Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

[colomom]

If you ask him to take a big inhalation on his own, he really cant, its just one short breath lasting 1 second and thats him at his limit. He cant do one long slow and steady inhalation… he had heart surgery a couple of years ago and prior to his surgery they did a pulmonary assessment to see that he had sufficient lung capacity to undergo the surgery. The surgeon said there might be issues due to his scoliosis, but the test would clarify… he passed the test successfully.

I would question whether or not a Cardiologist checking a box and saying lung function is good enough for surgery is a good enough assessment of his lung function. Have they done a pulmonary function test since the surgery? I have asthma and my allergist had me do a PFT in office just last month. It’s an easy test that’s readily available, I would push for a PFT if it hasn’t been done recently. I’m not familiar with the health system in the UK, but in the US if your dad had a PFT with abnormal findings it would likely get him into the door with a specialist who could better assess the issues.

If spine issues are restricting breathing as you suspect, sleep position might be worth diving deeper into. The question being what is the optimal sleeping position to limit any compression of the lungs that might be caused by your dad’s spinal issues?

Your dad and my father have some similar health issues, my father also has severe scoliosis and has had heart valve issues. Unfortunately it sounds like both of our dad’s paths to getting the proper care have been long and difficult. You’re father is fortunate to have you advocating for him! Hope you will find the path to improvement for your dad!

[Rubicon]

Why be nasty?

Cause these MFs don't understand anything else.

[Rubicon]

I have asthma and my allergist had me do a PFT in office just last month. It’s an easy test that’s readily available, I would push for a PFT if it hasn’t been done recently.

OK but I wouldn't get a "Screener", which is what you'd get in a physician's office. I'd get a "Complete" to get a look at the Flow-Volume Loop.

[colomom]

I have asthma and my allergist had me do a PFT in office just last month. It’s an easy test that’s readily available, I would push for a PFT if it hasn’t been done recently.

OK but I wouldn't get a "Screener", which is what you'd get in a physician's office. I'd get a "Complete" to get a look at the Flow-Volume Loop.

I agree, but the thinking behind my suggestion is that the first step is the screener tests, which hopefully will open the door to more. I don’t know how it works in the UK, but my assumption is that like in the US they make you jump through a series of hoops before shelling out for the more expensive tests/ docs.

[Rubicon]

... like in the US they make you jump through a series of hoops before shelling out for the more expensive tests/ docs.

Actually, they look for necessity ("indication"). You can figure out if you're going to qualify by checking the "LCD" for the particular test.

Like for PFT:

https://www.cms.gov/medicare-coverage-d ... 247&ver=37

That said, the flow-volume loop will be part of Spirometry as long as the office has a real PFT machine and not some POS they got on Amazon that only spits out FVC and FEV1.

[Rubicon]

As a frinstance, one of the WAGs thrown out was perhaps as a complication of surgery there is some vocal cord dysfunction. A flow volume loop in that case might look like



While this format looks a little strange because inspiration is on the bottom and expiration is on top, you can see how we got some glitchy stuff on inspiration.

[Steerpike58]

I can't add anything of value to this thread but I just want to say, EggYolkeo, the level of care and attention you are giving your dad is nothing short of wonderful!

[Egg Yolkeo]

There is no AHI problem, it's all about trying to improve the inspiratory waveform.

It appears whatever that is is not particularly pressure-responsive as there is some marginally good stuff at any pressure. And bad stuff at any pressure. Perhaps body position, neck position and/or sleep stage has influence on waveform.

BiPAP, with some fiddlement of Advanced Settings like I:Time, is definitely worth a shot to improve that inspiratory waveform rather than jacking that pressure any higher.

Thanks for clarifying, I am looking at avenues for Bipap's and have also found a local respiratory physiotherapist who has experience with both physical and neurological breathing issues, this should be the quickest way to get the ball rolling once I have talked my dad into.

[Egg Yolkeo]

If you ask him to take a big inhalation on his own, he really cant, its just one short breath lasting 1 second and thats him at his limit. He cant do one long slow and steady inhalation… he had heart surgery a couple of years ago and prior to his surgery they did a pulmonary assessment to see that he had sufficient lung capacity to undergo the surgery. The surgeon said there might be issues due to his scoliosis, but the test would clarify… he passed the test successfully.

I would question whether or not a Cardiologist checking a box and saying lung function is good enough for surgery is a good enough assessment of his lung function. Have they done a pulmonary function test since the surgery? I have asthma and my allergist had me do a PFT in office just last month. It’s an easy test that’s readily available, I would push for a PFT if it hasn’t been done recently. I’m not familiar with the health system in the UK, but in the US if your dad had a PFT with abnormal findings it would likely get him into the door with a specialist who could better assess the issues.

