Clear airway apnea

Hello good folks,

I am relatively new to xPAP therapy, very new to cpaptalk.com (so glad to have discovered this!), and brand new to SleepyHead (thrilled finally to have data I can look at carefully). My APAP therapy is not going particularly well at this point, and I'm overwhelmed by the information out there and the questions I have. I can't even get my head around the latter.

I have a great relationship with the respiratory therapist I'm seeing, but he does not have answers for many of my questions.

My diagnosis was made on the basis of an oximetry baseline test on room air (AHI = 29), an APAP trial, and a follow-up oximetry test on APAP (AHI = 3 and, I might add, a reduction in my average heart rate of 20 bpm). I am waitlisted for a sleep study, which will take place eventually. (I have an appointment with an allergist on May 10, 2012, but haven't even heard from the sleep specialist yet.)

Now that I've had SleepyHead for a few days, I've had the opportunity to spend some time poring over my own data, looking for patterns and correspondences but not seeing many.

But what really concerns me -- and my therapist -- is that over the past 43 days that I've had my own machine, my AHI has averaged 2.23 and I am still very tired, and of that average AHI, nearly half appear to have been CA apneas. Is this indicative that I may also have central apnea, or is it possible that something else is going on that the machine is reporting as an apnea without a blockage? FWIW, I also seem to have a major problem with vibratory snores.

Thanks for you advice. I think I'm going to go read my manual now...

Hello, with an AHI of 2.23 and half of them being clear airway events- well, that is not enough CA's to worry about, even if they are centrals. Your sleep test will show if you are having centrals. It takes some of us longer than others to feel better so I would not be too concerned that you don't feel better yet. I don't know about the vibratory snores. You are right to read the manual and I would also read the clinical manual.
Good luck, hang in there.

msat wrote:... I am relatively new to xPAP therapy, very new to cpaptalk.com (so glad to have discovered this!), and brand new to SleepyHead (thrilled finally to have data I can look at carefully). ...

Greetings! I'm a bit surprised you have not yet had any other responses. So, let me welcome you to xPAP therapy, to the forum and to the world of data analysis! It's amazing what you can learn by having data available (as we shall discuss later).

msat wrote:... My APAP therapy is not going particularly well at this point, and I'm overwhelmed by the information out there and the questions I have. I can't even get my head around the latter. ...

I am sorry to hear that you are not yet attaining the restful sleep that you need. And yes, there is a LOT that you will need to learn if you are to be an active manager of your own health in regards to sleep.

msat wrote:... I have a great relationship with the respiratory therapist I'm seeing, but he does not have answers for many of my questions. ...

It's great to hear that you have a good relationship with the RT. Don't be surprised if there is a lot that he can not answer. They do not have the training to answer many of the sleep related questions. Still that relationship can be invaluable.

msat wrote:... My diagnosis was made on the basis of an oximetry baseline test on room air (AHI = 29), an APAP trial, and a follow-up oximetry test on APAP (AHI = 3 and, I might add, a reduction in my average heart rate of 20 bpm). I am waitlisted for a sleep study, which will take place eventually. (I have an appointment with an allergist on May 10, 2012, but haven't even heard from the sleep specialist yet.) ...

Let's tackle several things here.

First, the over night oximetry study shows that you have apneas an hypopneas that required treatment. Since the follow up study showed a reduced heart rate, it probably indicates that you had obstructive sleep apnea, which the APAP is not helping to address.

However, there is a LOT more that an overnight oximetry study does not show. Do you have periodic limb movements? Do you attain proper sleep architecture? Do you get enough deep sleep? Do you get enough REM sleep? And so on. That is the purpose of the overnight sleep study. It will help see if there is some other factor at play that contributes to your excessive daytime sleepiness.

Second, depending on the location and practice it can sometimes take a while to chat with a sleep specialist. Some don't want to talk until they've seen the sleep study results. That might be the hold up in your case.

msat wrote:... Now that I've had SleepyHead for a few days, I've had the opportunity to spend some time poring over my own data, looking for patterns and correspondences but not seeing many. ...

Remember, this just shows your breathing patterns during the night. It does not show any other issues that might interfere with restful sleep.

msat wrote:... But what really concerns me -- and my therapist -- is that over the past 43 days that I've had my own machine, my AHI has averaged 2.23 and I am still very tired, and of that average AHI, nearly half appear to have been CA apneas. Is this indicative that I may also have central apnea, or is it possible that something else is going on that the machine is reporting as an apnea without a blockage? FWIW, I also seem to have a major problem with vibratory snores. ...

An AHI of 5 or less is considered normal. Those "clear airway" events may just be when you hold your breath as you toss and turn in bed. We all do it. It's perfectly normal. Or it might be due to awakening during the night. When we fall asleep or awaken we go through a state transition when those clear airway events occur. They are perfectly normal and not an issue. Or you might have central apneas. However, at 5 or less per hour, they should not be a problem for you. They should not be causing you to be sleepy during the day.

One thing that can help the vibratory snores is to DECREASE the range for the machine. If it average pressure is 8 and the 90th percentile is at 12 and the machine is set at a range of 4 to 20, then it would probably work better if your reduced the range to 6 to 15. This would allow the machine to respond a little more quickly to snoring and/or obstructions.

msat wrote:... Thanks for you advice. I think I'm going to go read my manual now. ...

Hope the information help. Best wishes as you try to sort out your therapy. And here's hoping you soon attain better sleep!

Hi, it is very possible you sleep (once asleep) with your mouth open and lose all the good air that way... you could test for it by taping for a few nights to see if that helps (do a forum search on the subject) and if it does, you should probably try out full face masks like the Quattro or Hybrid, etc. that let you breath with an open mouth but still get effective therapy.

I was getting Ca's on my encore analysis on bipap and now I'm showing hypopneas and central apnea on bipap st. They are significant- sometimes it is so bad I can't function for 2 days, but I don't know how reliable the machine detection is. I would trust the sleep study data more since they have better equipment and brain wave-oxygen testing.
I have read that raising the pressure will eliminate the Ca's but I prefer to go with a lower setting that gives me more continuous sleep. it's important to clean your mask every day also

My husband uses the same machine as you and it seems to be ultra sensitive in scoring snores. I know for a fact that my husband is not snoring yet the machine is scoring as such. It's almost as though it's recording the sound of his breathing? I was told not to pay to much attention as long as he's not being disturbed. As for centrals, raising the pressure may increase them and the machine does not take any action for centrals.

sickwithapnea17 wrote:I have read that raising the pressure will eliminate the Ca's

I believe it is the reverse: lowering the pressure will reduce CAs.

msat, what is your pressure range?

I think I get better sleep, continuous sleep on lower settings like 12/8 instead of the 18/14 I was prescribed by the sleep lab. I don't think I can get continuous sleep that often on the higher settings. on the higher settings I may sleep through the night but I wake up feeling tired and stressed like I had just gone to sleep.