Why doesn't APAP respond to apneas?

[StillAnotherGuest]

LOL! Well, there's a Sandman sitting right here in this thread! Mayhaps we can take a look-see!

Thanks! And hooray!

But we will need a volunteer to allow us to "go inside her head".

Bev - attachments sent.

SAG

[Snoredog]

SAG: Well, what do you think about this dial wingin' case?

B&W: The AHI on CPAP 14.0 cmH2O is 1.4.

SAG: Good point. I wish I had thought of that.

B&W: OK, I gotta split.

SAG: Right, thanks. Say hi to the family.

B&W: Back atcha.

Somehow your answer sounds the SAME as she got from her doctor after 2 PSG's, you are doing fine. Based on what? her AHI?

Sure have another PSG we'll figure it out this time..... Sure they will... or she will end up with new drugs to make her sleep then another one to make her awake then another one to counter act the side effects of those two.

IF one of these underlying etiologies such as UARS, CAP or something else is present and they didn't find it after 2 PSG's, what makes one think another PSG will find the answer this time around?

I don't even think she knew she had some of the CSDB traits until she put up her PSG's in this thread and it was pointed out to her, it is not like they share any of those possibilities of what the cause might be with the patient. If it was UARS and it wasn't covered by insurance well that doesn't do the patient any good, patients don't really give a damn what a disorder is called or what the etiology behind it, in other words if they had her all hooked up and were titrating her on 4 cm pressure support, why wouldn't they increase that pressure support on up to say 8 cm to see if there would be any benefit?

Sure she had 2 PSG's within the last year, first on CPAP, second on Bilevel, she is currently on CPAP at 14 with the low AHI, they didn't seem to find that in the CPAP titration. Didn't find it in the bilevel titration either. If she has another PSG she better know with a cold chance in hell what it is before hand to say "look for this" because if she doesn't they will never find it and will only be going thru the routine to pad her doctor and the labs wallet. Wouldn't surprise me if they don't add the MLST to the menu.

Maybe we should have a newbie start a Poll asking how many people resolved their residual daytime fatigue after having a MLST?

I bet I already know the answer to that one, ZERO. But they are good money makers aren't they.

Hey Bev, when you first went to see your Sleep Specialist what was your main complaint for going?

Your AHI was too high?
You thought you had UARS or CAP?
You believe you had tendencies to go into Periodic Breathing and Central dysregulation?

My guess is you went in because you were tired during the day. After all this time, expense, night time discomfort are you any better?

[rested gal]

Not living in the lingo, I had to search for what GFL mean.

I had a laugh when I found this "Gesellschaft für Labortechnik" as one of the possibilities. ("Gesellschaft" means "company" in German, but it also means "Society").

Which made me wonder, SAG if you were using the salute of the Society that keeps all those secrets...

I had it down to either: 1) Grotesque Flow Limitations, or 2) Girl Friend's Lithuanian.

It's nice to have erudite friends! Me... I continue to read it as "Good F__in' Luck."

[StillAnotherGuest]

IF one of these underlying etiologies such as UARS, CAP or something else is present and they didn't find it after 2 PSG's, what makes one think another PSG will find the answer this time around?

Unless, of course, one or more of the endless other possibilities exist, including: (1) they didn't "find it" because they didn't know what they were looking for; (2) they didn't "find it" because they simply missed it; (3) they "'found it" but didn't think it was clinically relevant; (4) they "found it" and thought it was clinically relevant but didn't act on it (I would certainly hope that wasn't the case); and/or (5) they found it but didn't understand the clinical relevance because they don't know "The Big Secret".

Bev, I have attached The Big Secret, next time you talk to them, feel them out and see if they have a handle on it. Maybe nobody told them The Big Secret, but we shouldn't be the ones to do that in case there's a good reason "They" don't want "them" to know.

SAG

Attachment: thebigsecret.doc

[OutaSync]

SAG,
I got the attachments. I don't pretend to understand it all, but I do try. From the looks of his profile, do you think my DR. has the educational background to see anything even if he knows what to look for? I wonder if the Doctors actually look at the data, or do they get a synopsis from the techs?

Snoredog,
This morning when my clock radio went off, I left my mask on and fell back asleep. I dreamed that I was trying to make breakfast but my head hurt from the loud radio, so I kept trying to turn it off and it wouldn't turn off, so I tried to unplug it, but everytime I unplugged something, it was the wrong appliance and the radio kept blaring. I tried to take the appliances out of the room to make the music stop, but more and more kept appearing on the counter and the blasted music wouldn't stop. When I woke up my heart was pounding and I was panting in short, fast breaths. It was one of those dreams where reality creeps into dream. Nothing interesting showed up on the Encore Report for that period of time, not even a hypopnea. I wish I had been using the SV, as the graphs there are more interesting.

Rested Gal,
I think you got it right.

Bev

[StillAnotherGuest]

From the looks of his profile, do you think my DR. has the educational background to see anything even if he knows what to look for? I wonder if the Doctors actually look at the data, or do they get a synopsis from the techs?

Well, there's only one way to find out...

ROAD TRIP!!!

OK, maybe a teleconference. Let's try to set something up with the techs first before you hit the MD up with "Some nut on the internet told me..."

