New to this- Husband vpap III 5 days but not taking breaths

rested gal · Post by **rested gal** » Fri Mar 07, 2008 6:37 pm

goose wrote:What he told her was that I probably have 20+ years of sleep debt to sleep off and that I'd probably be sleeping this way the rest of my life.

I hope the doc was humorously exaggerating, 'cause that's not how sleep debt works. Don't ask me "how" ... LOL!! ... but it's definitely not a "gotta pay back one hour for each hour missed" thing at all.

goose · Post by **goose** » Fri Mar 07, 2008 6:53 pm

I'm sure he was exaggerating a wee bit.
And thankfully you are right!!!
I don't expect to be "normal" overnight, but hopefully someday....(well. Whatever normal might be).
It doesn't bother me to finally sleep well and I hope it keeps going for a long time!!!! But 20 years of sleep debt.....I sure hope not!!!!
I'll continue to use it as an example of no instantaneous "cure" though....

take care
cheers
goose

Banned · Post by **Banned** » Sat Mar 08, 2008 12:05 am

Anonymous wrote:Well, I finally made it here.

I am getting used to the current setting of the ADAPT SV. As far as we can currently tell I am no longer having central apnea's. I have had a couple of startles this week but compared to before that it nothing. This weekend we will download the data from the machine and see what it looks like then let you know.

The Adapt SV will take a minimum of two to three weeks to get used too. It will take even longer before you really start to respond to the rhythm of the machine and take the breathe naturally when the it is delivered and in accordance to your breathe flow-rate. It is a totally different experience from the CPAP or VPAP, so it takes time. Your startling awake thing (although it sounds like it is improving) is still a unsettling in that the Adapt has not already smoothed it out entirely. Can you describe those episodes in more detail? What is happening with your breathing as you startle awake? Is it a panic kind of awake? I wake up (although I do not get up) many times each night it is never fitful or eventful. I always use it as a time to roll over on my other side and go back to sleep. i also sleep with the hose down at my side (not up over my head). Sounds like your EEP is definitely 6cmH2O. In three weeks you could possibly consider spinning the MIN PS dial up to 4.2 and try that setting for a week or two. Then see what your stats are (Maybe SAG will be in the Bahamas so he can't yell at us). After some time on the Adapt SV you will find those .2 increments of MIN PS can make a big difference. For example, I'm totally locked into my high EEP pressure of 9cmH2O, (thank you RG!). And, I have found that if I adjust below MIN PS 5.4 or above MIN PS 5.6 I'm either getting to little, or too much inspiration pressure. My point is this, As the months go by, you should be able to sense when you are getting the right amount of inspiration pressure. Anyway, guy, when I was in Viet Nam, we only had agent orange to slog thru. God know what chemicals were in the oil fires, smoke, and other crap you guys inhaled. Keep us posted,

Banned

StillAnotherGuest · Post by **StillAnotherGuest** » Sat Mar 08, 2008 5:54 am

Banned wrote:Maybe SAG will be in the Bahamas

Greetings from the Bahamas!

Did you know that they have Internet Access here?

Banned wrote:so he can't yell at us

Us? Who is us? All I see is you and your unfounded theories.

However, I have finally solved this mystery. Admittedly, I was thrown off a bit by

Banned wrote:And I defer to SAG as the senior unofficial spokesmodel for the (albeit mediocre) Respironics BiPAP AutoSV.

With the light of day, it is now clear that:

Everything that you have said about the AdaptSV has been incorrect and could result in failure in therapy.

The only thing that you have said that isn't wrong is that the ResMed Quattro FFM is a good mask.

The ResMed Quattro FFM is compatible with the Respironics BiPAP AutoSV.

Therefore, you must, in fact, be a Respironics salesman.

Banned wrote:In three weeks you could possibly consider spinning the MIN PS dial up to 4.2 and try that setting for a week or two.

EEP, MIN PS and MAX PS are not "comfort measures" to be adjusted during Wake. They have specific functions during sleep which may be adversely affected if you use Tarot Cards or newspaper headlines to make adjustments (like, "Oh, look! Earthquake in Sumatra, 5.2 on the Richter Scale! I think I'll use 5.2 for MAX PS tonite!")

