Hiatal hernia and Bipap with still uncontrolled sleep apnea

[College3girls]

I haven't posted in some time, but previously had been asking for help for my Mom with severe, treated, but not controlled sleep apnea. To refresh memories, Mom started on APAP and was left on a wide open range of 4-20, and would run at a pressure of 20 all night. Despite that high pressure, she used her APAP every night, all night. Finally, after almost a year of this, she was changed to BIPAP. Now after over 6 months of BIPAP, her AHI is still often in the 20's. Her sleep Dr has decided since her monthly average is around an AHI of 15, to call her apnea controlled. A second sleep study determined she was not eligible ( did not meet the medicaid insurance parameters for the next level of machine beyond BIPAP.) I can't remember what it is called, but it was refused for her anyway.

Now Mom has been in and out of the hospital over the past 2 weeks. She had been alone in Florida, and it was a very trying and scary time trying to get her well enough to return to NY and see her medical Dr.(April 1.) We did get her home this week, and she is attempting to use her BIPAP for the first time in 2 weeks, but has not managed a full night since being very ill with vomiting. She already is sleeping with the head of her bed elevated. Sleeping in her recliner has been her only option. She was diagnosed with a combination of a virus and a small hiatal hernia, following an endoscopy.

I saw some older posts from 2012 mentioning hiatal hernias could cause sleep apnea and vice versa, but nothing definitive or helpful in those posts. Does anyone have more updated experiences with sleep apnea therapies and hiatal hernias? In Mom's case, her age and the fact that the hernia is considered to be small means surgery will not be considered. It would be far too risky for her.

She will again ask to see a sleep Dr., and I've told her I will take her anyplace she needs to go to see someone other than her current sleep Dr., who has never really seemed to care if she has effective therapy. The attitude is she is too old, so why bother. This makes my blood boil.

I am an hour away from Mom, so I do not have any recent data on her AHI or machine settings. I will get those and post them as soon as possible. I do know the machine is a ReMed BIPAP, and she uses a simplus full face mask, and heated, humidified tubing. She does not use a ramp, and typically falls asleep in 5 minutes time. I THINK her pressure range is 16 for inhale and 12 for exhale, I know there are other settings, but I can't remember them.

My main concern and question now is what is worse? An AHI of 20-40 and no BIPAP, or BIPAP with pressures high enough that Mom always has gas, all day, and a distended looking stomach. I'm worried that this has been the cause of the hernia.

For Mom's part, she prefers to use her BIPAP- she says it is "comforting" and "comfortable". This despite needing a gel pad across the bridge of her nose to prevent bleeding pressure sores from her mask. She puts many of us to shame.













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[mgaggie]

I'm sorry I can't help with your questions, just want to wish you luck in helping your mum. Also I wanted to 'bump' your post to keep it up near the top

[Julie]

I suppose there's no question of e.g. leaks (also) being responsible for the AHI's? Is anyone looking at her overnights with software? Lots of people have HH's, but I'm not sure they'd be the only reason at all that she's having Cpap problems.

[robysue]

Welcome back College3girls.

I think I remember you posting data from your mom. At the time Muffy/NotMuffy/Mollete/Sludge (I can't remember which name he was using back then and he's now posting as Morbius) thought that a lot of the OAs being scored by your machine might in fact be pressure induced, if I am recalling the right set of posts. Am I recalling the situation with your mom correctly?

Was there any effort made to put an upper limit on the max pressures? If her AHI doesn't go up with a lower pressure setting and her digestive system distress goes down, perhaps that's a working compromise at least for now.

[College3girls]

Yes, folks are remembering the earlier posts correctly, and it was "sludge/Morbius/etc, ect," who had been helping interpret Mom's data and situation. Leaking is not the issue. I had access to earlier APAP and BIBAP data, used sleepyhead, and am positive leaks are not the cause of the high pressures.

The RT worked hard over a period of a couple of months and did get her off that pressure of 20 all night, every night. He agreed that the high pressure being forced into my Mom's 5 ' 2" frame was not good. He'd even tried some new monitoring system that used a cell phone or internet signal designed to let him directly view Mom's data on her machine without needing to read the SD card, but unfortunately, the signal did not work properly, and he was not able to get this to work. He was able to finally properly fit a mask. We must have tried over a dozen.

Another sleep study to consider an ASV(?) determined too few central apneas to qualify, however, Mom said she did not sleep at all during this in- clinic study. I think for her, an at home study would provide more reliable data, since she would actually go to sleep. Should another study be set up, I'm going to push for it to be at home.

Too sum up where things are now, BIPAP has more effectively lowered Mom's AHI, but not optimized it to a point where she is getting effective therapy. She still feels tired all the time, and for 87, my Mom can outlast many people 30 years her junior with the amount she accomplishes in a day. I also wouldn't suggest you attempt to beat her at scrabble. Just imagine what she could do with controlled sleep apnea. In October, her monthly average AHI was just under 15. Certainly better than 20-40 every night, but still high.

I"m also concerned that it may be causing this hiatal hernia, which had a very sudden onset of symptoms from which Mom is still struggling to recover from. Hopefully I will hear more from other hiatal hernia sufferers, also on BIPAP or APAP of some kind.

[LSAT]

I had been a GERD sufferer for many years. In fact I had the fundoplication surgery to repair the LES and HH 13 years ago. Knowing where the HH is and what affects it make me very doubtful that OSA can cause it....usually it is related to GERD. Years ago I read somewhere that a very large percentage of people have HH and don't even realize it because they have no symptoms. If your mom had an endoscopy, I'm curious about what the GI doctor said about the HH and its cause.

[College3girls]

LSAT,
My siblings and I are still working on getting to the bottom of her medical reports. Initially we were getting all kinds of conflicting info. First it was food poisoning, then it was a nasty stomach bug, then it was a virus combined with a hiatal hernia, but the hernia was small and "not a problem". However, as soon as Mom was sent home from the hospital, she'd be back in the same night, and re-admitted with vomiting and dehydration. (twice).

Copies have been obtained of all her records, and submitted to her regular Dr. Her appointment is April 1, but we are trying to get one sooner.

It has been two weeks, and Mom is still "not feeling right, and fuzzy-headed". Hmmm,don't suppose sleep deprivation has anything to do with that, right. She still can't sleep through the night with her BIPAP, and has been sleeping in a recliner. Without BIPAP her AHI is likely to be over 40. Anybody is likely to be "fuzzy" with that.