APAP to CPAP?

[Wulfman...]

Just out of curiosity I pulled out the sleep study from July 30th. The REM periods correspond with the clusters. They are at similar intervals as all my recent Sleepyhead charts I was supine a lot but on my right side for the last cluster which was very long
Early in the study was one other big cluster before the first REM where O2 went down to 88.9 right after it but avg desat is 3.4%

I can't remember if this has been asked or mentioned, but what are you taking for your reflux/GERD? The "Purple Pill" or something else?


Den

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[Sleepysuz]

Den did you see I reported on sleep study?
Taking ranitidine ( Zantac). Took generic previcid in the past. No symptoms with either of these. Before I took it I had post nasal drip in morning

[Pugsy]

REM sleep stages are fairly predictable as long as someone isn't waking up a gazillion times a night for whatever reason.
It will get a person close enough to have a fairly good idea.
If it is REM stage sleep needing remarkably higher pressures and the higher pressures are creating more problems with aerophagia than the clusters are causing...might be worth talking to the doctor about a compromise. Though I wouldn't be talking compromise until I had at least tried bilevel.

[Wulfman...]

Den did you see I reported on sleep study?
Taking ranitidine ( Zantac). Took generic previcid in the past. No symptoms with either of these. Before I took it I had post nasal drip in morning

Yes, and I made an "Edit" on that last post on the previous page.......to acknowledge that I saw your post.

I'm unclear as to what your reflux problem is or is caused by, but I'm wondering if you need to address (and or fix) that situation with your doctor before you can fix your "sleep" problem.


Den

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[Sleepysuz]

Ops didn't see edit. . ENT seems to think reflux under control. I saw him a 1 1/2 years ago for what I though was a sinus issue. Since taking med haven had any of sinus symptoms (infections, clearing throat, nasal drip, scratchy throat is thing in AM... ). Seemed we licked that with meds and diet. No soda, coffee etc. So not sure where to go with that.
Looks more and more like it might be a bipap in the cards

[Wulfman...]

Ops didn't see edit. . ENT seems to think reflux under control. I saw him a 1 1/2 years ago for what I though was a sinus issue. Since taking med haven had any of sinus symptoms (infections, clearing throat, nasal drip, scratchy throat is thing in AM... ). Seemed we licked that with meds and diet. No soda, coffee etc. So not sure where to go with that.
Looks more and more like it might be a bipap in the cards

I'm wondering if you should get all of your doctors "in the loop" and show them the reports and sleep study and see what they think......at this point. Just because you're not seeing those symptoms, something is still affecting your sleep quality (and blood oxygen).

As you said, that was a year and a half ago. I think it would at least be worth a discussion with them.
We don't really know if there is some other underlying issue that Bi-PAP wouldn't help, either.


Den

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[Sleepysuz]

Update: Last night my clusters were all the same. Same place in the cylce but really ugly I had it set from 9.5-12 The 12's weren't spikes, They looked more like plateaus. Long but not long enough to get a belly ache. Would imagine they could go higher if I had max higher AHI 7.93

Talked to doctor today. She doesn't think it's the reflux at this time. 1st step is to get a bipap, 2nd step is to do another sleep study. Just to let you know what's going on here. Wondered if you have any idea what settings to start setting the bipap. Looks like 9.5 is a comfortable minimum for this girl.

[Wulfman...]

Update: Last night my clusters were all the same. Same place in the cylce but really ugly I had it set from 9.5-12 The 12's weren't spikes, They looked more like plateaus. Long but not long enough to get a belly ache. Would imagine they could go higher if I had max higher AHI 7.93

Talked to doctor today. She doesn't think it's the reflux at this time. 1st step is to get a bipap, 2nd step is to do another sleep study. Just to let you know what's going on here. Wondered if you have any idea what settings to start setting the bipap. Looks like 9.5 is a comfortable minimum for this girl.

Well, I wonder what she thinks the possibilities are?

