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

WarpedTrekker wrote: ↑

Sun May 20, 2018 6:41 am

Well after adjusting pressure support to PS2 and MinEPAP 5,4 that helped for tonight, I got a few hours of sleep with no O2 drops, and instead of usually a 93-94% O2, I got between 95-97%.

I think they may release me today from the hospital. I'm ready to go home. I just wish I could figure out what causes those days where i feel unwell and then at night i have a lot of CA's and can't sleep. I asked the doctor for some tests but it doesnt look like they are too concerned, since this only happens occassionally.

Your ventilation was too high *for your current needs* with the PS you had,(for some people, it only takes a little too much to depress the respiratory drive), and your minepap is too low.. more epap will help with getting more oxygen into your system.

I'm glad you got some sleep.

palerider wrote: ↑

Sun May 20, 2018 1:23 pm

WarpedTrekker wrote: ↑

Sun May 20, 2018 6:41 am

Well after adjusting pressure support to PS2 and MinEPAP 5,4 that helped for tonight, I got a few hours of sleep with no O2 drops, and instead of usually a 93-94% O2, I got between 95-97%.

I think they may release me today from the hospital. I'm ready to go home. I just wish I could figure out what causes those days where i feel unwell and then at night i have a lot of CA's and can't sleep. I asked the doctor for some tests but it doesnt look like they are too concerned, since this only happens occassionally.

Your ventilation was too high *for your current needs* with the PS you had,(for some people, it only takes a little too much to depress the respiratory drive), and your minepap is too low.. more epap will help with getting more oxygen into your system.

I'm glad you got some sleep.

Well I'm home, but still having major issues with my sleep. I'm not sure if it is anxiety, or what. But I had set my machine back to my normal values of minEPAP 5, PS3, MaxIPAP14. Whenever I fall asleep, immediately within a few seconds to a minute, my Contec SpO2 sensor alarm goes off! I have it set low to 85-86%. It wakes me up, I check it, and says O2 dropped to 85 or lower sometimes. Then I notice my HR spikes up immediately to 100+. I wait a minute, then everything returns back to normal. This continues to happen repeatedly at night. Last night, I got NO sleep.

It felt like my respiratory drive was depressed, and it gets worse when I lay down. I shallow breath, leading me to have signficant O2 drops during even short OA/CA. I'm not sure what is causing me to feel "unwell" with depressed respiratory drive, during the day. But if I feel this way during the day, it then gets worse at night and then I can't sleep.

I tried taking a nap here this evening, and it wasn't long that i transitioned to sleep, that I awoke with O2 dropping. This just doesn't make sense to me.

My breathing in the second screenshot also looks bad. What could be causing this bad breathing, and why did my machine ramp up to maximum? My machine normally has always been at minimum and stays there throughout the night. But for some reason lately, it ramps up to maximum!

Are you on oxygen? Little known fact that too much oxygen, especially if you have COPD will depress respiratory rate.


You on any new sedatives? Consider meds like gabapentin, Lyrica, and even antidepressants if they're new or have had a recent dose adjustment.

Are you on an antibiotic? Zyvox, in particular, is an MAOI, and could cause issues if you're already on an antidepressant. That's kind of a long shot though.




How extensive is the blood clot? PEs classically start in the legs and travel to the lungs.

yourbrokenoven wrote: ↑

Mon May 21, 2018 10:15 pm

Are you on oxygen? Little known fact that too much oxygen, especially if you have COPD will depress respiratory rate.

CO2 is what affects the need to breath, not oxygen.

WarpedTrekker wrote: ↑

Mon May 21, 2018 7:59 pm

Well I'm home, but still having major issues with my sleep. I'm not sure if it is anxiety, or what. But I had set my machine back to my normal values of minEPAP 5, PS3, MaxIPAP14. Whenever I fall asleep, immediately within a few seconds to a minute, my Contec SpO2 sensor alarm goes off! I have it set low to 85-86%. It wakes me up, I check it, and says O2 dropped to 85 or lower sometimes. Then I notice my HR spikes up immediately to 100+. I wait a minute, then everything returns back to normal. This continues to happen repeatedly at night. Last night, I got NO sleep.