While EEP is used to address obstructive events and MAX PS is used to insure that Target is being met, MIN PS helps establish Target during baseline breathing and will affect the hyperpnea that occurs during the central apnea cycling. AdaptSV works in a two-fold manner. It supports the hyperpnea during central apnea cycling less aggressively, and addresses the apnea periods themselves more aggressively. If you arbitrarily raise MIN PS, what you could end up with is the overshoot that you get with plain ol' BiPAP therapy (which you just dropped 4 grand to get rid of).

Mr. Casiesea - Guested wrote:This weekend we will download the data from the machine and see what it looks like then let you know.

Great, while you're there, grab the whole file. If they can't find it, tell them to look in c:/ResMed/ResScan3.x/Patients/mr.casiesea

SAG

Banned · Post by **Banned** » Sat Mar 08, 2008 8:42 am

StillAnotherGuest wrote:

Banned wrote:so he can't yell at us
Us? Who is us? All I see is you and your unfounded theories.

Ok, it's just like I said. Leave those dials alone

Casiesea · Post by **Casiesea** » Mon Mar 10, 2008 4:42 am

My daughter woke me up around 4am this morning because she couldn't sleep. I moved over and told her to get in. I could not go back to sleep so I decided to watch my hubby for a while.

I rolled over to him and put my arms around his chest, but I couldn't feel him breathing. I lowered my arms to around his stomach. I still could barely feel movement. I started listening for a while and I could hear breathing (through the machine). He has a bad habit of slumping his shoulders when he sleeps (kind of smashes his upper body) so I nudged him to change positions. He kind of rolled back my way when he did so I had a much better visual on him. After a min or two he startled, which got me thinking. So I decided to try to find his pulse...but couldn't. I tried his wrist, then his jugular, then his femoral...no detectable pulse. Needless to say I was begining to get nervous. I tried his wrist again and got one, but it was very thready.

Then, as I lay there taking his pulse, I notice him moving his fingers. Just a jerky movement every min or so. Then his other hand would move, then his leg/foot. The psg said he had some limb movement but that it was not really affecting his sleep, well now it is. Would the psg notice a finger movement(that is mostly what he was doing)?

Anyway, so I got bored watching him, rolled over the other way to notice my daughter doing the same thing! Great!

Banned · Post by **Banned** » Mon Mar 10, 2008 9:10 am

Hi Casiesea,

I'm thinking you should look into one of those Oximetry thing'ys dsm was talking about. Also, you may want to schedule him with a neurologist about the startling awake that still seems to be a problem.

Cheers,

Casiesea · Post by **Casiesea** » Mon Mar 10, 2008 11:41 am

We just got back from the "new" sleep doc. It was not a pleasant visit. Lets just say his bedside manner was awful, and leave it at that.

This doc does not feel my husband has CSA. He feels it is OSA and he was not titrated properly. He also found it extremely humerous that my husband has now had 4 sleep studies/titrations (he was the only one laughing btw).

The new doc feels that the Adapt is causing the disturbances and is ordering a 3 day home study with the Auto Bipap.

I would love to hear everyone's thoughts on this. Should we go for a 3rd sleep doc opinion?

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CSA, auto

dsm · Post by **dsm** » Mon Mar 10, 2008 1:22 pm

Casiesea,

Speaking for myself - I would want to satisfy myself on the docs credentials before getting into a cycle of expectation. Is there any reason the doc who titrated with the adapt can't get another look at him ?

But, the points you raised about his breathing & pulse & movements are still a significant worry, the added worry is getting conflicting opinions from doctors who may not be experts in the field of Sleep Apnea, allowing that your husband is a special case.

The Bipap Auto could be an answer but the effect of constantly switching machines may be further confusion.

I don't envy your challenges.

DSM

Julie · Post by **Julie** » Mon Mar 10, 2008 1:58 pm

Only will add one thing here - when you turned your husband over in bed, I presume it was onto his back - which is known to be the worst position for apnea problems. Whether or not it's relevant here or now I guess you'll find out.

