[split] Still tired - too many clear airway events

[JamesD0079]

Hi there,
Just jumping onto this thread, as I'm experiencing a very similar issue with lots of clear way apneas. I've been on CPAP for about 2 months now and trying to get things right. The CPAP is helping compared to without it, but I'm waking up exhausted most mornings and having disturbed sleep. I'm curious as to whether the suggestions thus far helped your situation? 

My EPR is at max 3 on Airsense 10, so I'll turn down to 2 tonight to see if it helps. I'll upload some screenshots of my data, if anyone has any suggestions based on the data, I'd be so so grateful. I have an issue with soft-palate collapse, so I was wondering if these clear airways are actually my solft palate collapsing and I need to up my min pressure (which is usually 5), or if they are central apneas and the EPR might be the main culprit. Thanks so much in advance!
p.s. today is the first day I've ever looked at OSCAR and the data, so forgive my ignorance! Happy to upload more screenshots as required.

   
   
   

[Sleeprider]

I think you are on the right track to reduce EPR to deal with centrals. I don't see them as a major problem, and they will likely pass as you adapt to CPAP therapy. With EPR 2, I would suggest limiting pressure from 6.0 to 10.0. Not sure how you got a minimum pressure of 6.8 when your median pressure is 6.4. Just doesn't add up that median is lower than the minimum set pressure.

[JamesD0079]

Thanks very much, Sleeprider, I really appreciate your response. I actually changed my min pressure setting to 6.8 in early morning, hence the discrepancy. 

I'll attach my chart from last night, reducing EPR to 2 has definitely helped, check it out! 

Do you think I should try and get to EPR of 1? I did try it at 1 the other night and woke up after about an hour finding it a bit much. It's now back at 2. While I had a better sleep in general last night, I still don't feel particularly well rested and was disturbed quite a bit in the morning although not waking fully.

Also, I was a bit unsure about what you meant by "With EPR 2, I would suggest limiting pressure from 6.0 to 10.0"  - do you mean changing my min pressure to 10? Last night I had it set on auto at 6.4min and 9.0max, which seemed to work fairly well, at least from a data perspective.

I'm curious about some of these clear airway events in the morning, do they look like central apneas, or something else? I'm still wondering if they might be more related to me waking up (but not fully) almost immediately when my soft palate collapses (REs?). Oscar definitely picked up an RE in the early hours. I've screenshotted that cluster.

Sorry about my ignorance on all these matters, new to all of this obviously!

Thank you so much! 

   
   

[Sleeprider]

Let's try 6.0 to 8.0 pressure first, then we can look at EPR. Your pressure is increasing in response to flow limits, so I think you need the current EPR to deal with the flow limits and the central event rate is not that concerning.

[JamesD0079]

Hi Sleeprider, thanks so much for your response and advice. I set my min to 6.2 and my max to 8.4 last night (thought I would move gradually to the 6.0 / 8.0 you recommended). In general I had a more restful sleep and feel somewhat human this morning, which is nice, but definitely room for improvement. (Note - my setting was 6.4/9.0 the previous night.)

A couple of interesting notes:
- I had less clear airway events, which is really great.
- I had a bunch more hypopneas, compared with previous night, especially in a cluster around 4am (see attached) when I think I was sleeping on my back, so I'm wondering if my max is now too low?
- I was really bothered by leaks last night, especially out the bottom of my mask. I'm using a resmed f20 full face mask. Mouth breathing seems to be a factor here.

I have at my disposal a: mandibular advancement device / a wedge pillow / a soft cervical collar. Ideally I would prefer to not use any of them in conjunction with CPAP, but wondering if you think using any of these would give more insights?

I've attached last night full, last night hypopnea cluster and the previous night's full.

Really interested in your thoughts. Thanks so much again!!


Last night:
   
Last night hypopnea cluster: 
   
2 nights ago: 
   

[JamesD0079]

Hi there,

Interesting development, I added the soft cervical collar and have seen a significant drop in my AHI and generally feeling more rested. I'll post data for the first night without the collar and the following three nights with the collar (extra night posted in following reply). 

If someone could please advise: should I change my pressure settings based on the data to help reduce my clear airway apneas?


While I feel better in general, I would love to feel properly rested at some point!

Thank you!

   
   
   

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Here is night 3 with the collar also

   

[SingingWolf]

I have been on APAP about 20 months and am pretty satisfied with the treatment effects. Over the long term what I have noticed is that my Clear Airway score on Oscar is always higher than my Hypopnea index. For example my daily average AHI score for the past week is 1.69 and the Clear Airway average is 1.28, Hypo is 0.38, RERA is 0.12. I can pick out any week over, say, the past 200 days and these relationships hold.

My pressure range is 8-14, EPR is 3 and full time. I use an AirSense 10 with a Dreamwear nasal cushion and mouth tape. My leakage is always under 1.

Since Clear Airways are described as a cessations of breathing when the airway is open, am I right to assume that they generally are cognitive in origin? For example, yesterday I got a COVID booster and had a miserable night. AHI was 3.92, CA=3.78, Hypo=0.14, RERA=0.14

If they are cognitive in origin, is there any APAP adjustment worth considering? I am loathe to changing settings given my score pattern, but I could be convinced otherwise.

Thanks