[Treatment] Struggling to reduce Clear Airway events

[codebread]

Hello everyone

Back in June I was diagnosed with mild to moderate obstructive sleep apnea (AHI of 11). I've been using an AirSense 10 for a couple of months now and while I've eliminated all obstructive events, I'm typically sitting within a range of 6-8 AHI from Clear Airway and Hypopnea events alone.

I feel better than I did before treatment, but I'd really like to get my AHI down to less than 5 at a minimum. There were two nights about a month in where my AHI was around 2 and it was amazing. I've been waiting to seek advice in case it was treatment emergent CAs, but now that it's been about two months I'm worrying that I need to adjust my treatment.

I've attached OSCAR screenshots from my last few days of treatment. Any insight would be greatly appreciated!

[codebread]

Attaching my initial sleep report - as I couldn't add more than 3 attachments to my last post - and a zoomed in look at a group of CAs from last night.

Also adding a graph from 4 nights ago.

[codebread]

I decided to try CPAP at a fixed pressure of 6 because that's what I was using when I had my lowest AHI nights. I think I've got a handle on identifying real central apneas as opposed to arousals. Here's data from last night, zoomed in on a group of 3 CAs. I think the first one is a real central apnea, and the next two are arousals?

[THEVGE]

I would start with increasing your pressure, I think it is too low for you. You can also see your device goes to way higher pressures during the night. This should bring your hypopneas down and reduce your flow limitations, both good indicators for improvement. Not sure how your CA's will respond, your actual question, we will have to see but it could get worse. I would make a 1 cm step or so and try it for several days and then re-post images, although I expect you will need to increase your pressure further.

[staceyburke]

This is not your main problem but you have times of positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

Also your flow limits are very high - FL are apnea just like O and H events.  They are controlled by using  EPR.  You have EPR off.  I would  TRY turning on EPR to full time set at 2.  You need the min set to 7 to fully use it.  Give it a try for one night and please post again.

[Deborah K.]

I'm not sure you have positional apnea, as it appears that the large number of events bunched together are Central Apneas, which have nothing to do with your sleep position.  I would not worry about your sleep position for now.

I may be misunderstanding your sleep study report, but it appears that you had only one CA event that night. Lots of people have treatment-emergent CAs when they begin treatment, and they usually go away or greatly lessen over time. Yours have remained high for eight months, which is very puzzling.

Hopefully, Sleeprider will come along and offer his always excellent advice.

[Sleeprider]

I don't know if you have tried EPR, but I need to see how your respond to it. Many of your events have flow limitation associated with them, including the central events. It will help if you will trial a night with minimum 7.0, maximum 12.0 and EPR full-time at 2.