You posted last fridays pic, in that particular one, the pressure was going up because of flow limitations.

I don't know about last night, but whatever was working the last few days, you should set the machine back to it... you may need more min epap, and less ps.

palerider wrote: ↑

Mon May 21, 2018 10:37 pm

yourbrokenoven wrote: ↑

Mon May 21, 2018 10:15 pm

Are you on oxygen? Little known fact that too much oxygen, especially if you have COPD will depress respiratory rate.

CO2 is what affects the need to breath, not oxygen.

Yes! Precisely! High oxygen use lowers CO2 levels and therefore the drive to breathe. Must be cautious in patients with COPD.

yourbrokenoven wrote: ↑

Wed May 23, 2018 7:16 pm

Yes! Precisely! High oxygen use lowers CO2

No, it doesn't.

CO2 is a result of metabolic processes, it's not something that goes down just because inhalations are more oxygen rich.

palerider wrote: ↑

Mon May 21, 2018 10:44 pm

WarpedTrekker wrote: ↑

Mon May 21, 2018 7:59 pm

Well I'm home, but still having major issues with my sleep. I'm not sure if it is anxiety, or what. But I had set my machine back to my normal values of minEPAP 5, PS3, MaxIPAP14. Whenever I fall asleep, immediately within a few seconds to a minute, my Contec SpO2 sensor alarm goes off! I have it set low to 85-86%. It wakes me up, I check it, and says O2 dropped to 85 or lower sometimes. Then I notice my HR spikes up immediately to 100+. I wait a minute, then everything returns back to normal. This continues to happen repeatedly at night. Last night, I got NO sleep.

You posted last fridays pic, in that particular one, the pressure was going up because of flow limitations.

I don't know about last night, but whatever was working the last few days, you should set the machine back to it... you may need more min epap, and less ps.

I've been doing well now at:
minEPAP 5.4
IPAP 14
PS 3

Well all was good the last few nights again. Now tonight, I'm having that same "unwell/tiredness" feeling. My O2 is fine awake 95%+ which was more then usual, now that I'm on blood thinners and home from the hospital. The clots must be clearing now.

But....tonight I felt bad again. Tried to just take an early "nap" tonight to see what would happen. Immediately upon falling asleep, my O2 dropped and alarm went off.

I notice my FLOW RATE graph is larger then normal. Not sure what that means? Deeper breaths?

I know what's going to happen if i go back to sleep tonight....my O2 will immediately drop, waking me up. Won't matter if I set it to 84% or lower.

If I go back to my sleep doc, or to the ER, they will say all is good. Just like last time, my Pressure is shown going up for some reason.

NOTE: I was awake this entire time on this screenshot, except at the very end when the CA happened.

WarpedTrekker wrote: ↑

Mon May 28, 2018 9:07 pm

palerider wrote: ↑

Mon May 21, 2018 10:44 pm

WarpedTrekker wrote: ↑

Mon May 21, 2018 7:59 pm

Well I'm home, but still having major issues with my sleep. I'm not sure if it is anxiety, or what. But I had set my machine back to my normal values of minEPAP 5, PS3, MaxIPAP14. Whenever I fall asleep, immediately within a few seconds to a minute, my Contec SpO2 sensor alarm goes off! I have it set low to 85-86%. It wakes me up, I check it, and says O2 dropped to 85 or lower sometimes. Then I notice my HR spikes up immediately to 100+. I wait a minute, then everything returns back to normal. This continues to happen repeatedly at night. Last night, I got NO sleep.

You posted last fridays pic, in that particular one, the pressure was going up because of flow limitations.

I don't know about last night, but whatever was working the last few days, you should set the machine back to it... you may need more min epap, and less ps.

I've been doing well now at:
minEPAP 5.4
IPAP 14
PS 3

Well all was good the last few nights again. Now tonight, I'm having that same "unwell/tiredness" feeling. My O2 is fine awake 95%+ which was more then usual, now that I'm on blood thinners and home from the hospital. The clots must be clearing now.

But....tonight I felt bad again. Tried to just take an early "nap" tonight to see what would happen. Immediately upon falling asleep, my O2 dropped and alarm went off.