SAG

[OutaSync]

When he asked me why I wanted the raw data, I told him I had a friend who was an RT and was tired of hearing me complain, so he wanted to look at it. It worked, they let me have it. No one had ever asked before.

Bev

[Snoredog]

IF one of these underlying etiologies such as UARS, CAP or something else is present and they didn't find it after 2 PSG's, what makes one think another PSG will find the answer this time around?

Unless, of course, one or more of the endless other possibilities exist, including: (1) they didn't "find it" because they didn't know what they were looking for; (2) they didn't "find it" because they simply missed it; (3) they "'found it" but didn't think it was clinically relevant; (4) they "found it" and thought it was clinically relevant but didn't act on it (I would certainly hope that wasn't the case); and/or (5) they found it but didn't understand the clinical relevance because they don't know "The Big Secret".

Bev, I have attached The Big Secret, next time you talk to them, feel them out and see if they have a handle on it. Maybe nobody told them The Big Secret, but we shouldn't be the ones to do that in case there's a good reason "They" don't want "them" to know.

SAG

Attachment: thebigsecret.doc

Thanks for the response, and since you knew that was a loaded question I'm not going to ask you if you seen it before cause I know you have, the question is:

In your opinion, what is the likelihood they can titrate that out with any kind of a machine?

on a scale of 1 to 10 with 1 being no chance in hell.

[Snoredog]

Snoredog,
This morning when my clock radio went off, I left my mask on and fell back asleep. I dreamed that I was trying to make breakfast but my head hurt from the loud radio, so I kept trying to turn it off and it wouldn't turn off, so I tried to unplug it, but everytime I unplugged something, it was the wrong appliance and the radio kept blaring. I tried to take the appliances out of the room to make the music stop, but more and more kept appearing on the counter and the blasted music wouldn't stop. When I woke up my heart was pounding and I was panting in short, fast breaths. It was one of those dreams where reality creeps into dream. Nothing interesting showed up on the Encore Report for that period of time, not even a hypopnea. I wish I had been using the SV, as the graphs there are more interesting.


Bev

I've had that happen many times, my only guess is we are waking up in deep sleep and when you wake from there you wake in a form of a stupor like you are partially asleep (form of sleep paralysis??), I had one the other day took the mask off because it had a hissing noise coming from it, wondered what the heck that thing was doing on my face, tried stopping the air with my finger it wouldn't stop, had to go to the bathroom, couldn't figure how to turn the machine off, so I just tossed it on the pillow and realized what it was when I came back.

When I hit those dream periods in early morning after waking, those are the best ones. What dose of Melatonin did you take?

[-SWS]

When I woke up my heart was pounding and I was panting in short, fast breaths. It was one of those dreams where reality creeps into dream. Nothing interesting showed up on the Encore Report for that period of time, not even a hypopnea. I wish I had been using the SV, as the graphs there are more interesting.

I'm thinking that probably would have scored as periodic breathing on the other machine.

[Snoredog]

When I woke up my heart was pounding and I was panting in short, fast breaths. It was one of those dreams where reality creeps into dream. Nothing interesting showed up on the Encore Report for that period of time, not even a hypopnea. I wish I had been using the SV, as the graphs there are more interesting.

I'm thinking that probably would have scored as periodic breathing on the other machine.

Bev keeps revealing these subtle little indicators to us LOL, kind of explains why it showed up on the SV now don't it. What is worse, having PB on an auto that doesn't do anything about it or central dysregulation or a machine that can resolve it and the centrals?

What would happen with a lower EPAP, I mean really low like 6 or 8 and IPAP with a much higher Pressure Support (below the 10 cm limit, like 16/8 or something). Maybe set backup to Auto and go with Bilevel on spontaneous. Maybe if those pressures were fixed she would stabilize. Can't you manually use fixed values to bring up pressure support just as the SV does? It looks at target peak and says not high enough and increases IPAP working pressure rapidly to compensate.

[OutaSync]

So what is periodic breathing, anyway? And why is it bad? Or how bad is it?

[-SWS]

Periodic breathing is defined as alternating periods of hyperventilation with waxing/waning tidal volume and periods of central hypopneas or apneas.

http://www.respironics.com/UserGuides/B ... 042299.pdf

That hyperventilation causes pulmonary over-ventilation or respiratory "overshoot". That in turn tends to cause those ensuing central hypopneas or apneas.

[dsm]

dsm - if you do write up a poll, i think you should do two polls, or somehow distinguish between : people that have already sorted out their problems (and their solutions), and people that are still trying to sort out their therapy (and for how long?)

Just back from trip to Melbourne - will be thinking of 2 sets of questions for 2 related polls - not sure what we will learn but if a lot of folk have strong thoughts on this issue that alone is worth trying to find out.

DSM

[dsm]

Periodic breathing is defined as alternating periods of hyperventilation with waxing/waning tidal volume and periods of central hypopneas or apneas.

http://www.respironics.com/UserGuides/B ... 042299.pdf

That hyperventilation causes pulmonary over-ventilation or respiratory "overshoot". That in turn tends to cause those ensuing central hypopneas or apneas.

But Bev, just to help position this, I am not sure we have seen much evidence of hyperventilation in your data. From what I see your BPM and tidal volume aren't showing it. Snoredog did question if the opposite was occurring (not clearing out enough CO2).

DSM