But, another sleep study should give them (and you) more information regarding the nature of the problem.
I'm sure they'll determine what your (Bi-PAP) settings will need to be in your sleep study.

Thanks for the update.

Den

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[Sleepysuz]

She's suggesting the Bipap first and the sleep study if that doesn't fix the clusters

[Wulfman...]

She's suggesting the Bipap first and the sleep study if that doesn't fix the clusters

I wonder what she thinks she's trying to "fix"?

Sigh......


Den

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[Pugsy]

Do you know if she is leaning towards fixed bilevel or auto adjusting bilevel? I hope the auto just in case....

Most likely EPAP will need to be close to your minimum APAP or that 8.5 to 9.0 to 9.5 range.
IPap around 12 or 13 and see what happens with the clusters and the belly.
This is the same doc that wanted to stick you on fixed 15 cm?

I would rather see you try to work up to suitable bilevel pressures than see you start high and try to work down.

Hopefully the mixture of IPAP higher than 10 (where aerophagia wants to pop up) with the lower EPAP will keep the aerophagia monster away.

A sleep study titration would be handy in figuring out what pressure is needed to break up the clusters but they don't have any way to monitor aerophagia ramifications at the sleep lab unless it wakes you up. So it has its limitations too. It's a cold hard fact of life that in your situation the aerophagia is something that has to be dealt with too.

[Wulfman...]

Do you know if she is leaning towards fixed bilevel or auto adjusting bilevel? I hope the auto just in case....

Most likely EPAP will need to be close to your minimum APAP or that 8.5 to 9.0 to 9.5 range.
IPap around 12 or 13 and see what happens with the clusters and the belly.
This is the same doc that wanted to stick you on fixed 15 cm?

I would rather see you try to work up to suitable bilevel pressures than see you start high and try to work down.

Hopefully the mixture of IPAP higher than 10 (where aerophagia wants to pop up) with the lower EPAP will keep the aerophagia monster away.

A sleep study titration would be handy in figuring out what pressure is needed to break up the clusters but they don't have any way to monitor aerophagia ramifications at the sleep lab unless it wakes you up. So it has its limitations too. It's a cold hard fact of life that in your situation the aerophagia is something that has to be dealt with too.

And, the conundrum with this scenario is........
EPAP is set to eliminate Apneas.
IPAP is set to eliminate Hypopneas.......there are practically no hypopneas.

APAP/CPAP setting of 9 or 10 isn't eliminating the Apneas.
The "nature" of her Apneas is unknown. Most of them are "frank"......so, there's nothing to trigger pressure increases.
Practically no Flow Limitations preceding the "clusters" of Apneas.

I dunno.

Den

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[Sleepysuz]

Fact is I've been snoring for 40 years. This is nothing new but the GERD is the just the last few years. So many things to consider. It's a mystery! As you said Den - hardly any FLs



But the night before was loaded with them they weren't in any special place! It's weird these clusters are almost always in the same place.

[Pugsy]

And, the conundrum with this scenario is........
EPAP is set to eliminate Apneas.
IPAP is set to eliminate Hypopneas.......there are practically no hypopneas.

APAP/CPAP setting of 9 or 10 isn't eliminating the Apneas.
The "nature" of her Apneas is unknown. Most of them are "frank"......so, there's nothing to trigger pressure increases.
Practically no Flow Limitations preceding the "clusters" of Apneas.

I hear you but there's more than one way to skin a cat and get at those probable frank apneas. But I see with the last couple of reports the machine did max out it looks like....so it tried to respond it looks like.
Killing the apneas is easy.
Doing it without sacrificing sleep quality and quality of life might be a challenge but things sure aren't working now so might as well try the next step...and the next step...and the next step if need be.
And we take it one step at a time.

[Pugsy]

What did you use last night for maximum? Was it 12? It looks like it tried to go higher and maxed out briefly (that's the flat plateau looking line)...how about letting it have more room? Like about 15 maximum? Let's see what it wants to do.