Reducing Central or Clear Airway Events?

[bluemom51]

I read some older posts last night where some folks were advised to reduce their upper limit on their APAP's to reduce the clear airway events. The last few months my AHI's have gone from about 4-6 to 8-15 with half being clear airway events. Sleepyhead says my average pressure is 12.8 - 13.8 - that part has been pretty consistent. My settings recently were 10-18. Last night I reduced the upper number to 17 with little effect. I was just wondering with 12.8 - 13.8 average pressure, what most people would set as their range. I've always thought you had to set the upper limit high enough to cover the infrequent times the machine bumps up to 18 - maybe once or twice a night.

I had been using an Airsense 10 for Her but could never control the rainout - whether manual or climate control. That machine stated a higher average of about 13.5-14.5 and it just felt like a "softer" and nicer experience, but the constant drowning caused me to put it away. So I went back to the S9 that has no rainout but feels "rougher" and stronger, but it's average is about one point less - don't know why.

Anyway, if someone could advise on the current thinking on reducing the clear airway events - up until a few months ago, mine were about 1-2 - now they are 4-6. Also I do feel much worse and my sleep quality is pretty terrible - exhausted every day, etc. Thanks for any help.

[DariaVader]

What do you have EPR set to? To reduce CA, you want to start by reducing pressure changes. Select a lower EPR number or turn it off, and narrow the range of pressure or even try straight CPAP. Currently you are 10 to 18 with an unknown EPR. What are the highest pressures you hit, and how long do you stay there? What pressure are you at when a CA happens? is it usually at the highest pressures? near pressure changes? Those answers might change the advise you would get... but I think I would begin by turning off EPR (assuming you are using it) and raising the lower pressure to closer to the median. You should make small changes so you know what does or doesnt help, and you should give a change several nights to a week before making a further change.

[richb]

I read some older posts last night where some folks were advised to reduce their upper limit on their APAP's to reduce the clear airway events. The last few months my AHI's have gone from about 4-6 to 8-15 with half being clear airway events. Sleepyhead says my average pressure is 12.8 - 13.8 - that part has been pretty consistent. My settings recently were 10-18. Last night I reduced the upper number to 17 with little effect. I was just wondering with 12.8 - 13.8 average pressure, what most people would set as their range. I've always thought you had to set the upper limit high enough to cover the infrequent times the machine bumps up to 18 - maybe once or twice a night.

I had been using an Airsense 10 for Her but could never control the rainout - whether manual or climate control. That machine stated a higher average of about 13.5-14.5 and it just felt like a "softer" and nicer experience, but the constant drowning caused me to put it away. So I went back to the S9 that has no rainout but feels "rougher" and stronger, but it's average is about one point less - don't know why.

Anyway, if someone could advise on the current thinking on reducing the clear airway events - up until a few months ago, mine were about 1-2 - now they are 4-6. Also I do feel much worse and my sleep quality is pretty terrible - exhausted every day, etc. Thanks for any help.

Seems like you have 2 issues here. Rainout in one machine and CAs in both machines. Resmed has an algorithm that sends high frequency pulses through your airway to see if it is open or closed. If your airway is clear and you stop breathing the machine codes a Clear Airway event. This Clear Airway event would most likely be coded as a Central Apnea event during a PSG (sleep study). Some people are sensitive to higher pressures which "washout" CO2 and cause the CA events. Having a high number of Hypopneas is also disruptive to sleep. You need to gather more information which would help fine tune your present machines or even suggest a different machine altogether.DariaVader has asked several questions that would help provide suggestions. I have some more. What is your rate of Hypopneas? It is possible that your Hypopneas are being converted to CAs by the higher pressures and or pressure differential (EPR). Do you have any obstructive events? Have you looked at detailed sleep charts using Sleepyhead? Posting a 5 to 10 minute section of your Sleepyhead chart showing some of the CAs and other events would be helpful.

Rich B

Regarding the rainouts. You might have a defective heated hose. Try working on the rainout issue some more. The newer machine being more gentle could also help reduce the CAs.

[bluemom51]

I read some older posts last night where some folks were advised to reduce their upper limit on their APAP's to reduce the clear airway events. The last few months my AHI's have gone from about 4-6 to 8-15 with half being clear airway events. Sleepyhead says my average pressure is 12.8 - 13.8 - that part has been pretty consistent. My settings recently were 10-18. Last night I reduced the upper number to 17 with little effect. I was just wondering with 12.8 - 13.8 average pressure, what most people would set as their range. I've always thought you had to set the upper limit high enough to cover the infrequent times the machine bumps up to 18 - maybe once or twice a night.

