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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Papit
 
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Low CA at sleep lab, high CA at home

Postby Papit on Sun Apr 15, 2012 5:21 pm

Pretreated numbers from my Nov2011 sleep lab were: CA 5.2, OA 24.1, HA 8.1 >>> 37.9 AHI. (RERA was 29.9, giving a DBI of 68.)
Those numbers over previous 7 weeks,CPAP 8 cmH2O: CA 6.4, OA 0.7, HA 0.6 >>> 8.5 AHI, 95%Leak 8.4, Slept 7.15 hours avg.
Those numbers over past three weeks,CPAP 7 cmH2O: CA 9.2, OA 0.4, HA 0.7 >>> 10.7 AHI, 95%Leak 2.4, Slept 4.53 hours avg.

What has changed over the entire 10-week period? My weight has increased from 158 to 163. Sleep quality has not been as good as during the 7 weeks before and average sleep time has fallen off from 7.15 to 4.53 hours per night. Nexium was substituted for Prevacid and the dosage per day was doubled, taking it in the morning and now at night. Burping symptoms are primarily during the day, a little at night. Nothing else I can think of.

My doc has been concerned by the CA going up for some time now. He hoped reducing the pressure would help. If anything, it seems to have worsened matters even though Leak, which was not an issue (8.4 avg.), has come down some more and stayed down.

So what's going on? Any ideas. Thanks if you have any, --papit

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Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Machine:S9 VPAP Adapt, Software:ResScan 4.3.0, SH 0.9.3, Oximeter:CMS-50F, Pillows Adjustment Clip
Last edited by Papit on Sun Apr 15, 2012 9:01 pm, edited 2 times in total.

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moondoggy
 
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Re: Low CA at sleep lab, high CA at home

Postby moondoggy on Sun Apr 15, 2012 8:08 pm

Your comments indicate that you've ceased using your humidifier. I'm not going to tell you that this may be contributing to your results but it might. I had a problem earlier this year where my nasal passages became so dried out they swelled up and caused me a bunch of trouble. I have since had my S9 modified by my DME so that I can control the humidity better than the default setup and I've not had any problem. I know you wear nasal pillows but you may also have a leakage problem. I wear a nasal mask and I had a lot of leaks and a week ago I added a mask liner and it has reduced my AHI by about 2 points. You may also be unaware and breathing thru your mouth especially if you are having problems breathing thru your nose. Of course none of this may be happening or all of it may be happening. That's the joy of CPAP is that there are so many variables that can affect what's going on. Hope this helps though.

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avi123
 
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Re: Low CA at sleep lab, high CA at home

Postby avi123 on Sun Apr 15, 2012 8:42 pm

Hi, If you berp thru out the night you should see a Gastro Doc.


http://www.mayoclinic.com/health/gas-an ... ns/DG00014

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Machine: S9 AutoSet™ CPAP Machine
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Papit
 
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Re: Low CA at sleep lab, high CA at home

Postby Papit on Mon Apr 16, 2012 11:06 am

Thanks for the concern, Avi. I don't know how much of this burp symptom occurs while I sleep. Maybe a whole lot, maybe not much.

However, in bed before falling asleep and after awakening, I notice that I don't do that nearly as much as during the day, perhaps one-tenth as much is a rough estimate. This symptom was and is part of a chronic gerd/acid reflux condition I have had for years and for which I was treated with Prevacid. It eliminated some much worse symptoms I used to have. Another doc 3 weeks ago prescribed Nexium instead and said I should take it at night in addition to in the morning as I previously did for years. I see absolutely no change in symptoms. I am doubtful that either Nexium, Prevacid or my treated acid reflux is interfering with my xpap therapy. But I don't know what is.

Last night, this worsening trend of increasing central apnea not only continued, but got a great deal more distressful. Oxygen desaturation hit new lows and for longer periods than usual. I sure wish more eyes were looking at this for me. Thanks again, Avi. Your continued thoughts are invited.

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Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Machine:S9 VPAP Adapt, Software:ResScan 4.3.0, SH 0.9.3, Oximeter:CMS-50F, Pillows Adjustment Clip
Last edited by Papit on Mon Apr 16, 2012 12:54 pm, edited 1 time in total.

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Pugsy
 
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Re: Low CA at sleep lab, high CA at home

Postby Pugsy on Mon Apr 16, 2012 11:24 am

I am looking but I can't think of anything constructive to offer especially with desats.
While we might explain away some "centrals" with turning over in bed and sleep onset and those would be discarded in a sleep lab...the drop in O2 levels wouldn't.

You are already working with your doctor about the centrals and he is concerned also. Do you know what his plans are if the centrals don't come down?

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
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Papit
 
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Re: Low CA at sleep lab, high CA at home

Postby Papit on Mon Apr 16, 2012 12:07 pm

Last night's numbers added. See my next post.

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Last edited by Papit on Mon Apr 16, 2012 12:27 pm, edited 1 time in total.