If spine issues are restricting breathing as you suspect, sleep position might be worth diving deeper into. The question being what is the optimal sleeping position to limit any compression of the lungs that might be caused by your dad’s spinal issues?

Your dad and my father have some similar health issues, my father also has severe scoliosis and has had heart valve issues. Unfortunately it sounds like both of our dad’s paths to getting the proper care have been long and difficult. You’re father is fortunate to have you advocating for him! Hope you will find the path to improvement for your dad!

Hi Colomom, thanks for your reply.

As you say its unclear as to how in depth his test was, but as I recall it was a separate pulmonary assessment and not done by the cardiologist. I recall due to the requirements of having minimally invasive surgery, the ability to pass the test was higher than regular open heart surgery as I seem to remember them saying they would have to do open heart surgery and use a different ventilator if he doesnt pass.

I have found a respiratory therapist nearby who covers these areas and that will be the next and quickest step in terms of further investigation.

[Egg Yolkeo]

I can't add anything of value to this thread but I just want to say, EggYolkeo, the level of care and attention you are giving your dad is nothing short of wonderful!

Thanks for the kind words Steerpike58,

My dad is lucky enough to have had almost 7 decades of completely trouble free good health. Unlike his attitude to maintaining and cleaning his cars and keeping them in good order, he is completely asleep at the wheel as to his own health awareness. He was like a deer in the headlights when he encountered serious health problems and still is to some extent today.

I on the other hand have had a number of health issues, injuries and surgeries from an early age and had to work around a lot of those things. Combined with a working background that involes a lot of analysis and troubleshooting, I cant let these issues go without trying to finding a solution. My Dad is happy to bumble along oblivious and when a problem occurs will stick his head in the sand, for that reasons I had to take over his situation as otherwise he wouldnt be here.

[Applecheeks]

Cause these MFs don't understand anything else.

Think being a nasty bully works? YMMV, but it does nothing to impress.

The "disagreement" between Granny and Max didn't involve you, so why inject yourself by juvenile name calling.

Have a fine day fishing.

[Rubicon]

The "disagreement" between Granny and Max didn't involve you, so why inject yourself by juvenile name calling.

Cause it gives a busybody like you something to do.

[zonker]

Cause these MFs don't understand anything else.

Think being a nasty bully works? YMMV, but it does nothing to impress.

The "disagreement" between Granny and Max didn't involve you, so why inject yourself by juvenile name calling.

Have a fine day fishing.

concern troll is concerned.

[Egg Yolkeo]

There is no AHI problem, it's all about trying to improve the inspiratory waveform.

It appears whatever that is is not particularly pressure-responsive as there is some marginally good stuff at any pressure. And bad stuff at any pressure. Perhaps body position, neck position and/or sleep stage has influence on waveform.

BiPAP, with some fiddlement of Advanced Settings like I:Time, is definitely worth a shot to improve that inspiratory waveform rather than jacking that pressure any higher.

Hi Rubicon,

One other question came to mind.

As I understand it EPR is kind of like a poor mans Bilevel function. I did do a very brief test with EPR enabled last month. At the time and not being able to assess the waveforms well, my only observation was that his AHI's and figures generally got worse and I switched it off. However since importing the data into SleepHQ and being able to scroll through the waveforms on different days, whilst still bad overall, it seem like I can find more short batches of better looking waveforms on the days EPR was enabled.

Assuming I am not seeing things, and enabling EPR does improve the waveforms but worsens apnea figures, should the APAP min/max pressures be raised slightly when enabling EPR to compensate for the dropping of pressure during exhalation?

[Rubicon]

As I understand it EPR is kind of like a poor mans Bilevel function.

It would be more accurate to say EPR is a very limited form of BiPAP as the maximum "PS" is 3.0 cmH2O.

Assuming I am not seeing things, and enabling EPR does improve the waveforms but worsens apnea figures, should the APAP min/max pressures be raised slightly when enabling EPR to compensate for the dropping of pressure during exhalation?

Depends on what "worsens apnea figures' means. If they are central in nature you would consider turning it down or abandoning the idea. If they are obstructive in nature you would consider turning it up. If they are due to sleep disturbance ("SWJ") you would consider leaving it alone. Sleep stage, body position, APAP vs fixed pressure-- there's no simple answer to a complex question, and you can't necessarily decide what's best by looking at 14 breaths during a night where there's 5200.