Casiesea · Post by **Casiesea** » Mon Mar 10, 2008 4:16 pm

They are both Diplomates of the American Board of Sleep Medicine. One of them (doc #1, a psychiatrist who specializes in Sleep Med) is a board member of American Academy of Sleep Medicine and is supposedly a "nationally recognised expert". The new doc (doc #2, a neurologist/sleep doc) is recommended under the "find a sleep lab" part of this website and was highly recommended by a trusted physician who said "he is the smartest and best in the area". Both are in good standings with the state medical board. Not sure what else I can find for credentials.

I can see the new doc is smart. Maybe he was having a bad day, who knows. We have called the doc #1 two times, no call back yet. I just don't trust her, she doesn't seem to make patient care a priority. My husband has been seeing her for 2 years (4 psgs as the other doc pointed out) and she still hasn't gotten it right. I am not wild about this new doc (to say the least) but if he can help my hubby I can deal with his personality (or lack there of).

I guess I basically need to know if what doc #2 is saying makes sense. Could the new type of arousals be caused by the Adapt SV? I remember how much better his AHI got when we adjusted the bipap a little. Doc #2 said the very first psg did not show Central apneas so he feels this is primarily an OSA issue. He does not seem that concerned about the oxygen sats,"I like to keep them above 88".

That all being said, I have two dr's saying two different things. Should he go for a 3rd?

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, AHI

dsm · Post by **dsm** » Mon Mar 10, 2008 5:11 pm

Casiesea,

From what you say, stay with this new doc & your attitude is good (if he fixes hubby, you will allow for his manner )

Also take a read of the last post I put into this thread

viewtopic.php?t=29016&start=15

In this post I highlight some aspects of the Adpat SV as stated to me by a Resmed doc this morning. The heart of the matter being that the Adapt SV is best suited to someone with less OSA & who may experience very short periods of irregular breathing as it is very good at normalizing them & keep the person steady (RG has summed this aspect up quite well elsewhere). But, If someone has a steady pattern of declining respiration the machine will slowly track the patient down & tend to hold them there when and if the patient's breathing starts to move back up to more normal respiration.

From what you say, Doc#2 doesn't see Centrals in hubby's PSG & thus can't see what the Adapt SV will do for him and he believe's hubby is dominantly impacted by OSA - he probably thinks that the Adapt SV may be tending to hold hubby's breathing down as it is obvious he goes into 'slowdowns' as you have so astutely observed.

I'm back to thinking the Vpap Auto or a Bipap Auto may well be the better bet.

So - stay with doc #2

Cheers

DSM

-SWS · Post by **-SWS** » Mon Mar 10, 2008 5:18 pm

Casiesea, my feeling is that the best-qualified person here to render an opinion is SAG. I would suggest going back through this thread and rereading what he has already written.

That way you'll be up to speed if he decides to come back into this thread with any more suggestions. SAG, hint, hint.

Good luck!

dsm · Post by **dsm** » Mon Mar 10, 2008 5:32 pm

-SWS wrote:Casiesea, my feeling is that the best-qualified person here to render an opinion is SAG. I would suggest going back through this thread and rereading what he has already written.

That way you'll be up to speed if he decides to come back into this thread with any more suggestions. SAG, hint, hint.

Good luck!

Ditto

DSM

Banned · Post by **Banned** » Mon Mar 10, 2008 6:18 pm

Hi Casiesea,

My feeling is that most sleep-doctors are the bottom of the barrel and even a Republican (on a good day) would have more gray matter. Prescribing titratiion on an BiPAP Auto is dismissive, and pure nonsense. However, if the IPAP during this study suggests a higher pressure than 10cmH2O, than I suggest Casiesea's husband come ahead with a bit more MIN PS on his Adapt SV. Heck, I can get more air fanning myself with a piece of paper, than setting the machine for an inspiration pressure of 10cmH2O. On the bright side, I think his EEP of 6cmH2O is good enough to leave alone, but I'm happy to crank up the MIN PS.

Banned

New to this- Husband vpap III 5 days but not taking breaths

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