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Complex sleep apnea occurs usually later in night

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steviekm3 +0 points · 3 months ago Original Poster

My doctor thinks I have complex sleep apnea and is doing another sleep study in a few weeks.

I use the sleepy head software. It reports very little obstructive apnea. Less than 2 usually. But I have high clear airway apnea. Around 10 to 20 score each night.

The thing is when looking at graphs almost always the clear airway comes mainly in 2nd half of night. Over 90 pct in second half. What does this mean ?

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Sierra +0 points · 3 months ago Sleep Enthusiast

I would like to give you a simple direct answer, but with central apnea there seems to be nothing simple about it. One of the things I have noticed is that if I try to sleep too long, I tend to get more apnea, especially near the morning. I think that when you are waking up and going back to sleep that is conducive to apnea of both types. More pressure can generate more CA events. Is it possible that your machine is responding with more pressure toward the morning? It would be helpful to post a Daily Report screenshot to look at. On a PC, use the F12 key to save the file and then left click and drag the image file it saves in SleepyHeadData/Screenshots to the body of the message.

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steviekm3 +0 points · 3 months ago Original Poster

Hopefully below shows my graphs. I'm working on a Mac. I used to have 8-16 pressure on the machine and I was getting about double the clear airway apneas. I have now switched to just fixed pressure of 8 and get less clear airway and it happens in 2nd half of night ( or more towards last 1/4 of night ). I'm hoping that I can sleep long enough in the sleep study for the study to show this.

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Sierra +0 points · 3 months ago Sleep Enthusiast

About all I can think of until you get your next sleep study done is to try lower fixed CPAP pressures. If you are comfortable adjusting pressures, you may want to try 7 cm for a night, then 6 cm for another night to see if your total AHI goes down as the pressure goes down.

I would be interested in seeing what those areas of high numbers of CA events looks like with an expanded time scale. On a PC you just left click repeatedly and the data window closes down and expands the time scale. The purpose would be to see what the flow rate looks like when it is expanded to the point each breath can be seen, and there are still a number of CA events in the window.

Have you tried EPR at 3 cm? If you turn it on without changing what you find is the best pressure you will see if it makes things worse or better.

To optimize your screen layout, I would suggest clicking on that triangle in the date bar to close the display of the whole month of dates. Not sure if it is the same with a Mac, but in Windows you can get suppress that pie chart which adds nothing by using File, Preferences, Appearance, and then uncheck the box to display the event breakdown pie chart. This will allow more details of your setup to show.

How long have you had the AutoSet 10 machine? It may be necessary to go to an AirCurve BiLevel machine, or ASV if some adjustments on the AutoSet don't help.

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sleeptech +0 points · 3 months ago Sleep Enthusiast

Central events can do that sometimes. A couple of weeks ago I had 2 patients who only get central events while they were on their back. However, the treatment (Bi-level of some sort) should work for them just the same.

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steviekm3 +0 points · 3 months ago Original Poster

Doc told me that depending on the sleep study I may have to go on another machine. I just hope I can fall asleep for study so they get good data.

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Sierra +0 points · 3 months ago Sleep Enthusiast

If you have not already you may want to read the article at the link below. It comes from another part of the website where this forum is. In the article it suggests complex sleep apnea is more likely to occur in the non REM sleep period of the night. That may be an explanation as to why you are seeing different levels of apnea during different times in the night.

Complex Sleep Apnea

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steviekm3 +0 points · 3 months ago Original Poster

I did reduce the pressure last night to 5 and only had about 6 events per hour. But I forgot to put disk back in machine so cannot tell what the events are. I have put it back in for tonight, so I’ll see tomorrow. My wife told me I was snoring last night and I don’t snore when it is in a higher pressure. I did have little bit of headache today. Possibly central events are not has bad as obstructive ones ?

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sleeptech +0 points · 3 months ago Sleep Enthusiast

Nah. They're all bad.

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Sierra +0 points · 3 months ago Sleep Enthusiast

If you are changing pressures on the machine you must be in the clinical menu. If you scroll down in the clinical menu there will be an Options section and a menu item called Essentials. If you go into that and select the Plus setting you will get a more detailed sleep report right off the machine that should tell you what portion of the AHI was central apnea. I think it may be still there even if the card was out.

The AHI score just counts the apneas and does not rate their severity. The total time in apnea number is a good overall number that not only counts the number but also the length of the apnea. It is not compensated for hours of sleep though. And, of course it needs the card in to see it in SleepyHead. Some summary data will be saved in the machine and recovered but for the night you left the card out, the detailed data will be lost.

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steviekm3 +0 points · 3 months ago Original Poster

Ok thanks for telling me about the clinical sleep report. It shows 5.7 AHI and 4.3 Central. Not sure what to make if it all but I’m trying again tonight at 5.0 pressure. I’m also thinking about trying a dental device if I can locate a good dentist with experience in these devices close to Houston.

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Sierra +0 points · 3 months ago Sleep Enthusiast

An AHI of 5.7 that is 75% central shows you have some room to move pressure down potentially without increasing obstructive apnea that much. Trying a night at 5 cm should verify this one way or the other. The trick will be to reduce CA without increasing OA too much, and get a total of less than 5.

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