Apnea wakes me while on Bi-PAP

[tonycog]

Hello
I have posted questions here about my search for a mask. While I am afraid to be too hopeful, I may have finally found one that keeps its seal on me.

Another question, though. I have been diagnosed with Central Sleep Apnea (Cheyne-Stokes respirations). While trying to nap today (with my Bi-PAP turned on) I dozed off and was awakened gasping for a breath. I don't know what to make of this.

Why would this happen when on my machine? Shouldn't the machine take care of this for me so I can sleep?

Thanks,
Tony

[Riv]

These are some good questions. I guess your post has been overlooked because I'm surprised nobody answered yet.

I'm no expert, others can answer you more fully and I don't know the reason or reasons you awoke gasping for breath. As I read on the forums, there can be dozens of different reasons why a person with apnea (or without apnea) awakes and wasn't breathing.........the obvious answer is that you had an event and woke up but who can know if you had a central apnea or an obstructive apnea or a mixed apnea or a hypopnea and there can be lots of different reasons as to WHY you had the event...............Yes, the machine should take care of these events but perhaps you had an air leak from your mask which might have made the pressure less effective.

Which mask did you find? Is it full faced? What pressures are you on? Is your new mask still working satisfactorily?

Have you also been diagnosed with Obstructive Sleep Apnea?

[cflame1]

Tony, I'd suspect it was your settings... not knowing exactly what it's set to.

These machines can do a lot, but they can only conform to what they're designed to do. Which is to say that if your lower settings aren't high enough to deal with the events thrown at them, they may not get there in time, if at all. And also if your high settings aren't high enough then they may not be able to handle all of your issues.

Have you considered getting the software to see the full data offered on the reports?

[tonycog]

Thank you for the replies. I have my titration sleep study on July 2nd. My doctor initially set my IPAP pressure at 10-20 and my EPAP to 10. After about 10 days worth of data my IPAP highest pressure averaged 16.5, so he adjusted my IPAP pressure to 10-16.

I finally seem to have found a mask that will stay sealed. I am using the Fisher-Pakel 431 Full Face Mask and have used it for 2 nights now (out of 19 nights total) and am finding it to be tolerable (in addition to better sealed).

I will purchase the card reader and software as soon as I can afford it. My doctor said I do not have Obstructive Sleep Apnea - only Central. I will confirm this with him again when I see him.

Thanks,
Tony

[ozij]

Tony, is you Cheynne Stokes respiration related in any way to cardiac heart failure?
ASV machines are set up differently from others -- I'd be very careful about making changes.

Perhaps you should contact the doctor and ask him about that awakening -- may layperson's analysis is that theoretically it could have been his limiting of the maximum that is responsible for your awakening. Do you have any idea why the doctor limited the IPAP to 16? Did you have those awakenings when your maximum was 20?

The ASV also has timing parameters -- that is, when it decides the time has come to respond -- and those too may have to be professsionaly tweaked.

CSA (central sleep apnea) and CSR (Cheynne Stokes Respiration) are both very far from being run of the mill OSA.

O.

[tonycog]

Tony, is you Cheynne Stokes respiration related in any way to cardiac heart failure?
ASV machines are set up differently from others -- I'd be very careful about making changes.

Perhaps you should contact the doctor and ask him about that awakening -- may layperson's analysis is that theoretically it could have been his limiting of the maximum that is responsible for your awakening. Do you have any idea why the doctor limited the IPAP to 16? Did you have those awakenings when your maximum was 20?

The ASV also has timing parameters -- that is, when it decides the time has come to respond -- and those too may have to be professsionaly tweaked.

CSA (central sleep apnea) and CSR (Cheynne Stokes Respiration) are both very far from being run of the mill OSA.

O.

No, according to my cardiologist, my heart is healthy, unclogged, not enlarged, valves working, etc. I am an otherwise (I thought) healthy 42 year old. Just this week an MRI ruled out any tumors, etc. in my brain. I see a neurologist in about 2 weeks to investigate the causes of CSA further.

My IPAP was originally 10-20 and the doctor had it turned down to 10-16 to try to help keep the mask from losing seal at higher pressures, while waiting for my titration study (July 2). (RE: my other posts here), since I generally would only get the big leaks when I dozed off and the pressure jumped up at that point. I won't be tweaking my own settings without my doctors consent at this point since I don't understand all of what is going on yet, only 3 weeks into this stuff.

I will call him tomorrow and let him know about waking yesterday with an apnea while trying to sleep.

Thank you for your help and input,
Tony

[dsm]

Tony

Do you have a Bipap Auto or a Bipap Auto SV ?

Re Cheynes-Stokes Respiration, it is a characteristic of Congestive Heart Failure. People can also have what is called Periodic Breathing (PB) which means
cyclic patterns of breathing & CSR is one such cyclic-pattern. The ASV machine is specifically designed to address CSR as well as some other patterns of PB.
If your heart is ok it seems unlikely you would be diagnosed with CSR as such.

If you can provide some more info we may be able to offer feedback.

Good luck

DSM

[dsm]

Thank you for the replies. I have my titration sleep study on July 2nd. My doctor initially set my IPAP pressure at 10-20 and my EPAP to 10. After about 10 days worth of data my IPAP highest pressure averaged 16.5, so he adjusted my IPAP pressure to 10-16.

