Sierra

Yes, you should be concerned. A clear airway is an event where there is no breathing but the airway is open. That is essentially a central apnea by a slightly different name. The CPAP manufacturers use the clear airway term because that is essentially what they know from the machine. The airway is clear and there is no breathing for 10 seconds or more.

The objective is to get the total AHI including clear airway events under 5 per hour. I would suggest discussing these results with your sleep doctor as I would suspect having 67 in a night is probably putting the AHI over 5?

Another option would be to download SleepyHead and look at the detailed results for the night. It requires a SD card reader, and a PC or Mac to install the free software. There is a way to copy the daily report and post it here if you want comments on what the issue may be. One problem could be the use of too much pressure, but each case tends to be a little different. In general more pressure is good for reducing obstructive apnea, but may increase central or clear airway apnea. Also use of EPR can aggravate central apnea too in some cases.

There is also a condition called treatment emergent central apnea where no or little CA is identified in the sleep study but it emerges with CPAP treatment. In most cases it goes away after 6-8 weeks.

In my opinion the DreamStation is a better machine for operating when not connected to the AC power grid. The DreamStation operates on 12 volts and all it needs is an adapter cord to connect to a 12 volt battery. No inverter or power converter is required. The ResMed on the other hand uses 24 volts. For that reason you need an inverter to convert 12 volts to 110 AC, and then use the normal power adapter which produces 24 volts. Or you need ResMed's special and expensive 12 volt to 24 volt DC to DC converter. These converters lose a lot of power, while the adapter cord for the DreamStation does not lose anything.

I also believe the DreamStation is a two piece unit with a separate humidifier and the two components can be separated for use without the humidifier? Or was that an older model? And if you buy an unheated hose the hose heating will obviously be defeated. I am also surprised that one could not defeat both the humidifier and hose heating by using the Clinical Menu if necessary. Here is a link to the technical manual for the DreamStation.

I have no experience with one. However, I see you are using a AirSense 10 machine. If it is an Elite or AutoSet it can save data that can be viewed with SleepyHead. SleepyHead can also import data from an oximeter. Here is some information from SleepyHead on which meters it supports. I would expect they would be good meters to use. The advantage of a meter that inputs to SleepyHead is that you can compare the sleep results to the oximeter results on the same time scale.

Generally if your jaw drops open air pressure from the CPAP will force the lips open and cause a mouth leak. Probably the most direct solution to try is a chin strap. I found that many do not work, or were uncomfortable. The best one I used was the Breathewear Halo. In addition to helping keep the mouth closed it can also keep the mask straps in place. However, to be fair, it does introduce some additional level of discomfort. I used it for a while but found I still needed mouth taping. I eventually went to two layers of mouth tape and abandoned the chin strap. The first layer was 3M Micropore tape 25 mm wide. I then cover this with a larger 60 mm x 100 mm piece of Mefix tape. What I found was that the Mefix tape was flexible and stayed well attached, but it was not as moisture resistant as the 3M Micropore. For that reason I use the 3M to seal my lips, and the larger layer of Mefix to give it a bit more strength. I fold the edge of each layer over a bit so there is an easy way to remove it. This has allowed me to abandon the chinstrap. But the combination of chinstrap and tape does give the lowest leakage rates. I gave that up for additional comfort. For the most part I stay under the leak redline.

As far as your concern about the tongue falling back and blocking the airway, that is the basic purpose of using a CPAP. The air pressure is intended to keep the airway open. Air pressure stays in place while you are inhaling and exhaling, especially if you avoid use of the EPR or Flex features on the CPAP.

Most people that report on using this mask seem to like it. I am not sure that I would like the idea of the air tubes going up the side of my face and having the air connection at the top of my head. However, the proof is always in the pudding and I have not tried it, so am not the best source of information on it.

Generally lower pressure makes the mask easier to fit, as the straps do not have to be as tight. I suspect most using a full face mask would be using higher pressures than 9 cm.

Cpap.com is not usually the cheapest place to buy, but I believe there is an option to return the mask if you don't like it on most masks.

Another similar mask is the ResMed F30 which is quite new. Not sure if it is better or not, but the hose attachment is more conventional on the F30. It has a special vent design that makes it as quiet as the P10.

Another option may be to use a Breathewear Halo chin strap. I tried various chin straps and this one was the best. It serves two purposes. One is to keep your mouth closed during sleep, and the other is that it will keep the P10 straps in place during sleep. It is probably more comfortable than a full face mask.

I believe the most popular one is the ResMed F20. I tried it, and just could not put up with it. I need more pressure, but not much more, and I just could not get it to seal. It was very aggravating and I just could not sleep with it. I guess if I was forced to try another one, it would probably be the Respironics DreamWear Full Face mask. However, I have not tried it.

Welcome to the site. What is possible with CPAP treatment is somewhat dependent on the type of apnea you have, more than the initial diagnosed severity. My wife was diagnosed with apnea in the 85+ range, and now she routinely gets less than 1 for an AHI while using a ResMed S9 APAP. I on the other hand was diagnosed at I think 37 for an AHI and have trouble getting my AHI consistently below 3. My wife's apnea is almost all obstructive apnea. CPAP pressure is quite effective in preventing obstructive apnea. In my case my AHI is now predominantly central apnea, and pressure if anything can make it worse. I actually have mixed or complex apnea so my strategy to date has been to keep my pressure as low as possible to prevent obstructive apnea, but not create central apnea. Central apnea is not an obstruction, and instead the airway is clear, but the body does not try to breathe for longer than 10 seconds.

What type of machine do you have? The APAP ResMed and DreamStation machines are supported by a freeware software called SleepyHead. Some download and use that software to monitor their apnea more closely. Development of the software has been shutdown but the current version is quite functional providing you have a compatible APAP, a Mac or PC, and a SD card reader. If you use SleepyHead and post your daily report her you will get comments on what your issues might be. The goal of CPAP treatment is to get AHI under 5, while minimizing side effects of the treatment. SleepyHead can help you determine what is going well when you get an AHI of 2.6, and what is not going so well when your AHI is 10.6. The main purpose is to find out what type of events you are having, and when they are occurring during the night.

Hope that helps some. Any questions, just ask away...

My wife's obstructive apnea events went down when she started mouth taping.

Complex (both central and obstructive but with central dominant) sleep apnea is difficult to deal with. Here is a link to a good discussion about Complex Sleep Apnea. An ASV is a probable solution providing you do not need more than 20 cm of pressure to deal with obstructive apnea. They are expensive if insurance is not covering it though.

Are you using SleepyHead to monitor your apnea? If not it would be a good idea to get a better understanding of what is going on. An APAP can aggravate central apnea. Even when the machine does not increase pressure to a central apnea, it may respond to a central hypopnea because no machine that I am aware of can distinguish between a central and obstructive hypopnea. About the only way of dealing with it is to limit maximum pressure to the level required to deal with obstructive apnea and no more. You could also try with and without EPR.

Insurance companies can be difficult. To date the APAP has not worked, so that is the first step. Next they may insist on a BiLevel machine which does have a bit more capability, but in most cases it cannot deal with central apnea very well either. You may want to think of it as step you have to go through to get them to approve the ASV.

The other thing to check out with your doctor and heart specialist are other issues. Some heart issues can cause central apnea, and some drugs as well. If you live at high altitude that can aggravate central apnea as well.

Keep in mind that if they cannot get total AHI under 5 the treatment is not successful.

Hope that helps some,