75 percent clear airway events

[aevans410]

After 2 weeks of data collection (Still no time to post graphs, but its pretty conclusive whats going on. My leak line isn't erratic, the machine rarely even reports a leak) my AHI is still over 5 on average, and 75 percent of these are clear airway events. A bulk of them are an hour or so before I naturally wake up (although this may be why I'm waking up) but there are some scattered throughout the night. Out of those 2 weeks, I rarely have OSAs

The kicker though : I weighed 285 during my sleep study, now I'm at 271. I'm considering lowering my pressure for a couple of nights to see what happens from 9cm to 8.6cm. My concern is if I do this, will the DME be able to tell? I'm still on the compliance radar with Insurance.

I read somewhere that generally a 20 lb weight loss = 1 cm decrease in pressure. Is this accurate?

[LSAT]

After 2 weeks of data collection (Still no time to post graphs, but its pretty conclusive whats going on. My leak line isn't erratic, the machine rarely even reports a leak) my AHI is still over 5 on average, and 75 percent of these are clear airway events. A bulk of them are an hour or so before I naturally wake up (although this may be why I'm waking up) but there are some scattered throughout the night. Out of those 2 weeks, I rarely have OSAs

The kicker though : I weighed 285 during my sleep study, now I'm at 271. I'm considering lowering my pressure for a couple of nights to see what happens from 9cm to 8.6cm. My concern is if I do this, will the DME be able to tell? I'm still on the compliance radar with Insurance.

I read somewhere that generally a 20 lb weight loss = 1 cm decrease in pressure. Is this accurate?

No validity to that statement!

[Pugsy]

Yes, the DME will be able to tell if you change your pressures IF they bother to look at anything other than just hours of use.

Ditto to what LSAT said about the validity of that statement.. Weight loss doesn't guarantee anything when it comes to OSA.

[chunkyfrog]

Other factors have an effect on open apnea--some we can control.
Some sleep meds, or alcohol can really throw a monkey wrench into your motor--avoid if possible.
Also, the DME is unlikely to care about anything but compliance--that's how they get PAID.
If you drop your pressure a half centimeter, check your data for 5 days, drop again or go back up,
it's all the same to them; but if you can get your AHI and OA's down, that would be great.
I was titrated about 2-4 cm high, (One night titration--how close can they possibly get?)

[Julie]

Well, I think that if losing weight were to make a difference, maybe a bit more than your 15 (a relatively small percentage of large you ) might be needed to see a difference... maybe if you dropped 50 lbs you would see a change, but whether or not you could stop cpap would be another story (for another sleep study to decide).

[aevans410]

I really don't wanna stop CPAP, I just want the centrals to stop and I'm not interested in doing another sleep study. I don't believe I slept long enough or well enough to produce centrals.

I am going to call the sleep clinic today.

[SleepyToo2]

What did the sleep center say? As has been noted above, there are many causes of "centrals" including turning over in bed. Sometimes the treatment of OSA can unmask other sleep disorders, such as restless legs syndrome. That may not show up in your sleep study, especially if you didn't sleep for much of the night (quite possible!). I have yet to figure out which of my "centrals" are real and which are not. Without an EEG lead (the "head" lead during your study), I am not sure if you can tell. I get some very strange looking patterns on my flow rate chart, but I don't see a consistent pattern to them. Definitely a question for my sleep doc when I next see him (November).

Are you having problems with allergies? Do you have asthma? Is your room too hot? Do you need humidification or less humidification? These things all seem to affect my "centrals".

[archangle]

Don't get panicked over centrals. They're probably no more harmful than obstructive apneas. They may just be harder to eliminate.

If you're feeling OK and are sleeping OK all the time with the CPAP, don't worry too much about numbers under 10 for the first month or so, especially if the apneas aren't that long in duration. You can tinker later if need be.

[aevans410]

The sleep clinic said that they will review the data when I have my follow up appointment in mid september. No openings until then.

I'm sleeping ok most nights and feel good, so maybe I'm just being a little too "concerned" about it all. I have a few bad nights, and it seems I get a little more freaked out afterwards. Last night however I slept almost all night, didn't have to get up to go to the bathroom (woke up once, went right back to sleep) and had a AHI of 3.4.

Thanks for all the thoughts and encouragement guys, its very much appreciated.

[DavidCarolina]

There is SOME evidence that weight loss can reduce OSA. But besides that, losing weight when youre significantly overweight is just about the most important thing you can do for your health, so keep it up and get to your target weight!!! Its a win-win proposition.