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Papit
 
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Re: Low CA at sleep lab, high CA at home

Postby Papit on Mon Apr 16, 2012 12:17 pm

Pugsy wrote: "I am looking but I can't think of anything constructive to offer especially with desats.
While we might explain away some "centrals" with turning over in bed and sleep onset and those would be discarded in a sleep lab...the drop in O2 levels wouldn't.
"You are already working with your doctor about the centrals and he is concerned also. Do you know what his plans are if the centrals don't come down?"


I understand, Pugsy. Except for two replies, in the absence of suggestions from all of the group's most active members it's been looking like my 'dominant central apneas' syndrome has everybody stumped. My doc has been focused on the problem for awhile now. He dropped my pressure from 8cm to 7 three weeks ago, but CA worsened. It's strange how the trend developed. Centrals never did come down much from the 5.2 CA measured during the lab test, while OA came down very nicely from 24.1 to now consistently under 3 and often under 1.0.

Yes, sleep onset (?and sleep stage-transitions maybe?) could be written off. But there are a whole lot of centrals showing up lately. And some of them lasted pretty long last night. I think I saw at least one that lasted 40 seconds. On the other hand, about a third to a quarter of the nights' reports show up with CA's down around 1 or less, just like the OA! Strange.

Have any others in the group gone through this sort of experience in their therapy? Comments certainly welcome here.

Last night's stats: CA: 17.8, OA: 1.3, 95%LK: 0.0, AHI: 20.4, Oxd: 80; T<90: 9.8 minutes

Here are last night's "pictures."
Image

Image

Image

Here is the trend information again:
Pretreated numbers from my Nov2011 sleep lab were: CA 5.2, OA 24.1, HA 8.1 >>> 37.9 AHI. (RERA was 29.9, giving a DBI of 68.)
Those numbers over previous 7 weeks,CPAP 8 cmH2O: CA 6.4, OA 0.7, HA 0.6 >>> 8.5 AHI, 95%Leak 8.4, Slept 7.15 hours avg.
Those numbers over past three weeks,CPAP 7 cmH2O: CA 9.2, OA 0.4, HA 0.7 >>> 10.7 AHI, 95%Leak 2.4, Slept 4.53 hours avg.

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Machine:S9 VPAP Adapt, Software:ResScan 4.3.0, SH 0.9.3, Oximeter:CMS-50F, Pillows Adjustment Clip
Last edited by Papit on Sat Apr 28, 2012 3:48 pm, edited 1 time in total.

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Re: Low CA at sleep lab, high CA at home

Postby Pugsy on Mon Apr 16, 2012 1:04 pm

Aliens.....that is who we blame for unexplained stuff that makes no logical sense. :lol:

If the centrals were triggered by pressure...logic tells us that they should reduce if pressure is reduced..not increase...so then logic would tell us that they are not related to pressure. Of course logic is not always correct. :shock:
If not related to pressure..that what is it related to? Rule out the usual standard cardiac or neurological issues....and if nothing to blame them on then idiopathic "we don't know why"...

Assuming you have had a complete work up for the usual standard health issues that might point to a reason for the centrals then..
To be honest...if this were my report and I was having the desats and likely feeling like crap and your wife isn't putting a pillow over your head in the wee hour of the morning.....I would be wondering if I needed to be on that high dollar machine. This is obviously going in the wrong direction and while I am pretty fearless with my experiments on my own in most cases...I would be pushing the doctor to work with me to find out what is going on. This one has me stumped as well. I might pooh pooh off a few centrals but not this many with the desats. I know your doctor isn't pooh poohing them off either. Did he offer any idea what his next step would be if reducing the pressure didn't help?

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Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
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Papit
 
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Re: Low CA at sleep lab, high CA at home

Postby Papit on Mon Apr 16, 2012 1:51 pm

Ha ha ha ha! That's beautiful, Pugsy! I love your well-timed sense of humor. Cracked me up. I needed that right now. I had to look up "idiopathy". Now I know about aliens!

I think I'm going to intentionally create some 'idiopathic' intervention of my own tonight! I'm gonna go to my usual swing dance class, come home, drink a lot of wine and break the CA trend. No xpap tonight. First time without it since Dec. 7, 2011. How's that for an experiment.

No, my doc didn't mention any future strategy. I'm trying to get an early appointment with him. When I see him I'd like to have a couple (or more) ideas to run by him in addition to just sitting there and listening to what he might, or might not, come up with.

So put your thinking caps on, folks, and shoot your ideas in to me here or pm me. Now's a good time to check out what one, two or more sleep docs think about what you might have in mind. I consult with a couple other well regarded sleep docs in addition to my regular. ' Twill be interesting to track this alien down, IF that's possible.

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Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
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Additional Comments: Machine:S9 VPAP Adapt, Software:ResScan 4.3.0, SH 0.9.3, Oximeter:CMS-50F, Pillows Adjustment Clip
Last edited by Papit on Mon Apr 16, 2012 5:03 pm, edited 1 time in total.