I notice my FLOW RATE graph is larger then normal. Not sure what that means? Deeper breaths?

If you're still having centrals, then I'd suggest lowering the PS even more.

and I'd raise your EPAP a couple CM,

the higher flow rate doesn't mean deeper breaths (which I'd say "more tidal volume", but rather faster intake/exhale, ie, you can have a very deep breath, but a slow inhale, and exhale... (deep breathing exercises) and those would show up as smaller, but longer peaks on the flow graph. does that make sense?

If you were awake during the whole period then you cannot compare the data to when your asleep as our awake breathing patterns are very different to the asleep waveform patterns

palerider wrote: ↑

Mon May 28, 2018 9:57 pm

WarpedTrekker wrote: ↑

Mon May 28, 2018 9:07 pm

palerider wrote: ↑

Mon May 21, 2018 10:44 pm

WarpedTrekker wrote: ↑

Mon May 21, 2018 7:59 pm

Well I'm home, but still having major issues with my sleep. I'm not sure if it is anxiety, or what. But I had set my machine back to my normal values of minEPAP 5, PS3, MaxIPAP14. Whenever I fall asleep, immediately within a few seconds to a minute, my Contec SpO2 sensor alarm goes off! I have it set low to 85-86%. It wakes me up, I check it, and says O2 dropped to 85 or lower sometimes. Then I notice my HR spikes up immediately to 100+. I wait a minute, then everything returns back to normal. This continues to happen repeatedly at night. Last night, I got NO sleep.

You posted last fridays pic, in that particular one, the pressure was going up because of flow limitations.

I don't know about last night, but whatever was working the last few days, you should set the machine back to it... you may need more min epap, and less ps.

I've been doing well now at:
minEPAP 5.4
IPAP 14
PS 3

Well all was good the last few nights again. Now tonight, I'm having that same "unwell/tiredness" feeling. My O2 is fine awake 95%+ which was more then usual, now that I'm on blood thinners and home from the hospital. The clots must be clearing now.

But....tonight I felt bad again. Tried to just take an early "nap" tonight to see what would happen. Immediately upon falling asleep, my O2 dropped and alarm went off.

I notice my FLOW RATE graph is larger then normal. Not sure what that means? Deeper breaths?

If you're still having centrals, then I'd suggest lowering the PS even more.

and I'd raise your EPAP a couple CM,

the higher flow rate doesn't mean deeper breaths (which I'd say "more tidal volume", but rather faster intake/exhale, ie, you can have a very deep breath, but a slow inhale, and exhale... (deep breathing exercises) and those would show up as smaller, but longer peaks on the flow graph. does that make sense?

Yes I think I got it now. Thanks.

Any way, I had an appointment today with my Hematologist that is managing my blood thinner. She works in an Oncology center. I told her about my ongoing symptoms where I feel my central-respiratory drive gets depressed some nights. Also how I occasionally have major night sweats, and how my O2 drops at night when I have that depressed feeling.

She had me do some blood work, 24hr urine sample, and may do a CT Scan of my abdomen. She said she didn't want to scare me, but mentioned some type of carcinoma syndrome. She didn't want to tell me more to scare me, but said let's check the blood work and 24hr urine first.

I felt "ok" for most of the day, but tonight again, I have this "unwell" feeling, feel very tired then normal, and like my system may be depressed. I guess I'll find out soon tonight, once I lay down, if my O2 drops and CA's happen.

I asked my cardiologist if it could be the Multaq (for AFIB) or Bystolic(for BP)) causing the issues, but they couldn't give me a definite answer. Now, they added Xarelto since I had major blood clots in my lungs two weeks ago.

My situation may be nothing like yours - just offering this as my experience.

When I first started using a "Bi-PAP" for the first time. They insisted on having me use a Pressure Support around 6 or so. I had moved to Bi-PAP strictly for the higher overall pressure ceiling of 25 vs. my APAP which topped out at 20. I was consistently hitting 20 each night and it looked like my machine wanted to go higher. Now I sometimes hit 23 but it doesn't go to 25. So hopefully I found my own personal ceiling and won't need more pressure to control my apnea in future.

