Urgent advice needed - In hospital - Lots of CA's and respiratory feels depressed

I got admitted to the hospital a couple days ago for blood clots in my lungs. They have been giving me Lovenox injections blood thinner. I was on my last night here to go home, when suddenly I developed a lot of CA's and feel like I'm stopping breathing at night, whenever I go to sleep.

It happens almost immediately when I go to sleep, my SPO2 drops to 80's also and their oxygen sensor beeps and wakes me up. I try going back to sleep but same thing happens. The nurses don't seem concerned and said i need to talk to the doctor.

I had NO sleep last night. It takes me awhile each time to fall to sleep, then suddenly it wakes me up with low oxygen warning.

I'm not sure what is going on, my NORMAL AHI is almost always <1.

I'm on Multaq, Bystolic, and now the blood thinner. My oxygen when awake is 94%+.
But when i doze off to sleep it immediately goes to 80's and I have CA's!

Please do you have any thoughts on what I can say to the hospital doctor to run tests on me while I'm here?
I don't want to go home in this condition! I have the head of bed slightly raised just like I have at home. And the first nights here at the hospital I slept okay.

Did a respiratory therapist come in the room in the beginning of your hospital stay, to check your machine before allowing you to use it in lieu of their own? This would probably be a good question to ask them, if so, and also the doctors who come in to do early morning rounds, or to check in on you.

I don't know anything about the medications you are on, but some medications can indeed cause respiratory depression. It's why on some labels they will warn people about taking them, without asking their doctor, if they have certain health conditions.

In a quick Google of the medications you're on, it's probably dangerous for anyone here to give any specific medical related advice.

Your VAuto machine won't be able to do anything for central apneas. I would ask the doctor who stops in to check on you next, and also ask to speak with the RT if possible. They can maybe have you use one of their machines which is back-up rate capable, but I don't know if they will be able to make it like how you have it set up in the VAuto mode. I assume it would just be straight bi-level IPAP/EPAP with a backup rate applied.

There are probably clinical signs of respiratory depression. So start by telling the doctor your symptoms, and see what happens.

Why can't you ask to see either your doctor or another one, e.g. a cardiologist or someone who knows at least a bit about pulmonary issues and/or apnea? This doesn't seem like a good situation to have to depend on nurses or even techs to help (or not help) with!

Sounds like for some reason you are having an inordinate number of sleep onset centrals.
Normally they aren't a problem because we might just have one or two and no desats and we progress into sleep but sometimes when a person has a truckload of sleep onset centrals a person will have desats and of course trouble proceeding into real sleep stages.

As for why....I don't know unless it has to do some how with your meds or a combination of meds.
Will it resolve itself with a bit of time....that's an unknown and with the significant drops in O2 I don't know how much time I would want to give it anyway.

The fix is a different machine....ASV bilevel or other bilevel with a back up rate available. I prefer ASV bilevel back up because it kicks in only when needed instead of forcing a breath all night long whether you need it or not and if you only need the help during sleep onset then it would mean higher pressures all night instead of part of the night if you went with bilevel with fixed back up rate.

You really need to be talking to a doctor who understands central apneas and potential causes.

Pugsy wrote: ↑

Sat May 19, 2018 8:06 am

Sounds like for some reason you are having an inordinate number of sleep onset centrals.
Normally they aren't a problem because we might just have one or two and no desats and we progress into sleep but sometimes when a person has a truckload of sleep onset centrals a person will have desats and of course trouble proceeding into real sleep stages.

As for why....I don't know unless it has to do some how with your meds or a combination of meds.
Will it resolve itself with a bit of time....that's an unknown and with the significant drops in O2 I don't know how much time I would want to give it anyway.

The fix is a different machine....ASV bilevel or other bilevel with a back up rate available. I prefer ASV bilevel back up because it kicks in only when needed instead of forcing a breath all night long whether you need it or not and if you only need the help during sleep onset then it would mean higher pressures all night instead of part of the night if you went with bilevel with fixed back up rate.

You really need to be talking to a doctor who understands central apneas and potential causes.

There can be a link between certain medications (such as sedatives) and respiratory depression. And one sign of respiratory depression can be central apneas (one other is an abnormally low respiratory rate, where the person is breathing slow and shallow without much chest movement in breaths).

Hopefully, if the medications the OP is taking are for an acute condition, once OP is off them his sleep breathing should go back to normal. But OP, you need to ask your medical team, as we don't know if this new pattern is dangerous in the short-term. And we are just users on an internet forum, and cannot diagnose your conditions in any way.

raisedfist wrote: ↑

Sat May 19, 2018 8:17 am

There can be a link between certain medications (such as sedatives) and respiratory depression. And one sign of respiratory depression can be central apneas (one other is an abnormally low respiratory rate, where the person is breathing slow and shallow without much chest movement in breaths).

Yeah, I know about meds that can suppress respiration and how they work.
I haven't had time to go digging into the known meds and then we have the blood thinner also involved anyway.
If meds were involved then why only at sleep onset unless maybe it wouldn't be only sleep onset if a person could actually progress into the other sleep stages. I wonder if he could progress into sleep if the alarm wasn't waking him up.

