Many Clear Airway Apneas with Zero Obsructive Apneas? What Does This Mean?

[CPAPsnoozer]

Hi All,

This is my first post here but i'm looking for a little bit of guidance. Background on me: i'm a fit 6'4" 190 ib 22 year old male that was diagnosed with severe obstructive sleep apnea of 40+ ahi. This diagnoses was out of the blue last year and I have been using a cpap ever since. The ahi was so high for me because I was a mouth breather with large tonsils. I have since had my tonsils removed and my breathing has been much improved.

I still need to use the CPAP for a quality night sleep (airsense 10 with p10 nasal pillows) but i've been noticing something when I use sleepyhead to look at my data. I never have any obstructive apneas, only "clear airway" apneas. I generally have between 3-10 CA's per night and I want to reduce that number as low as possible. Could the CA's be due to too high of a pressure? or too low? My understanding is that CA's are sometimes the body/brain's response to the CPAP pressure (My current pressure settings are 7-11). If anyone is knowledgable on this topic I would appreciate some advice.

Thank you!

[Miss Emerita]

Welcome, CPAPSnoozer! It would be great to have some more information. Could you upload a typical Sleepyhead daily chart? And you might consider switching to Oscar, which is the successor to Sleepyhead. More here: https://www.sleepfiles.com/OSCAR/

CAs can be a form of "sleep-wake junk," meaning you are having a brief arousal followed by a pause in your breathing. CAs can also indicate that CO2 is washing out a little bit too much, so that you are not getting the "breath now" signal from your brain until the pause in your breathing allows the CO2 to build up again.

But either way, at the levels you are reporting (assuming you are on the machine 7 or more hours per night) the CAs aren't anything you should worry about. Still, if you want to experiment a little, and you have EPR set at 3, you could try dropping it to 2 to see what happens.

The elimination of obstructive events is great! How are you feeling during the day?

A little bit of housekeeping: could you put your machine and mask in your profile so the information will be easy for people to find? I'm assuming your ResMed machine is an Autoset; you may need to hunt around in the Rs to find it.

[LSAT]

There are not enough CAs to be concerned about...If you were averaging 5+ an hour...you should discuss it with your doctor. Pressure adjustments will not eliminate CAs. Many people have them usually while they are falling asleep, waking up or just restless during the night. A CA is simply a Clear Airway Apnea...You stopped breathing for 10+ seconds and there was no airway blockage.

[Pugsy]

You aren't having enough central apneas to worry about.

First of all it's normal for everyone to have an occasional central apnea. Entirely normal...even people without the sleep apnea diagnosis.
Centrals are only a problem when present in large numbers and causing desats or extreme sleep disruption.

Doctors won't even bother looking at them unless the person is having more than 5 centrals per hour...every hour...every night.

It's normal to have a sleep onset central or transition from wake to sleep status...entirely normal.
If people wake frequently during the night then they have greater numbers of sleep onset when they go back to sleep they are very apt to have more sleep onset centrals.

3 to 10 centrals over the entire night...unless the night consists of 2 hours of sleep....it's not going to be a problem.

Finally it's fairly common to have false positive flagged centrals....we pause our breathing while awake with the mask and machine on and the machine flags a central. Remember the machine has no idea if you are really asleep or not.

Watch the videos here
http://freecpapadvice.com/sleepyhead-free-software

Yes...different things can trigger centrals but we don't worry about them unless we are looking at large numbers often.

[Dog Slobber]

As suggested 3-10 CAs a night is nothing. BTW listing the number of events per night isn't really meaningful, the standard is events per hour.

The few you are having could be false positives, or sleep onset. Having said that, sometimes EPR can trigger Centrals. If you're using EPR consider turning it down or off. Personally given the choice of the comfort of EPR vs an occasional Central, I'll take the comfort of EPR.

[CPAPsnoozer]

Welcome, CPAPSnoozer! It would be great to have some more information. Could you upload a typical Sleepyhead daily chart?

Thank you all for the replies! I attached a screenshot of last night's sleepyhead data, i'll look into downloading OSCAR. Although i've been using CPAP for a year a lot of this is still new to me.

Stay safe and healthy during these turbulent times.

Screen Shot 2020-04-12 at 8.28.25 PM.png (226.53 KiB) Viewed 2857 times

[Jas_williams]

The ca’s that are there are not enough to worry about, your Autoset is treating successfully your obstructive apnoea.

[Miss Emerita]

As everyone has said, your CAs are nothing to worry about, and the Sleepyhead chart makes that apparent.

The chart also shows a pretty fair amount of leaking. Some of it looks as though it might be mouth leaking. (It's hard to tell just from a chart, but when there's a plateau with a ragged top, that tends to be mouth leakage.)

Do you know whether your mouth opens at night? There are some remedies you could try if you would like to experiment with them; just let us know.

[Pugsy]

Unless the leaks are waking you up they aren't a big deal no matter what the cause. They are within the machine's ability to compensate for them.

The only way to know for sure if those leaks are mouth breathing or mask movement is to 100% eliminate the chance of it being mouth breathing by taping the mouth shut. I have done this a couple of times when faced with a new mask and some big leaks and I needed to know what the cause was. Mask movement leaks can also show up as those plateau looking leaks. I have reports to prove it...big leaks and lots of plateaus and I taped my mouth and the tape was secure the next morning so only thing left was mask movement.
Since I was trying one of the DreamWear masks with a medium frame...wasn't a big surprise that the mask was moving a lot. The medium frame was way too big for me.

So if you are curious you might try that but unless the leaks are disturbing your sleep I wouldn't worry about them.

[DreamDiver]

CPAPSnoozer,

Welcome!
I too get nothing but Centrals or Clear Airway apneas. I don't snore. I just stop breathing. There is at least one other person on this forum - SunnyU - who also has only centrals that is treated with APAP. If your centrals were worse, you would probably be put on a more expensive and interesting machine. As others have said, if your centrals aren't long (way over 20 seconds all the time) and they are relatively infrequent (low AHI) your machine's therapy is working.

In your profile, there's an area where you can fill out what your equipment is: machine, mask, humidifier. If you could fill that out, along with the information about pressure settings, those who are in-the-know will be able to dial in a better response to your questions.

It looks from your chart like you're mostly sorted. I hope you'll stick around.

Chris