Apnea wakes me while on Bi-PAP

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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dsm
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Re: Apnea wakes me while on Bi-PAP

Post by dsm » Wed Jun 24, 2009 4:18 pm

ozij wrote:
ResMed wrote:The minimal pressure support during normal breathing or hyperventilation prevents over-ventilation and hypocapnea
Resmed documentation quoted

Since a proprely titrated VPAP adapt SV is supposed to avoid overventilation and hypocapnia, and since we're discussing a VPAP adap SV is on self titrated settings, then if it were me, I would certainly consider a wrong setting - possibly in the minimal pressure support - as a root for that problem.


O.
Thought about this overnight. Will probably revert to Vpap SV this w/e & set EEP=9 & leave IpapMin at 13.

Tks to all for the very interesting lines of thinking. I really hope there is some useful data coming out of this experience.

Cheers

DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)

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dsm
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Re: Apnea wakes me while on Bi-PAP

Post by dsm » Wed Jun 24, 2009 4:27 pm

-SWS wrote:I also favor the general theory that autoSV "ventilation" itself indirectly helps to keep DSM's leg cramps at bay. And that's essentially the theory DSM has been maintaining for quite some time, regarding inefficient gas exchange w/out SV. Along those lines, DSM mentioned feeling "stretched" on APAP (pulmonary stretch, right??). So one possibility along that gas-exchange theory is excessive inspiratory stretch followed by inadequate elastic recoil---thus not all CO2 is adequately expelled. This stretch-without-full-recoil theory essentially converts part of the lungs' capacity into additional CO2-retaining dead space. So there's a hypothetical possibility for CO2 buildup toward those leg cramps with pulmonary stretch followed by inadequate CO2 expel. The SV machines can help DSM avoid that hypothetical etiology with adequate (and on-demand) inspiratory volumes and much easier expiration facilitated via EPAP/EEP's instantaneous pressure drops (the core purpose of servo "ventilation").

<snip>
Very interesting thinking. To describe the cramp onset it goes like this ...

Wake, feel the need to do a big stretch (extend legs, breathe deep) no cramps at that point. Then having stretched right out, wham !, cramp will occur.
On Cpap/Apap they could be very painful & might even have me getting up to walk around & massage legs. One other observation is that I am pretty sure there is a 'tingling' feeling in my legs before & during the whole process.

The wanting to stretch & the cramps seem to go hand in hand. These past mornings I would wake in a similar fashion & was consciously aware I didn't feel the need to stretch out.

One other loose theory I have had is that what I am experiencing is likely age related. at 64 this year I am pretty sure that my respiratory system is not as elastic nor as effective as it was say 20-30 years ago. Support for this would be if other 60+ year olds were experiencing similar patterns of both loss of cpap therapy effectiveness or cramping etc:

DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)

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OutaSync
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Re: Apnea wakes me while on Bi-PAP

Post by OutaSync » Thu Jun 25, 2009 7:04 am

So, Tony, how did you sleep last night?

Bev
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1

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tonycog
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Re: Apnea wakes me while on Bi-PAP

Post by tonycog » Thu Jun 25, 2009 8:40 am

OutaSync wrote:So, Tony, how did you sleep last night?

Bev
Hi
It was a fairly good night. I am on sort of an every-other-night thing for the past week or so, it seems. Changing the backup rate from 12 to auto made a pretty big difference. Getting a blast every 5 seconds was more than I wanted.

Thank you very much,
Tony

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Additional Comments: EPAP = 12 / IPAP = 12-20 / Backup rate = AUTO / Central Sleep Apnea - Cheyne-Stokes Respirations diagnosed May 29, 2009; otherwise healthy

-SWS
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Re: Apnea wakes me while on Bi-PAP

Post by -SWS » Thu Jun 25, 2009 9:17 am

tonycog wrote:
OutaSync wrote:So, Tony, how did you sleep last night?

Bev
Hi
It was a fairly good night. I am on sort of an every-other-night thing for the past week or so, it seems. Changing the backup rate from 12 to auto made a pretty big difference. Getting a blast every 5 seconds was more than I wanted.