I had been using an Airsense 10 for Her but could never control the rainout - whether manual or climate control. That machine stated a higher average of about 13.5-14.5 and it just felt like a "softer" and nicer experience, but the constant drowning caused me to put it away. So I went back to the S9 that has no rainout but feels "rougher" and stronger, but it's average is about one point less - don't know why.

Anyway, if someone could advise on the current thinking on reducing the clear airway events - up until a few months ago, mine were about 1-2 - now they are 4-6. Also I do feel much worse and my sleep quality is pretty terrible - exhausted every day, etc. Thanks for any help.

Seems like you have 2 issues here. Rainout in one machine and CAs in both machines. Resmed has an algorithm that sends high frequency pulses through your airway to see if it is open or closed. If your airway is clear and you stop breathing the machine codes a Clear Airway event. This Clear Airway event would most likely be coded as a Central Apnea event during a PSG (sleep study). Some people are sensitive to higher pressures which "washout" CO2 and cause the CA events. Having a high number of Hypopneas is also disruptive to sleep. You need to gather more information which would help fine tune your present machines or even suggest a different machine altogether.DariaVader has asked several questions that would help provide suggestions. I have some more. What is your rate of Hypopneas? It is possible that your Hypopneas are being converted to CAs by the higher pressures and or pressure differential (EPR). Do you have any obstructive events? Have you looked at detailed sleep charts using Sleepyhead? Posting a 5 to 10 minute section of your Sleepyhead chart showing some of the CAs and other events would be helpful.

Rich B

Regarding the rainouts. You might have a defective heated hose. Try working on the rainout issue some more. The newer machine being more gentle could also help reduce the CAs.

Tried just about everything for the rainouts including replacing hoses (and machines). Resmed says I will get major water spraying (more than typical rainout) with a Breeze pillows mask. The Tech at Resmed start laughing like crazy when I told him I used the Breeze, and he said it would probably never work because they had built more humidity into the Airsense 10 and the Breeze is almost impossible to use with it...... I am trying a few nasal masks, but can't seem to tolerate them.

I haven't posted any graphs because they are so very different day to day. One day AHI may be 5 and it's not too bad - last night was around 12 and woke up with terrible dry mouth gasping for breath, but SH shows virtually no leaks - very confusing. CAs were 6 averaging 13 seconds. I have such terrible sleep - sometimes bad insomnia, sometimes tossing and turning, wakeful periods.

I end up spending way too much time in bed trying to get 8 hours of sleep and thus way too much time breathing with CPAP. Many times it will be from midnight to 11:30 the next day - that just doesn't seem like a good idea at all, but the only way I can get enough sleep somewhere in there. I've tried setting the alarm, but after being up for a couple of hours, I can't stay awake and go back to bed for more hours anyway. It's a mess and every day's chart looks like a mess. I may have 2 days of 5 AHIs split between CA's and Obstructive, then several days of 12-19 AHI's - most days about half obstructive and half clear airways.

I really would like to use the Airsense 10 instead of the S9, but even with a nasal mask, and trying both manual and auto humidity, there was still strong rainout. I am going to keep trying though. I just ordered another nasal mask to try and I am going back to the Airsense 10 for a few nights. I also have a FF mask I could try, but have never been able to sleep with it.

Maybe if I can find where someone gave the instructions on how to post a graph I will post a couple of the crazy things. I'm not good at stuff like that. What are the pieces that I should post that would be helpful?

Anyway, thanks for the reply - I will keep trying for better "sleep hygiene" (even though I'm not sure how to achieve it) and keep trying masks. Starting to wonder if I need an ASV machine (have tried Bipap in the past and it was a no go) - have finally made an appt with a sleep doctor so I'm sure there will be a sleep study, etc. and maybe some answers.

[bluemom51]

What do you have EPR set to? To reduce CA, you want to start by reducing pressure changes. Select a lower EPR number or turn it off, and narrow the range of pressure or even try straight CPAP. Currently you are 10 to 18 with an unknown EPR. What are the highest pressures you hit, and how long do you stay there? What pressure are you at when a CA happens? is it usually at the highest pressures? near pressure changes? Those answers might change the advise you would get... but I think I would begin by turning off EPR (assuming you are using it) and raising the lower pressure to closer to the median. You should make small changes so you know what does or doesnt help, and you should give a change several nights to a week before making a further change.

