity cause for concern?
3. Should I be happy with an AHI of 2.0 or should I try bumping the pressure up to "6" and monitor the results?

Thanks in advance.

John

Hi John,
I clusters on the S9 -- and have discovered that many of my apnea clusters occur when I'm tossing an turning, not really asleep, and they are often not obstructive apneas.

ResMed machines let you raise pressure in 0.2 increments.

[jerainey]

My savvy RT looked at my S9 records and identified those "clusters" as being normal for "incipient sleep". In other words, when you are just starting to doze off something about our physiology (muscles relaxing???) produces these repeated apneas. For me this can happen when I first go to bed or when I start over after a pee break or after an arousal during a normal sleep period. For me, they don't happen all the time so I hope the occasional event is not too damaging.

[jonnybee]

Thanks for the info. Makes me feel better knowing others have experienced same.

John

[Stetson]

I get the same thing. Mine happen at the same time each night, exactly when my partner gets in bed. So I would have to agree with the movement causing cluster therory.

[xenablue]

I get the same thing. Mine happen at the same time each night, exactly when my partner gets in bed. So I would have to agree with the movement causing cluster therory.

Well... how about that?? That explains my 'events' every night some time between 1:30am and 2:30am - when my 2nd shift hubby goes to bed.

I never fail to learn something on this forum

xenablue

[roster]

After the second night on the S9, detailed data showed a "cluster" of 26 AI's in a 25 minute period followed 15 mins later with another group of 5 AI's in 10 mins.

Positional sleep apnea (PSA) is very common; maybe more than 50% have it. If you normally sleep on your sides and tummy but roll onto your back for some minutes, PSA could be the cause. With PSA the patient's apnea is more severe when backsleeping and may require more pressure to control.

Here is an old post of mine:

Do you know if you have positional sleep apnea? It may be much on your back than on your stomach or sides. Here is an extract from a post:

............
I would like to make you aware of "positional sleep apnea" (PSA). Maybe 40% or more of patients have PSA.

PSA means the apnea is much worse in one sleeping position (on the back) compared to other sleeping positions. For example, my sleep apnea is very severe when I am sleeping on my back.

For people with PSA, the sleeping position can have a big effect on CPAP pressure requirements. For example, I have been titrated in a sleep lab and at home have confirmed my pressure requirements for different positions. On my back I require a pressure of 19 cm (Yow!). On my side or stomach, a pressure of 8.5 cm is sufficient. So I have some devices and train myself to sleep only on side or stomach and use pressure of 8.5 cm.

You may want to make some observations about the possibility of PSA in your case. There may be information from your lab PSG also.

.............

[jonnybee]

Thanks for the replies.

No, I don't know if I have PSA and it certainly is something to research/experiment with. I'm glad I was able to convince my GP to insist that the DME exchange my S8 for an S9. Now, at least, I can follow what is going on.

John

[DoriC]

Jonnybee, do you know your titration? Did your Dr prescribe that pressure? A pressure of 5.0 seems pretty low and most people at that setting would find it hard to breathe.

[rosiefrosie]

Jonnybee, do you know your titration? Did your Dr prescribe that pressure? A pressure of 5.0 seems pretty low and most people at that setting would find it hard to breathe.

Dori's right. I think I would try bumping my pressure up alittle.

rosie

[jonnybee]

Jonnybee, do you know your titration? Did your Dr prescribe that pressure? A pressure of 5.0 seems pretty low and most people at that setting would find it hard to breathe.

I did the initial sleep study at the local hospital and a few days later was informed by telephone that I had "mild" apnea. I returned for the titration a few nights later. Being fairly ignorant of the process at that time, I failed to ask very many questions. At the conclusion of the titration, I was referred to a DME where I was issued an outdated CPAP and advised by the DME that the prescription had called for a pressure setting of "5" and that the machine was set as called for. How to turn the CPAP on was pretty much the extent of the brief. I did the compliance month and then had the face to face visit with my GP. By now, having joined this forum, I had accumulated enough knowledge to realize I had been issued a recycled yesterday's technology machine and had received virtually no information concerning my condition. I asked my GP if she would be willing to contact the DME and request an exchange of equipment to an S9 series machine which was data capable and she did so. She was totally unaware of the differences between machines, i.e. which had the cards for collecting data and which didn't. At that visit, I suggested that somewhere along the line I should have been briefed on the results of the sleep study, what equipment I should be issued, and what to expect. She was sympathetic but offered no real opinion since, after all, she is not a sleep specialist. Bottom line, I did the sleep study, was issued a machine, and told to go for it on my own.

So, I received my S9 series machine, continue to follow this forum and plan to monitor my machine (I have the software), ask questions here, and do the best I can. There are no sleep specialists in my area. So far, I have been pleased with my results. I feel much better, have more energy and am sleeping longer and much more soundly.

Sorry for the semi-rant. From reading posts from others, I suspect that my situation is the rule rather than the exception.

[jonnybee]

Jonnybee, do you know your titration? Did your Dr prescribe that pressure? A pressure of 5.0 seems pretty low and most people at that setting would find it hard to breathe.

Dori's right. I think I would try bumping my pressure up alittle.

rosie

The breathing is fine but I think I will try bumping the press up a tad and see what happens.

Thanks.

[DoriC]

Also check the EPR setup keeping in mind that the pressure on exhale drops from 1-3cms depending on the setting.. At your low pressure you probably would be comfortable turning it off. Keep us posted.

[robysue]

Also check the EPR setup keeping in mind that the pressure on exhale drops from 1-3cms depending on the setting.. At your low pressure you probably would be comfortable turning it off. Keep us posted.

My understanding from reading my S9 manuals is that regardless of the EPR setting, the lowest the S9 will drop the pressure to is 4cm. In other words, if the OP's S9 is set to 5cm and EPR is set to 1, 2, or 3, the most the exhale pressure will drop by is 1cm (from 5cm to 4cm).

[jonnybee]

Also check the EPR setup keeping in mind that the pressure on exhale drops from 1-3cms depending on the setting.. At your low pressure you probably would be comfortable turning it off. Keep us posted.

My understanding from reading my S9 manuals is that regardless of the EPR setting, the lowest the S9 will drop the pressure to is 4cm. In other words, if the OP's S9 is set to 5cm and EPR is set to 1, 2, or 3, the most the exhale pressure will drop by is 1cm (from 5cm to 4cm).

Experienced another "cluster" event last night. Have bumped the pressure to 5.6 for tonight.
I think that's correct concerning the EPR drop. Mine was set to "3" by the DME but the min pressure is "4" so that's the min the machine will allow.