Thank you very much,
Tony
We can easily get side tracked in just about any AutoSV thread, Tony. Sorry about that! Thanks for getting us back on topic, Bev.

Tony, the fact that your doctor has you on AutoSV before your July 2nd titration---and is willing to hear your feedback and make adjustments---speaks volumes IMHO. That sounds like the kind of proactive sleep doctor many of us wish we had. The good news is that therapy tends to get much better with data, subjective assessments, and appropriate tweaks.

iIt sounds as if you and your doctor are on the right track. Please keep us in the loop. And good luck on that July 2nd sleep study!
Last edited by -SWS on Thu Jun 25, 2009 9:24 am, edited 1 time in total.

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OutaSync
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Re: Apnea wakes me while on Bi-PAP

Post by OutaSync » Thu Jun 25, 2009 9:24 am

Tony,

I'm glad you got that much figured out. Again, I would encourage you to get the software so you can monitor exactly how each change affects you. I hope your doctor will be supportive in that regard.

I promise that it does get better, even if the progress is slow. You are on the right track.

Bev
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1

-SWS
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Re: Apnea wakes me while on Bi-PAP

Post by -SWS » Thu Jun 25, 2009 9:41 am

OutaSync wrote: Again, I would encourage you to get the software so you can monitor exactly how each change affects you. I hope your doctor will be supportive in that regard.
I agree that would be money well spent in the long run.

The bad news is that the software and card reader are typically an out-of-pocket expenditure. Occasionally insurance will cover that expenditure if the doctor makes a strong case for therapy monitoring/adjustment as a "medical necessity". But that's the rare exception rather than the rule.

The good news is that the software and card reader don't legally require a prescription:
https://www.cpap.com/productpage-bundle.php?BundleID=64

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dsm
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Re: Apnea wakes me while on Bi-PAP

Post by dsm » Thu Jun 25, 2009 4:53 pm

tonycog wrote:
OutaSync wrote:So, Tony, how did you sleep last night?

Bev
Hi
It was a fairly good night. I am on sort of an every-other-night thing for the past week or so, it seems. Changing the backup rate from 12 to auto made a pretty big difference. Getting a blast every 5 seconds was more than I wanted.

Thank you very much,
Tony
Tony

Good to hear you are progressing & hope you didn't mind the detour The Bipap AutoSV is a very interesting machine.

Re the software, that is one item I encourage you to get. I have been using EncorePro for over 4 years & still check results every day or two. After a while you get the confidence to recognise what some score actually were. e.g. I can see AI scores & know that they were me burping due to a bout of aerophagia on that night as a result of nasal congestion causing me to mouth breathe.

But in general terms you get to relate night time usage to what shows in the charts.

Good luck

DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)

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dsm
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Re: Apnea wakes me while on Bi-PAP

Post by dsm » Mon Jun 29, 2009 10:01 pm

Tony,

Do you have any more feedback ? - I trust it is going well for you.

I have reverted to my Vpap AdaptSV & it is a struggle but the daytimes are fine. As have mentioned
before sleep with the Vpap AdaptSV is very light but the sleep works.

Am struggling with mask leaks (lost so much weight + shaved off beard - mask seals 'burp' & that is
always an issue with the Vpap AdaptSV due to its rapid rise times (slightest skewing of the mask
when machine is applying SV support, the mask to face seals will easily let air out).

Also started off by lowering EEP to 9.4 & PS at 3.6 but last night reverted EEP to 10 & PS 3.0.

Am tempted to switch back to the Bipap AutoSV but will stay with the Vpap AdaptSV for a week or so
in the expectation I'll get it back in balance.

Am aware that cramps could easily return. Legs just have that feeling that says 'cramp alert' but
thus far none have happened.

DSM

#2 Last night was back to normal with the Vpap AdaptSV (still no cramps thankfully, just a sensation that they are lurking )
I am sure that setting the machine back to my previously determined optimum settings has helped. I had put a lot of time into
tuning the EEP (epap) & PS settings to get it just right. Seems 10/13 (EEP=10 & PS=3) are the optimal settings for me.
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)