On the PS of 6, I was having a lot of centrals compared to before. Everything else looked pretty good. After monitoring my numbers for a while I kept lowering my PS till I had it somewhere close to what it was when I was on APAP. Mine is now set at 2.6 I now have 1 or fewer centrals a night and my overall AHI is very low on average. like 1 or so.

If your PS was set too high I know it can contribute to Centrals. You may have a different issue happening but wanted to toss out my experience for what it's worth.

Hope your doing better. Hope also you get good news from the doctor.

Take care and rest well.

Gryphon

palerider wrote: ↑

Mon May 21, 2018 10:44 pm

WarpedTrekker wrote: ↑

Mon May 21, 2018 7:59 pm

Well I'm home, but still having major issues with my sleep. I'm not sure if it is anxiety, or what. But I had set my machine back to my normal values of minEPAP 5, PS3, MaxIPAP14. Whenever I fall asleep, immediately within a few seconds to a minute, my Contec SpO2 sensor alarm goes off! I have it set low to 85-86%. It wakes me up, I check it, and says O2 dropped to 85 or lower sometimes. Then I notice my HR spikes up immediately to 100+. I wait a minute, then everything returns back to normal. This continues to happen repeatedly at night. Last night, I got NO sleep.

You posted last fridays pic, in that particular one, the pressure was going up because of flow limitations.

I don't know about last night, but whatever was working the last few days, you should set the machine back to it... you may need more min epap, and less ps.

Last night, I went out with friends to movie. Ate popcorn, and went to restraunt to eat. Afterwards started having general tiredness and "unwell" feeling again, with low breathing. I went home, tried to go to sleep, and measured my O2 with my Contec oximeter. It kept alarming me my O2 dropping to low 80's%. I tried another O2 monitor and it said the same thing.

I could not sleep, since I had high anxiety of my O2 dropping, and because I felt that "unwell" feeling. I had palpitations coming from my lower abdomen near belly button, and face flushed feeling as well.

Even while fully awake and laying down in bed, the O2 dropped to 80's. So something medically is going on with me.

Here is a sample of what my breathing looks like, when I have these episodes. I basically start having mini-CA's until they get long enough to be classified as a CA. I tired taking Melatonin for sleep, and also Klonopin for anxiety, but those didn't help. I stayed up a couple hours, and finally started feeling better, and then my sleep went okay, with no oxygen drops.

You may or may not have an anxiety problem, a Cpap problem, or cardiac problem, but I strongly suggest you see your doctor and find out once and for all what's going on... because something certainly is and asking us online - a bunch of strangers with none of your medical history, labs, etc. (and we're not doctors), may be prolonging your finding an answer. And it may be important to find it very soon... please get looked at!

WarpedTrekker wrote: ↑

Sun Jun 17, 2018 2:27 pm

palerider wrote: ↑

Mon May 21, 2018 10:44 pm

WarpedTrekker wrote: ↑

Mon May 21, 2018 7:59 pm

Well I'm home, but still having major issues with my sleep. I'm not sure if it is anxiety, or what. But I had set my machine back to my normal values of minEPAP 5, PS3, MaxIPAP14. Whenever I fall asleep, immediately within a few seconds to a minute, my Contec SpO2 sensor alarm goes off!

but whatever was working the last few days, you should set the machine back to it... you may need more min epap, and less ps.

Here is a sample of what my breathing looks like, when I have these episodes. I basically start having mini-CA's until they get long enough to be classified as a CA.

I notice that you ignored my advice... The advice that *worked* for you in the hospital.

Oxygenation happens at EPAP, so raise that. ventilation, which can encourage centrals (and does in your case) happens with PS, so lower that.

WarpedTrekker wrote: ↑

Sun May 20, 2018 6:41 am

Well after adjusting pressure support to PS2 and MinEPAP 5,4 that helped for tonight, I got a few hours of sleep with no O2 drops, and instead of usually a 93-94% O2, I got between 95-97%.

You had something that was working better... and you immediately threw it away.

I'd suggest a minEPAP of 7, and PS of 2, and see what happens.

Also, please stretch out the graphs so that only the top 6 are showing, and thus not so scrunched up.