Help with Events

I am looking for some help with each of the following events. I don't understand why I have so much PB and I am hoping that the following screenshots will give enough information for some answers. All suggestions are also greatly appreciated. I am a very new member and so if I posted too many images at once probably one short reply will be enough for me to learn from.

ddcckc wrote:I am a very new member and so if I posted too many images at once probably one short reply will be enough for me to learn from.

[img]http://i.imgur.com/Dn9ACbN.png/img]

[img]http://i.imgur.com/K8AHHlG.png/img]

[img]http://i.imgur.com/FXjw4we.png/img]

[img]http://i.imgur.com/u2muzN0.png/img]

it's a good idea to use 'preview', then you'd see that all your img tages are broken (missing [ on the end tag) and could fix them. go back and edit the post with the 'edit' button.

ddcckc wrote:I am looking for some help with each of the following events. I don't understand why I have so much PB and I am hoping that the following screenshots will give enough information for some answers. All suggestions are also greatly appreciated.

for your machine, it's best (unless requested otherwise) to post charts with events, flow, pressure and leak. it's hard to tell what's going on with your pressure in the squished little chart. however, it looks like you need more minimum pressure to get the obstructive and hypopneas down.

have you had your heart checked out, the patterns of your breathing aren't good looking.

Thanks that was my second post with an image and I did use preview, I just wasn't sure how it should have looked and I will show the the right charts in the future. I thought that there was so little change in the pressure and leaks I would try to get more info to look at. That is a really good catch on my heart, I have cardiomyopathy with an EF of 45. I am also on several meds, morning 200mg Zoloft, 150mg Lamictal, 50mg Losartan, 12.5mg Carvedilol and so at nigh it is Ambien 10mg, Xanax .5mg and Carvedilol 12.5mg. I am sure some of the meds are probably contributing to the sleep apnea, so far I don't have diabetes yet and not too much over weight 6'1" and 210#. Do you stay up 24/7 and post to help all those looking for answers. I sure appreciate the help you are giving me.

palerider wrote:have you had your heart checked out, the patterns of your breathing aren't good looking.

This and the rapid large variations in SPO2 noted in your other thread makes me tend to agree with PR. (BTW, It might be better to consolidate or post to one thread so that people can review your history without having to jump in and out of threads)
As you noted, you are taking some serious meds that could interact and have the potential to affect sleep architecture. From the nature of the drugs, I suspect you are under the care of more than one doctor? If so, I would suggest you make sure these people are working as a team. You may have to become the team leader, if you aren't already, and maybe your cardiologist should be second in command.
As PR says, it looks like you need more min pressure (EPAP), I think up around 10.
It does look like you have some actual periodic breathing going on, but I think SleepyHead tends to over report it. I am not qualified to comment or analyze what it might mean. Again, reason to get your medical team involved.
Some of what you have presented looks to be disturbed sleep (eg.,the CA around 0300), cause unknown. The disturbances could stem from any number of things; just an arousal, meds, cardio, pain, pressure changes, etc. However, the total number of CA is few and I think insignificant.
You might try putting the machine into straight CPAP, say at around 12, to rule out machine induced disturbances.

ddcckc wrote:Thanks that was my second post with an image and I did use preview, I just wasn't sure how it should have looked and I will show the the right charts in the future.

if posting an img, within an img tagset, you should see the image.

ddcckc wrote: I thought that there was so little change in the pressure and leaks I would try to get more info to look at. That is a really good catch on my heart, I have cardiomyopathy with an EF of 45. I am also on several meds, morning 200mg Zoloft, 150mg Lamictal, 50mg Losartan, 12.5mg Carvedilol and so at nigh it is Ambien 10mg, Xanax .5mg and Carvedilol 12.5mg.
I am sure some of the meds are probably contributing to the sleep apnea

you're on the wrong machine, then, you're likely going to need either a ST (timed backup) or ASV machine to take care of your central apneas. the patterns of waxing waning breathing that you're showing is very close, if not textbook Cheyne-Stokes Respiration (eg: http://www.atsjournals.org/doi/full/10. ... 0708-129MG). the first time I saw that was in a friend, who'd been misdiagnosed as having a hiatal hernia by a doctor who nearly killed him due to incompetence. he's in heart failure treatment, and doing much better now.

ddcckc wrote:Do you stay up 24/7 and post to help all those looking for answers. I sure appreciate the help you are giving me.

there are some here who accuse me of never helping anybody with anything.

Jay Aitchsee wrote:BTW, It might be better to consolidate or post to one thread so that people can review your history without having to jump in and out of threads

yes, so much this. keep all your stuff in one thread so people can help you better, think of it as the thick folder of patient history and notes your doctor has, think how much worse it'd be if every time you go in you had to fill out the new patient questionnaire.

palerider wrote:you're on the wrong machine, then, you're likely going to need either a ST (timed backup) or ASV machine to take care of your central apneas. the patterns of waxing waning breathing that you're showing is very close, if not textbook Cheyne-Stokes Respiration (eg: http://www.atsjournals.org/doi/full/10. ... 0708-129MG ). the first time I saw that was in a friend, who'd been misdiagnosed as having a hiatal hernia by a doctor who nearly killed him due to incompetence. he's in heart failure treatment, and doing much better now.