Whatever the cause....drops to 80% need to be addressed sooner than later IMHO.
If it is medication related and the blood thinner is involved somehow...he's going to be on the blood thinner for quite some time.

Again...the best advice I can offer is "get with the doctor and hopefully a doctor who knows about central apneas" to get the cause and treatment all sorted out.

This case is too complicated and too risky to give advice over this forum.

Central Apneas are intrinsically more complicated than obstructive ones. Furthermore, the other issues that you mentioned make it very dangerous and much more complicated. Only certified medical personnel should attempt to to you anything directly related to your treatment.

The one thing I will tell you is not to give up hope! Better days are ahead!

Pugsy wrote:
Yeah, I know about meds that can suppress respiration and how they work.
I haven't had time to go digging into the known meds and then we have the blood thinner also involved anyway.
If meds were involved then why only at sleep onset unless maybe it wouldn't be only sleep onset if a person could actually progress into the other sleep stages. I wonder if he could progress into sleep if the alarm wasn't waking him up.

Well the OP didn't give any information as to how he is feeling during the day while awake. Out of the ordinary lethargy, dizziness, headache, etc,. And I guess medically, alterations in respiratory rate, abnormal heart rate or BP, or CO2 levels could be helpful. Who knows what is being monitored, if they are in a cardiac unit, etc,.

Pugsy wrote: Whatever the cause....drops to 80% need to be addressed sooner than later IMHO.

Definitely. It sounds like that is abnormal for the OP.


IMO the OP is in the hospital for a serious condition. And is taking multiple medications related to the heart. There isn't much to do here except say to speak to your doctors.

Here is another screenshot. My respiratory rate does go way down. This is very concerning. It's Saturday and I can't get in contact with my Pulmonologist nor Sleep Doctor. I'm going to have to wait on the hospital doctor to come by and ask him.

The fix may be a Bilevel with Backup Rate, but i cant wait the weekend or a week for my sleep doctor to get one in. Maybe the doc can give me some med to get my respiratory rate back up or to keep it up at night in the meantime?

I'm calling some "on-call" phones for my Pulmonologist and Cardiologist to see what they suggest. I definitely dont want to go home in this state, with the depression going on and have a lot of CA's.

Whatever is going on likely we can't fix it with your current machine anyway.
I don't know of any magical little tweaks that we could try to resolve your issues even if we knew for sure what the issues were caused by. Even if I did I would be extremely hesitant to advise trying any changes unless you agreed to run them by your doctors....but I can't think of anything to even run by the doctors in terms of machine settings.

We can suppose and what if all day long but that's all it can be.

To fix a problem you first have to identify the problem cause and at this point we don't know exactly what the problem is caused by.
We know there is a problem but as to why we don't know. Medications obviously can play a part but it doesn't always have to be medication related.

On the weekend it's typical that not much happens - at least in my experience. If you get pressured to be discharged, you can request to speak to somebody in patient services and file an appeal to delay the discharge. You may have gotten a patient information packet when you were first set up in your hospital room. As far as I know a doctor has to sign off on the discharge order, so I would request to speak with a doctor in that event. As long as you remain polite but firm, you should hopefully be just fine.

Have you tried telling the nurse you don't feel well? I still think reporting symptoms, if any during the day, may be our best bet to starting the process of investigation (such as taking your temp and blood pressure). Until the normal doctor's come back to their shifts on Monday.

Have you asked to speak to the RT? I imagine there always has to be one on staff. You could even fib and tell the nurse you're having a problem with your machine...

I talked to the Pulmonologist that saw me yesterday, and to a doctor that came by to visit me just now. When I asked them about my medicines causing respiratory depression, the Pulmonologist said it was highly unlikely and the doctor said it is most likely "anxiety" causing the CA's.

The doctor said he will order an Oximeter that they can use to monitor me today and overnight remotely from their other room in the hospital. They already have me on an EKG that they are remotely monitoring me.

But they both basically asked how long has it been since my sleep study, and if my machine was setup properly. They said I should contact my sleep doctor on Monday.

This is concerning to me, they would make me go through this another night. Oh, and I had asked about CPAP machines, and they do have some, but the guy says they are huge machine, on rollers, used for CPAP and other things, so it is best to use mine.

Illness does not know weekends, "sabbaths," holidays, or vacations.

Specialists need to take turns working on these days.

Have they tried hooking supplemental oxygen to your machine? When I was in the hospital around four months ago, they added supplemental oxygen to my machine. This helped to keep my oxygen from dropping if I did have events.

Oh man...I am having a hard time figuring out how anxiety when falling asleep can cause O2 levels to drop to 80%.
Now if you reported just feeling air starved it would be one thing but for the O2 to drop that much someone has to hold their breath a very long time or something else is causing it....physiological vs mental. There is nothing "mental" that I can think of that can do it.

Maybe if they monitor the O2 and not let the alarms wake you up then you can see if the centrals stop once you are asleep for sure...or if they continue then that data would maybe help the sleep doctor know how to proceed.

Unfortunately there is no quick easy fix even if they did want to change machines and could. They wouldn't have any idea what to set a different machine at to help you out...if they even had a machine available that could help you out. Hospital personnel aren't much into WAGs and experimenting.