COv2 Narcosis, BiPAP and being hit by a bus

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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ifrimmel
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COv2 Narcosis, BiPAP and being hit by a bus

Post by ifrimmel » Sun Nov 23, 2014 8:42 am

Hi all,

It has been a while since I participated in this wonderful community. I am one that doesn't like to dwell too much on my problems. It seems to make the time go by slower. That said, those that do dwell's help and support are much appreciated, and I thought I would come back and offer some very important insights into something I discovered on my own after a few years of getting no help from my sleeps docs. (plural)


Background:
I was prescribed a BiPAP after one nights polysig. at pressure 21/17 with a AHI in the triple digits/hour ( I shit you not - docs say they never seen anything like it - NOT that it's any kind of race that I deserve a trophy for ).

First, usual disclaimers apply. YMMV, and this is not meant as advice of any kind. I am not your doctor. DO NOT do this on your own.

Symptoms:
Waking up feeling unbelievably tired and sore after 10+ hours of sleep. ( sometimes a lot more and sometimes a lot less - but always tired and sore )
Waking up feeling drunk and dizzy and very stuffy.
Waking up in the middle of the night pulling at my mask.
Waking up feeling like you want to hurl, and the feeling persists for the whole day.
Sleeping without the machine actually makes me feel better ! ? ( even with hang over because I passed out from overconsumption a couple of times. Yeah, go figure!! )
High AHI. very low A (zero).. high H.
Oxygen doesn't help and makes you feel worse.
CPAP makes zero difference.
Different machines make no difference.
APAP doesn't help and in fact titrates way below prescribed pressure. ( DON'T TRUST THE APAP PROGRAMS - READ THE GRAPHS AND MANUALLY ADJUST IN SMALL INCREMENTS FOR THIS - USE A DIARY!!)
Sleeping tablets, Nuvigil, Muscle relaxants, Alcohol, other non-prescription substances (that start with a M) <wink> don't make any difference.
Odd looking tidal volumes. ( I will not describe them because they may be unique to me )
Ov2 levels pretty solid @ >92%. 95-97%ish AVG
Humidity one way or the other makes no difference.
Dozens of Masks, tubes, inhalants, scented oils, etc etc etc
Abstaining from alcohol and other substances makes no difference to sleep quality.
Strict compliance makes zero difference, and subjectively makes me feel worse. ( worse than a bad hangover after above over consumption ).

As you can see I tried just about everything. I asked my docs (plural) why the H would be high and they said .. dunno .. not important.. machines misreport that all the time. (total BS!) although they could not tell me why I feel horrible in the morning.
the fact that my Ov2 was normal made them care less about my obvious fabrications. (lol).

While hunting around for more info on DPSD ( which I have too - joy! ) and sleep anxiety because of it. I bumped into this:
https://en.wikipedia.org/wiki/Obesity_h ... n_syndrome
I asked my doctor if this might be me, and he said probably not because my O2 levels were fine.
Despite what he said, the feeling of severe narcosis continued. So I started looking around for more info on COv2 narcosis. Not much is available on that topic. But the one thing I did find said that BiPAP WAS used to treat hypoventilation AND/OR high CO2. Here is the meat and potatoes of this whole post - if this has been discussed here by now, then it may not be a huge revelation, but it was for me, since no-one here a few years ago had much experience with titration with BiPAPs:

Very simply : The Delta between EPAP and IPAP is IMMENSELY important for this. One can go as low as 50% of IPAP to try this out.
The advice I saw said:
a) Find an IPAP that solves the obstruction problem.
b) Lower EPAP until you feel better. ( in 2 step increments )

After 6 days I am now on 12/21 and I feel TONS better. The bus has not been to visit for 3 days now. Tiredness is abating and a lot of the pain too.

I will leave it here. This post ended up being longer than I intended. But .. I am not going to crop it, since everything I tried led to little/no improvement.

I might end up hanging around. No promises. If this helps one person, I will be happy. I jumped through a lot of hoops and got nowhere. Good luck.
Ivan.

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Mask: AirFit™ N10 Nasal CPAP Mask with Headgear
Additional Comments: Started Jan '10 Diag AHI:169. BiPAP BiFlex 1 12/21
Last edited by ifrimmel on Sun Nov 23, 2014 4:31 pm, edited 1 time in total.

herefishy
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Re: COv2 Narcosis, BiPAP and being hit by a bus

Post by herefishy » Sun Nov 23, 2014 12:08 pm

Thanks for posting, never know who might benefit. Good luck.

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TangledHose
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Re: COv2 Narcosis, BiPAP and being hit by a bus

Post by TangledHose » Sun Nov 23, 2014 12:32 pm

Glad you posted all the information, I found it very interesting and I am sure others will too. It reinforces the idea that the patient is the best solution, if you want to get better many times it comes down to your own persistence and desire to educate yourself.....I think that is what this board is all about....taking control of your own destiny.