I finally seem to have found a mask that will stay sealed. I am using the Fisher-Pakel 431 Full Face Mask and have used it for 2 nights now (out of 19 nights total) and am finding it to be tolerable (in addition to better sealed).

I will purchase the card reader and software as soon as I can afford it. My doctor said I do not have Obstructive Sleep Apnea - only Central. I will confirm this with him again when I see him.

Thanks,
Tony

Tony

This info is inconclusive. What we really need is

Epap = 10
IpapMIn = ?
IpapMax = ?

The numbers you gave imply Ipap & Epap were set the same - this can be done but if it is then the machine is runninging Cpap mode but with Pressure Suport activated.

Epap = 10
Ipap MIn = 10 (means cpap mode)
Ipap Max = 20 (activates Servo Ventilation)

DSM
PS (or Servo Ventilation) will track your Average Peak Flow & if in a 3 min window you vary outside 90% of the current target, it will boost pressure very quickly to normalize (smooth out) your flow.
Also, If the machine *is* set to cpap mode, the timed mode will not be active. If that isn't active, then there is no mechanism to deal with Centrals.

[ozij]

CSR is not a diagnosis. It is a term describing breathing pattern "characterized by rhythmic waxing and waning of the depth of respiration; the patient breathes deeply for a short time and then breathes very slightly or stops breathing altogether. The pattern occurs over and over, every 45 seconds to 3 minutes".

It is not a diagnosis, it indicates further enquiries shoud be made, as is being done by Tony's doctors. Breathing regulation happens in the brain as well -- which is why Tony's brain is being investigated as well as his heart.

O.

[dsm]

CSR is not a diagnosis. It is a term describing breathing pattern "characterized by rhythmic waxing and waning of the depth of respiration; the patient breathes deeply for a short time and then breathes very slightly or stops breathing altogether. The pattern occurs over and over, every 45 seconds to 3 minutes".

It is not a diagnosis, it indicates further enquiries shoud be made, as is being done by Tony's doctors. Breathing regulation happens in the brain as well -- which is why Tony's brain is being investigated as well as his heart.

O.

Ozij

An odd post ? - try this link http://en.diagnosispro.com/differential ... 1-154.html

Maybe you have a particular frame of reference you are qualifying.

Cheers DSM

[ozij]

Not sure what you mean by my post being odd, but I'm glad you agree CSR is a breathing pattern for which differetial diagnosis is necessary.

O.

[tonycog]

My doc told me Cheyne-Stokes respirations are more of a symptom of something else. In April my heart went into atrial fibrillation -- out of the blue. The cardiologist performed a trans-esophageal echocardiogram ( a look at the heat by ultrasound from the esophagus ). He then did cardio-version to shock me back into normal rhythm. He recommended a sleep study as he suspected that apnea may have contributed to atrial fib. He also told us that my heart looked normal and healthy. I did not specifically ask about congestive heart failure, but my pulmonary/sleep doctor assured me that congestive heart failure would have been an easy pick-up for him at that point.

My sleep doc ordered an MRI of my head and those results were negative. I now see a neurologist in 2 weeks.

Here are my machine settings (Bi-PAP Auto Sv) IPAP = 10-16. EPAP = 10. Backup rate = 12.

Thanks,
Tony

[OutaSync]

Tony, you were right to call your doctor and report what was happening to you as you fell asleep. If you do not get a return call from him, don't be afraid to call again. Please let us know what he says. I'm sorry that you have to wait so long for your titration. Is it possible for you to be put on the wait list, so if there are any cancellations, they will call you to come in? It worked for me.

Bev

[tonycog]

I called my doctor's office today and filled him in. He is ordering my IPAP pressure turned back up to 10-20. EPAP is still at 10 and backup rate still at 12.

I will keep you posted.

Thanks for all of your help,
Tony

[dsm]

I called my doctor's office today and filled him in. He is ordering my IPAP pressure turned back up to 10-20. EPAP is still at 10 and backup rate still at 12.

I will keep you posted.

Thanks for all of your help,
Tony

Tony

Just check that again with the doc - ask him if he has set Epap = 10 = IpapMin (if true then it is in Cpap mode).
In fact, ask him what 'mode' the machine is in 'Bipap' or 'cpap'. (SV mode is activated by setting IpapMax higher than IpapMin (pref at least 3 CMs to get any benefit at all from backup rate & epap/ipapcycling ) ).

SV mode can operate in both Bipap & Cpap modes. But there a tiny doubt in my mind that the machine can address Centrals adequately, when in Cpap mode.
#3 (on further reflection, with a min-max gap of 10 CMs, Ipap will kick in very quickly if av peak-flow drops (like when a central is occurring) and then the machine cycling at the back-up rate would work. The SV boost can be as much as 3 CMs in one breathing cycle so the machine would then have enough gap between Epap & Ipap such that the central gets managed).


Good luck

DSM

#2 Tony - this presentation may be of some help to you in understanding the machine as it covers all aspects of
how the Bipap SV can be used.
http://www.internetage.ws/cpapdata/manu ... -preso.pdf