I do use EPR at the highest - 3. I will try 2 tonight and then 1, and then zero just to see if it helps. The pressure spikes to 18 a couple of times a night but stays mostly around 11-15 and the centrals usually occur there and they are usually grouped with a bunch of them together and usually get really bad after 7 a.m. I am in bed way too long every night - usually from 12-11:30 trying to get 8 hours sleep somewhere in there - varies from insomnia to tossing and turning to just wakeful periods. It's a mess and my numbers would be better if I could just get up earlier, but without 8 hours of actual sleep, I cannot stay awake and just go back to bed anyway. That's the worst part - I can't be on a "normal" schedule with most of the rest of folks - drives me crazy.

Thanks for the EPR suggestion - I will definitely try that.

[vsheline]

Hi bluemom51,

Obstructive Sleep Apnea is usually strongly positional, and sleeping flat on our back "supine" usually requires higher pressures to treat.

If we take measures to prevent the possibility of rolling onto our back while asleep, this will usually lower our pressure needs, which often lowers the number of CA events we get, too.

Some 'PAP users have found marvelous improvement by making sure they won't roll onto their back while asleep. Some sleep wearing a light knapsack with something light but bulky in it. Others sew a sock or pockets onto a teeshirt with a couple tennis balls inside, between the shoulder blades along the spine. Others use long body pillows under the sheet to help remain on their side. Others sleep in comfortable recliner chair so the head and neck are elevated but stay aligned. Whatever it takes.

[richb]

bluemom51,

You might be experiencing those Centrals during periods when you are "half asleep" or just falling asleep. Centrals and Periodic Breathing are more common during sleep transition. I suggest you consult with your sleep Doc regarding your quality of sleep. You might need more than just CPAP. The suggestion that you NOT sleep on your back is very good. You might eliminate Obstructive events by sleeping on your side.

Rich B

[nsherry61]

For what it's worth, I've found that many of the events that my APAP sees as central or clear airway apneas are associated with periods of disrupted sleep, especially after 5 or 6 AM when I seem to dose off and wake up repeatedly. Frustratingly, that morning time disrupted sleep pattern also seems to be exacerbated by my face mask. So, what I've been doing fairly frequently lately is, after 6 AM, if the mask and APAP are seeming to keep me in a state of disrupted sleep, I just turn off my APAP, remove the mask, cuddle up to my wife, which I haven't been able to do all night with the mask on, and make a point to sleep on my side.

Then, even if I have a few apnea events, I seem to sleep, that time of morning, better without the APAP than I do with it. And thus, I get a bit more sleep than otherwise.

[bluemom51]

For what it's worth, I've found that many of the events that my APAP sees as central or clear airway apneas are associated with periods of disrupted sleep, especially after 5 or 6 AM when I seem to dose off and wake up repeatedly. Frustratingly, that morning time disrupted sleep pattern also seems to be exacerbated by my face mask. So, what I've been doing fairly frequently lately is, after 6 AM, if the mask and APAP are seeming to keep me in a state of disrupted sleep, I just turn off my APAP, remove the mask, cuddle up to my wife, which I haven't been able to do all night with the mask on, and make a point to sleep on my side.

Then, even if I have a few apnea events, I seem to sleep, that time of morning, better without the APAP than I do with it. And thus, I get a bit more sleep than otherwise.

That's exactly what I have done a couple of times, and strangely, after 1-2 hours of sleeping without the APAP, I wake up feeling 10 years younger with none of the usual extreme pain I have all night, and waking in complete painful misery and grogginess. I am So Glad to know I'm not the only one. Most of my sleep issues begin about 6 a.m. - lots of disrupted sleep and weird dreams that are very complicated or scary. Then finally get up feeling like I have been at war all night (actually was). Eighty percent of my events - both obstructive and clear airway are between 6-10 in the morning. I've often thought if I could just survive on 4-5 hours of sleep, I could eliminate almost all events, but.....not possible.

The problem is - I can't sleep without the beast that all night - only for a couple of hours at the end of fighting the APAP. If I tried to sleep without it all night, I would wake up every 2-4 minutes trying to breathe. There has got to be a way to use the APAP as intended for the whole night and wake up actually feeling fairly good. It has Never happened. Only when, as in your example, I doze off for an hour or two after turning it off, or if I happen to lay down mid-day and take a 1-1.5 hour nap, I feel like a whole new person - no pain or fogginess - it's an incredible feeling. But.......why can't we feel like that with a full night of APAP - isn't that the point - to improve how we feel?

[Rick_V]

bluemom what the Resmed tech told you is BS about the Breeze. I have used mine with the humidity set at 6 and no rainouts. I don't use it every night as I am trying to transition over to the Airfit P10 only because my DME can't get the Breeze for me and I am too lazy to get a script sent to another DME. I am a side sleeper and the Breeze is perfect for me. I rigged the Airfit hose to go up over the top of my head and for the most part it works. I kinda got long winded here but, the Breeze is not your problem.