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RicaLynn
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Re: COv2 Narcosis, BiPAP and being hit by a bus

Post by RicaLynn » Sun Nov 23, 2014 12:56 pm

I asked my doctor if this might be me, and he said probably not because my O2 levels were fine.
Despite what he said, the feeling of severe narcosis continued. So I started looking around for more info on COv2 narcosis.
HORSE HOCKEY!!! (I edited my initial reply to the bolded) My father was within HOURS of dying of respiratory acidosis, due to the ER docS' faulty assumption that because his SpO2 was fine, he was fine. If not for the insistence of a good friend that SOMETHING was wrong (I was on the other side of the country), he would have gone home, gone to sleep and never awakened. First CBG his CO2 was 108 (normal for a healthy adult is 35-45) and climbed until he was placed on a respirator.

I am SO thankful that you kept looking for answers! I was blessed with another four years with my dad, because those who loved him refused to accept the doc's assessment; they are only human, after all.

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ifrimmel
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Re: COv2 Narcosis, BiPAP and being hit by a bus

Post by ifrimmel » Sun Nov 23, 2014 2:03 pm

RicaLynn wrote:
I asked my doctor if this might be me, and he said probably not because my O2 levels were fine.
Despite what he said, the feeling of severe narcosis continued. So I started looking around for more info on COv2 narcosis.
HORSE HOCKEY!!! (I edited my initial reply to the bolded) My father was within HOURS of dying of respiratory acidosis, due to the ER docS' faulty assumption that because his SpO2 was fine, he was fine. If not for the insistence of a good friend that SOMETHING was wrong (I was on the other side of the country), he would have gone home, gone to sleep and never awakened. First CBG his CO2 was 108 (normal for a healthy adult is 35-45) and climbed until he was placed on a respirator.

I am SO thankful that you kept looking for answers! I was blessed with another four years with my dad, because those who loved him refused to accept the doc's assessment; they are only human, after all.
Indeed lucky - glad to hear it worked out, 4 years "extra" must have seemed to be a God send !!

As I say I have been looking around for more info on the correlation of O2 and CO2 and the two ARE NOT directly proportional AT ALL. I have also looked for commercial co2 monitors, meters and other things and they are unbelievably scarce and or unbelievably expensive. In a non-ER setting they are prohibitively expensive, and I doubt even the sleep centers can do it. One of my docs said that the only accurate way to test co2 is via blood samples, sounded like some sort of test very similar to the way you test blood sugar for diabetics. I don't know how true that is. I would have thought that would be routine with CO2 and CO poisoning happening quite frequently.Either way, not something that would be straightforward in an outpatient setting either. So .. it's left to us to figure out.

And yes, the key here is to be in control. Capture the data and look at it. It may not mean anything to you initially, but it certainly helps to understand it. A good O2 monitor does help, even if it doesn't capture CO2. I think the point of this post is to highlight the fact that even though all your "parameters" are within "tolerance" doesn't mean there aren't others that aren't.

Thanks, take care.
Ivan.

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Mask: AirFit™ N10 Nasal CPAP Mask with Headgear
Additional Comments: Started Jan '10 Diag AHI:169. BiPAP BiFlex 1 12/21
Last edited by ifrimmel on Sun Nov 23, 2014 4:30 pm, edited 1 time in total.

JimP
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Re: COv2 Narcosis, BiPAP and being hit by a bus

Post by JimP » Sun Nov 23, 2014 3:36 pm

Great post Ivan.

To bottom line it, your EPAP was set so high that you were building up a toxic CO2 level.

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ifrimmel
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Re: COv2 Narcosis, BiPAP and being hit by a bus

Post by ifrimmel » Sun Nov 23, 2014 4:17 pm

Right exactly. Especially while in REM, marked by tachycardia on the pulse/ox. The tidal volume looks more like panting, or that's what I imagine it would look like if I could watch myself.

I believe that I was breathing against the machine. (That should be a song title. lol) Lowering the EPAP makes it easier to expel more co2 even though the breaths are smaller in volume.

The machine also doesn't pick it up as any klnd of major event because it's not CSA\Chenye-strokes or periodic breathing. So really the only indicator is the Hypopenia Index, and that can also be due to leaks or any number of things. So it gets discounted as a actual meaningful variable in most cases.

Oh, and I think because the IPAP is so high(21) I would take in a huge volume of air, and then not be able to purge it successfully, so the co2 would build up in my lungs too.

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cnaumann
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Re: COv2 Narcosis, BiPAP and being hit by a bys

Post by cnaumann » Mon Nov 24, 2014 8:33 pm

Very interesting post. The CO2 poisoning / Acidosis theory does seems plausible.

I am glad the pressure change is helping, however, I am concerned that there may be some reason other than high EPAP pressures that is contributing to your difficulty expelling CO2.

Have you had any blood work done recently?