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09-03-2024, 01:05 PM (This post was last modified: 09-03-2024, 01:06 PM by frolic.)
Clear Airway, CSR events
Looking for feedback regarding current sleep data. Previously posted by oscar data to request suggestions. Since quite a bit has changed, I thought a new thread was warranted.
Original sleep test prescription had a AHI >26. APAP helped, but it the last year or so my sleep quality has not been good.
I suspect that some of the previous Hypopnea flags were false due to side sleeping while wearing Resmed N30i / P30i "freedom" masks (that have the air channel going down the side). I switched to a N20 nasal AirFit (hose connects directly the mask). My AHi is now way down, some nights little to no Hypopnea.
However, I'm still seeing CA and last night there was a CSR event. Looking back at oscar history, I see may one CSR ever few months. I also see some "football" waveforms that aren't flagged as CSR. I need to study past history to get a better idea how often those waveforms happen, and if there is any correlation with other events. Not sure if I should worry about this or not.
My hypothesis is that the CA are CPAP induced, and that the occasional CSR may be triggered by CA. Its also possible that the CA is induced by sleep meds (which I think is a circular feedback loop: bad sleep > meds > other sleep issues)
The other thing I've noticed is my pressure goes up just after bed. I think this may be nasal inflammation, which I'm trying to control with afrin, breathe right strips. I'm wondering if the increase in pressure isn't kicking off the CA issues also. Of course, I can use afrin but so many days due to rebound.
(screenshots to be posted next)
Latest screenshots
Machine: Lowenstein Luisa Mask Type: Full face mask Mask Make & Model: Resmed Quattro FX Humidifier: separate F&P humidifier CPAP Pressure: Epap 4-20 PS 4-20; "auto" rate CPAP Software: Not using software
Other Comments: Using 45 degree angle upper body wedge (36"x36") and 4.5"soft cervical collar; 500 assured tidal vol
Most of the CSR events flagged by Resmed machines are false. Having a diagnosis like heart failure, for example, would make the CSR events more likely to be real. Also, having several episodes of CSR during sleep is common with real, true, CSR than a single event like you have here.
You mentioned sleep medications. Here is some reading on CSR from our wiki. There are a few other legitimate causes of CSR mentioned in this article also.
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.
Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
(09-03-2024, 01:05 PM)frolic Wrote: The other thing I've noticed is my pressure goes up just after bed. I think this may be nasal inflammation, which I'm trying to control with afrin, breathe right strips.
Your pressure is going up because its minimum is too low. I suggest setting it to 8 at least, but ten would be better. At your current 6 cm, you cannot fully utilize your EPR 3 setting.
09-04-2024, 08:58 AM (This post was last modified: 09-04-2024, 09:28 AM by frolic.)
RE: Clear Airway, CSR events
Thanks. Last night, I bumped it back to 7 because I understand that with EPR can only reduce the pressure to the min of 4. My concern is that with higher pressures, I was seeing an increase in CA events. Also, the higher pressures are more periodic short-term (especially at the beginning of sleep) with the APAP returning to lower pressures through most of the night.
Looking thru my charts, my flags are primary Hypopnea and Clear Airway. I have very few Obstructive events, often none at all. After reviewing the CRS wiki page, I read the Hypopnea page. According to the page, Hypopnea can be Obstructive or Central. To diagnose as a Central Hypopnea only if there is:
No Paradoxical breathing
- Not sure how I would know this
No Snoring during the event
- I see no snoring during the Hypopnea event
No increase in the flatting of the nasal pressure flow or PAP flow signal
- I've had to read this statement several times to make sure I'm interpreting it correctly. On the attached chart (zoomed in to several event), it appears to me that there IS an increase in flatting. Therefore, my Hypopnea event are not considered Central.
- However, I'm not sure I understand this point. The preceeding wave forms of the H & CA look simialr to me (football shape), except the CA "flatlines" for a few seconds before recovery.
My immediate thought was understanding the relationship the Hypopnea and Clear Airway events?
Are these events are CPAP induced?
Result of my original sleep test was >26 AHI. That was yeas ago. Since then, I've lost weight & am probably in slightly better health. Wondering if I should request a sleep test (without CPAP) to determine if I even need to be on CPAP now.
I agree that your Hs appears to be obstructive.
Hence, I suggest again increasing your minimum pressure to about 10 cm and seeing its effect on your Hs. Your current CAs are not so concerning.
Machine: Lowenstein Luisa Mask Type: Full face mask Mask Make & Model: Resmed Quattro FX Humidifier: separate F&P humidifier CPAP Pressure: Epap 4-20 PS 4-20; "auto" rate CPAP Software: Not using software
Other Comments: Using 45 degree angle upper body wedge (36"x36") and 4.5"soft cervical collar; 500 assured tidal vol
I agree with G. Szabo. All cpap machines can make errors in distinguishing and reporting different events at times. OSCAR simply reports what the machine tells it to report.
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.
Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
With the 3 CA counting for .38 of AHI in your just short of 8 hours of therapy, it's very close to nothing. Don't let this sway you into an action to avoid them. It'll inevitably make the well treated status of everything else get worse.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