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Re: Low CA at sleep lab, high CA at home

Postby Pugsy on Mon Apr 16, 2012 4:27 pm

Have fun tonight.
I slept without my machine for 3 hours one night last week. Thunderstorm and power went off and didn't come right back on like it usually does and I didn't want to sit up waiting.
That was the first time I have done more than a cat nap accidentally without my machine in nearly 3 years.
I got a huge reminder of why I am on the darn machine. :lol: Even a crappy night on the machine is better than no machine. Massive headache..just like the time I over indulged on Wild Turkey.. :roll: I don't drink Wild Turkey any more either and that was probably 20 years ago..I still remember.

I am not going to lecture you on "how bad it can be if you don't use the machine"...you already know that but it if you go without it tonight...you might find out that while the way things are going now isn't so great..that the other way is worse. Never know.

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Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
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Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
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Pugsy
 
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Re: Low CA at sleep lab, high CA at home

Postby Pugsy on Mon Apr 16, 2012 4:48 pm

Oh crap...I just realized that I spelled idiopathic wrong. Spell checker didn't flag it or I missed it.
English was my weak spot in my education. Brain and fingers don't always work together like they should.
Either I type too fast for brain or brain thinks too fast for fingers...or both. :lol:

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Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
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Re: Low CA at sleep lab, high CA at home

Postby JohnBFisher on Mon Apr 16, 2012 6:20 pm

Pugsy wrote:Oh crap...I just realized that I spelled idiopathic wrong. ...

When I'm talking about myself, "idiotic" seems more accurate than "idiopathic". :lol: :lol:

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Re: Low CA at sleep lab, high CA at home

Postby JohnBFisher on Mon Apr 16, 2012 6:29 pm

Papit, I think it is time to request a referral to a neurologist that specializes in sleep medicine. You need someone that can help sort out the central apnea issues. I don't know if the increased gastric problems have anything to do with the central apnea. It's possible that it is confusing some chemo-receptors. Additionally, even if you have sleep onset central apneas, if they are long enough they should be addressed.

That the amount you sleep has decreased is a warning sign that you are not sleeping well. (Been there, done that!)

Since you continue to have untreated central apneas and they are most of the events, it should be treated. You will need to insist on this. Not all doctors understand that a central apnea is just as bad - if not worse on the cardiovascular system. The O2 desaturations cause serious problems including (but not only) high blood pressure, cardiac problems, stokes, etc.

I used to awaken with HORRIBLE headaches and would take Ibuprofen to knock them back. Unfortunately, Ibuprofen combined with the uncontrolled (and uncontrollable) high blood pressure due to all my central apneas caused kidney damage. Gee thanks, doc, for *really* listening!

Take it seriously - even if the doctor does not. If the doctor can not refer you to another doctor, go and do the research on your own to find a good neurologist that specializes in sleep medicine.

Frankly, it sounds as if you would qualify for either supplemental oxygen or an ASV unit. But getting to the bottom of it is important for you.

Hope that helps.

_________________
Machine: PR System One REMStar 60 Series BiPAP autoSV Advanced
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Humidifier: PR System One Heated Humidifier
Additional Comments: User of xPAP therapy for over 20 yrs. Resmed & Respironics ASV units with EEP=9cm-14cm H2O; PSmin=4cm H2O; PSmax=15cm H2O; Max=25cm H2O
"I get up. I walk. I fall down. Meanwhile, I keep dancing” from Rabbi Hillel
"I wish to paint in such a manner as if I were photographing dreams." from Zdzisław Beksiński

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Re: Low CA at sleep lab, high CA at home

Postby avi123 on Mon Apr 16, 2012 7:14 pm

Papit, I agree with John Fisher that you should be re-tested b/c of the hi number of CAs, and also to qualify for an ASV. How come your ResScan Leak graph above is less jagged than your graphs from before? It was like this:

Image

Seek A Doctor who is holding an MD in Neurology, or Cardiology, and also holds an MD in sleep medicine.
What large town in VA is near you, I could try to locate a few such Docs. If you're ready to drive to Raleigh then Doctor Perkins is the Doc to see:


http://www.raleighneurology.com/special ... p-medicine

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Re: Low CA at sleep lab, high CA at home

Postby Pugsy on Mon Apr 16, 2012 7:51 pm

I guess you get my drift that I am agreeing with JohnBFisher. You are going backwards instead of forwards...not even standing still. Time to get the big boys involved find out for sure one way or the other what is going on here. Since it typically takes a bit of time to get in to see the specialist..you can be "giving it time" while you are waiting for the appointment instead of "giving it more time" now and then getting the referral and waiting any longer than necessary.

I will speak with the aliens the next time they come visit me and ask them if they have been messing with you. They are crafty little devils...they come visit me when I least expect it and I have some pretty weird reports when they do. :lol:

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice

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