3 months in - still high clear airway - suggestions?

newman08 · Post by **newman08** » Tue Nov 12, 2024 5:10 pm

Hi all:

I am about three months in and I can tell a difference between before and after the CPAP. Some nights my score is great and other nights my clear airways are out of control. I have tried to search, but I can not find a graph like mine in a post.

I posted two examples, including a breakdown of a clear airway. If there is a clear airway, they are typically bunched together like the second attachment.

I did an at home test and use AirTouch F20. I tried to use nasal pillows and what not, but the pressure would bust out of my mouth when I would sleep and wake me up.

newman08 · Post by **newman08** » Wed Nov 13, 2024 9:05 am

Same issue last night. I am definitely more rested than I was pre-CPAP. I know the clear airway could be caused by the cpap, but the nights are mixed. I either have clear airways like this, or it is completely fine.

Miss Emerita · Post by **Miss Emerita** » Wed Nov 13, 2024 12:37 pm

Welcome! Could you let us know the breakdown of your AHI when you had your sleep test? You could scan and post the sleep report, with your identifying information blanked out.

Do you live at a high altitude? Do you take medications or drugs that are opioids or like opioids?

(When you post your next chart, could you include the bit on the left that shows the indexes for each component of the AHI?)

newman08 · Post by **newman08** » Wed Nov 13, 2024 2:44 pm

Hello,

1) I did an at-home sleep study, so unfortunately it did not break down thee type. But, I did attach it. The diagnosis said this: Findings are consistent with Severe Obstructive Sleep Apnea (G47.33). High heart rate variability noted which may be suggestive of a cardiac arrhythmia. Note that heart rate measurement on home sleep apnea tests can
be subject to artifact and is not confirmed by EKG.
2) I am definitely high altitude - 9300 ft.
3) No opioids, but I do live in CO so I do take a small amount of things to help me fall asleep.
4) 34 y/o male, not overweight, no other health complications.
5) Reattached today's report. My tablet doesn't allow me to shrink the left bar down so I hid that part for now.

Miss Emerita · Post by **Miss Emerita** » Wed Nov 13, 2024 7:43 pm

Your report says all your events were unclassified apneas, so that isn’t helpful at all. I think you need to ask your sleep doctor for an in-lab sleep test so you can really figure out what is going on. I’d assume your sleep doctor has a lot of experience with high-altitude sleep stuff too.

Please let the sleep doctor know what your indexes last night were for CA, OA, and H. That should get his or her attention.

newman08 · Post by **newman08** » Wed Nov 13, 2024 9:13 pm

I have the appointment on Friday. I just wonder if it is altitude driven as my AHI was less than 5 three days in a row when I was in Texas

ChicagoGranny · Post by **ChicagoGranny** » Thu Nov 14, 2024 11:35 am

A 2011 study found that people with moderate-to-severe OSA living at higher elevation were more likely to develop central sleep apnea as well. But if they used a properly calibrated PAP machine, those who had developed central sleep apnea at higher altitudes did show clear improvements. A little bit more info:

Altitude associated central apnea has a significant negative effect on the quality of OSA treatment obtained during PAP titration for patients living at the altitudes addressed in this study.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3227706/

There are solutions. Your doctor might be able to help, even without an in-lab sleep study. I would rely on her judgment if you have faith in her.

Miss Emerita · Post by **Miss Emerita** » Thu Nov 14, 2024 12:01 pm

Many thanks for that link, ChicagoGranny. I'm especially struck by this:

The higher frequency of central apnea at altitudes above 6000 ft. indicates that such altitudes may be a relative contraindication for the routine use of limited channel OSA screeners and automatic technologies that are unable to clearly differentiate between central and obstructive apneas. The difficulty of treating OSA due to central apneas occurring on treatment with PAP at altitude is likely to lead to a higher level of untreated OSA among these patients.

So an in-lab test might be valuable after all.

To the OP: yes, high altitudes can definitely increase CA indexes. Since you are having an OA index over 5 with treatment, it's complicated. Higher pressure might help with the OAs but make the CAs worse.

I'll be quite interested to hear what your sleep doctor says.

newman08 · Post by **newman08** » Thu Nov 14, 2024 6:11 pm

Thank you all. I have been reading studies about the altitude and centrals. I am going out of town next week at a much lower elevation. The last time I did, my AHI was less than 5 each night. I will report back after next week.

Last night, AHI was 12 - comprised of 4 for OSA and the rest for centrals, but around when I was waking up. No change in what I did from previous night to last night.

My only concern is that if I go down to the city for an in-lab test, it will be almost half of the altitude as where I live, so I fear they won't see anything since I will be at a lower altitude.

Miss Emerita · Post by **Miss Emerita** » Thu Nov 14, 2024 6:30 pm

Oh, yes, getting a test at a lower altitude would not tell you much. Fingers crossed your body somehow works this out on its own, or with your sleep doctor's help. Keep us posted, would you?

newman08 · Post by **newman08** » Fri Nov 15, 2024 2:46 pm

Doc mentioned they want to have a steady but higher pressure and to check back in two months from now.

They acknowledged that I may need to get a bipap or ASV because of my altitude and severity of OSA, but they want to give it some more time.

At least I feel better than I did without CPAP - will update how I am doing over time.

FYI - I was reading other individuals that were at higher altitude and supplemented with oxygen and their centrals went away. But, my oxygen level has been at 95% or higher, so I would bet it is the altitude, but I am no doctor.

3 months in - still high clear airway - suggestions?

3 months in - still high clear airway - suggestions?

Re: 3 months in - still high clear airway - suggestions?

Re: 3 months in - still high clear airway - suggestions?

Re: 3 months in - still high clear airway - suggestions?

Re: 3 months in - still high clear airway - suggestions?

Re: 3 months in - still high clear airway - suggestions?

Re: 3 months in - still high clear airway - suggestions?

Re: 3 months in - still high clear airway - suggestions?

Re: 3 months in - still high clear airway - suggestions?

Re: 3 months in - still high clear airway - suggestions?

Re: 3 months in - still high clear airway - suggestions?