I'd also add to the avoiding alcohol list:avoid eating after dinner, avoid caffeine, avoid dairy in the PM, and try to elevate your head with two pillows while sleeping on your back or side.

I wish i knew more about dental appliances, but I strongly suspect using one alonside cpap is the best frontline defense you can have.

[Lizistired]

I wouldn't worry about lowering your pressure to see if it makes a difference. I would probably go a full cm. Just keep a journal of your changes and the results.
I made some adjustments to mine prior to my 30 day follow up with the sleep doc. Then the last 7 days, I put it back on the script pressure, so that detailed data would be there if they wanted to look at it. They didn't even discuss my data with me.
If it improves your therapy, or not, you will know. Why wait 3 weeks for them to try the same thing?

[Java Time]

my AHI is still over 5 on average, and 75 percent of these are clear airway events. A bulk of them are an hour or so before I naturally wake up (although this may be why I'm waking up) but there are some scattered throughout the night

aevans410,
I have a similar story. After 11 months of data collection my AHI is 4.5 on average, and I also find approximately 75 percent of these are clear airway events. I also find a bulk of them are an hour or so before I naturally wake up (although this may be why I'm waking up) but there are some scattered throughout the night.

Over the past year I've tried adjusting my minimum pressure up and down from 8 cm up to 11.5 cm for extended periods of time (my prescribed minimum pressure is 10), trying to move my AHI average down. I do find my nightly AHI goes up and down for a few days or even a couple of weeks, but my AHI trend over any several week period is consistently in the 4 to 5 range.

I've tried several nasal and pillow masks, changing sleep positions, changing humidity settings, medications that I can adjust, changed pillows, have reduced my weight by 10% and changing many other things, but I still stay in this same average range of 1.25 AHI for my "non" clear airway events and roughly 3.75 AHI for my clear airway events.

Since I've tried the reasonable things I can control to reduce my AHI, clear airway events and "non" clear airway events, at this point I'm just not worrying a lot about why I can't keep my total AHI below 4.5 on "average".

I'm truly happy for the folks who can drive their AHIs to really low numbers and wish that for everyone, but that might not be possible for all of us.

My pre-CPAP Sleep study showed me at 70 AHI. Pre-CPAP I was waking up gasping for breath at night and even felt like I couldn't get enough air during the day sometimes. For me I'm focusing on how much better I am on CPAP than I was before the treatment.

Best of luck to you and do let us know if you find a way to drive down these events!

[1041]

Java Time and aevans410, do your centrals look like this?

http://www.thoracic.org/clinical/sleep/ ... -event.php

[Java Time]

Java Time and aevans410, do your centrals look like this?

http://www.thoracic.org/clinical/sleep/ ... -event.php

Do you mean the "airflow" line from that link versus what I see in SleepyHead? I'm not sure that mine look like that, maybe I need to zoom in tighter.

Again, after 11 months of monkeying around, I'm okay averaging just under 5 AHI on average. My doctor and DME both seem to place "under 5 AHI" as the target to shoot for. Better than I was pre-CPAP
But, since you asked, I attached some examples of what I mean...

Here is a link that shows the high "clear airway" events that I see many mornings before waking up. I do also typically have a few of them scattered throughout the night.



Occasionally the "clear airway" events are bunched throughout the night like this



Here's a really good night (for me)

[sylvie]

I wish i knew more about dental appliances, but I strongly suspect using one alonside cpap is the best frontline defense you can have.

This is so true, people. I can't even tell you how true it is. Here's the really weird thing, though. In order to find out how far I should turn my Somnodent out, I was and am using it with the cpap, and checking each morning to see the waveforms, indexes, all on APAP mode. I finally nailed down the pressure to cpap mode at 10.0, and the Somnodent was out ONLY about midway, really no strain on my jaw at all. Then, just to see, I turned it out one click a night and took note of the indexes. (I don't know the exact mm the Somnodent was out, but let's just say it was at 3.0 (which is probably close to the actual mm)). When I went to 3.1 (and I kept it there for about 3 days), the indexes slightly increased and the waveform was "rougher." Once I turned it back to 3.0, everything calmed back down to zero recorded index events. Literally, one small 1/10th of a mm made the difference. It is a matter of "hunting and pecking" for a while to nail down a good pressure with the amount of jaw advancement, but it has really paid off. Hope this bit of info helps others. I'm a firm believer that anatomy is "huge" when it comes to apnea.