Thanks for the reference, PR. A very interesting paper.
As I said above, I am not qualified to speak on periodic breathing, Chyene-Stokes Respiration, and the like. I have no experience or expertise. My recommendation remains for the OP to get his medical team together to address these issues, in particular, I think it is important that all are on board with each medication prescribed and the cardio and the sleep dr should be in agreement as to the treatment.
Further, if the periodic breathing exhibited by the OP is indeed representative of CSR, I have no idea whether raising EPAP as I recommended is appropriate or not. I will leave that for others to comment.

Jay Aitchsee wrote:Further, if the periodic breathing exhibited by the OP is indeed representative of CSR, I have no idea whether raising EPAP as I recommended is appropriate or not. I will leave that for others to comment.

this looks like pretty classic CSR to me, or approaching it, I'd bet the constant line of centrals later in the night would be this, with centrals flagged in between.


CSR is a common side effect of his heart failure that he mentioned earlier.

They might be trying this machine instead of the ASV due to the cardiac EF of 45.

To OP....when is your next scheduled follow up with whomever is following your cpap therapy?
How long using this machine?
Did you use something else before this machine? If so, why the change?

Your situation is complicated for sure and warrants working closely with your doctor.

I appreciate the responses and I will keep everything in this post in the future. I do have 4 different doctors involved but I am still looking for a good sleep doc, although my Pulmonologist and Cardiologist do consult with each other and all are aware of all the meds. I have been taking the lead with all of my health problems for more than 20 years and this why I am on this forum, although I defiantly should have been doing more than lurking. That is why I have the Pulse OX and the ZEO to try to help find some answers for me and the doctors. I live 3 hours from my doctors, so that makes things a little more difficult. The night I posted is not my best but along way from the mid 20s as far as AHI. The 2 BP meds have kept my EF from getting worse over the past 1.5 years and I am hoping the PAP therapy will improve my sleep which also helps with the Cardiomyopathy. I was on a APAP and took some SH results on my Mac Book to my second appointment with my Pulmonologist and asked him about my I:E ratio which is usually about 1:1 and if a BIPAP would help. He said he would order a BIPAP titration study and see. It was going to take more than 2 months to get the study and so I just got the DS700 to find out if i could get any better results and they are improving. I will take some results to my next appointment in a month. Thanks again for the interest and help.

ddcckc wrote: I was on a APAP and took some SH results on my Mac Book to my second appointment with my Pulmonologist and asked him about my I:E ratio which is usually about 1:1 and if a BIPAP would help.

I don't know what kind of machine you had while monitoring I:E using SleephHead, but if it was a Respironics, it probably wasn't valid. See the quote below for a link to a thread that discusses I:E in detail and near the end details a method that can be used to verify the accuracy of the reported I:E.

Jay Aitchsee wrote: First, let me say that I don't think you should put too much stock in the Inspiration time to Expiration time (I:E) ratio. It is a metric used in conjunction with ventilation and does not really apply to normal CPAP use. Additionally, there is some question about the accuracy of these times using Sleepyhead and Respironics machines as well as using the 95% numbers to calculate I:E. Please see this thread for a detailed and long discussion: viewtopic.php?f=1&t=113290&st=0&sk=t&sd ... 0#p1094368

ddcckc wrote:I do have 4 different doctors involved

I mentioned getting all your doctors working together because I assumed you had someone other than the Cardio or the Pulmonary prescribing the Zoloft, Ambien, and Xanax. Zoloft is notorious for causing insomnia while Beta Blockers, such as Carvedilol, and other heart medications, such as Losartan, are known to sometimes cause disturbed sleep and insomnia as well. Additionally, there is some potential for interaction among these drugs. Probably most significantly between Zoloft and others:

WebMD Interaction Checker wrote:Significant - Monitor Closely:

• Significant interaction possible (monitoring by your doctor required)
  carvedilol oral + Zoloft oral
  Zoloft oral will increase the level or effect of carvedilol oral by altering drug metabolism

Significant - Monitor Closely:

• Significant interaction possible (monitoring by your doctor required)
  carvedilol oral + losartan oral
  carvedilol oral, losartan oral Mechanism: additive drug effects
  Additional Information: Risk of fetal compromise if given during pregnancy.

Significant - Monitor Closely:

• Potential for significant interaction (monitoring by your doctor is likely required)
  Lamictal ODT oral + Zoloft oral
  Lamictal ODT oral increases toxicity of Zoloft oral by unspecified interaction mechanism
  Additional Information: Combination may increase side effects of both drugs.

Significant - Monitor Closely:

• Potential for interaction
  carvedilol oral + losartan oral
  losartan oral and carvedilol oral both increase potassium levels in the blood

Minor:

• Interaction is unlikely, minor, or nonsignificant
  Ambien oral + Xanax oral
  Ambien oral, Xanax oral. Either increases the level of the other by added drug effects
  Additional Information: Combination increases risk of CNS (central nervous system) depression.