high respiratory rate

[zimlich@cox.net]

For the past eight nights I have had RR between 8-48, seven out of the eight nights. I have never had this occur before and wonder if the machine is misinterpreting something. I use a ResMedVPAP Auto 25 and have read the LED Data daily for two months. Does anyone have any ideas? AhI varies between 4.7 and 15 with AI 2.1 to 7.6 over the two month period. My AHI and AI numbers are coming down. RR was stable 6- 18 until the past eight days.

Thanks,
Mary Zimlich

[dsm]

Mary,

To better help you can you let us know what type of machine you have & what are the current settings ?

Vary RR can be for a variety of causes & can be a machine issue but also can be a health issue.

Some cautious exploration of your situation is needed.

Good luck

DSM

[zimlich@cox.net]

Thanks for your reply. I am contacting my DME and Doctor.

The machine is a ResMed VPAP AUTO 25 in BiLevel mode with an IPAP of 22 and an EPAP of 14, pressure support 4.
I feel fine. I take Nuvigil for continued daytime sleepiness.

Thanks again.

Mary Zimlich

[dsm]

Thanks for your reply. I am contacting my DME and Doctor.

The machine is a ResMed VPAP AUTO 25 in BiLevel mode with an IPAP of 22 and an EPAP of 14, pressure support 4.
I feel fine. I take Nuvigil for continued daytime sleepiness.

Thanks again.

Mary Zimlich

Mary

What were the stats from your sleep study ? (AHI & esp AI & HI) prior to being titrated.
The current pressure numbers suggest severe OSA ?

DSM

[zimlich@cox.net]

Truthfully I don't know the numbers from my last sleep study. My first sleep study in March of 2008 suggested mild sleep apnea with an AHI of 6 and AHI of 9 in supine position. The only remarkable number for me was that my longest apnea incident was 114 seconds. I started out on plain CPAP at a pressure of 7 (titrated at the sleep lab), this was later changed by my Doctor unbeknownst to me to 9. I changed Doctors, had two more sleep studies done, but was still so wiped out from undertreated OSA that I never asked for the numbers from him. I recently, about six weeks ago switched to a BiPAP machine as I was at a pressure of 18 and still having about 25 AHI an hour. November 18, at my last Dr.'s appointment (sleep specialist) he increased the pressure to IPAP 22 EPAP 14. My AHI has varied somewhat,but in general is on a downward trend. I see him again in January. I called the Doc and DME this afternoon, but neither were in their offices. Will try again tomorrow.
I've only been following my numbers for about 2 months so I don't know if this has ever happened before (the increased RR).
My last two sleep studies- the ones I don't have numbers from- were done in March of this year when I changed Doctors. The new Doc has been seeing me every six weeks during titration.

Sorry I can't be of more help. I guess I will call him again tomorrow and just keep watching the numbers. As I said I feel fine, no SOB during the day or rapid respirations noted.

Thanks,
Mary Zimlich

[dsm]

Mary,

Are you willing to comment on your height, weight & general state of fitness ?
I am trying to find possible reasons for why the pressure has been set so high.

Cheers

DSM

[Muffy]

The only remarkable number for me was that my longest apnea incident was 114 seconds.

That was probably artifact.

Were you ever a runner?

If so, what was your "Personal Best"?

When did you quit?

Muffy

[dsm]

Some other thoughts ...
Re high resp rate. One possible cause that can appear when using a bilevel, is the ipap to epap gap. If it gets too wide for some people it can allow rapid respiration - if it gets to small, it can allow centrals to occur if the user is prone to them.

Also, rapid respiration often occurs because of pCO2 levels in the blood & the 'panting' is a way of 'blowing off the CO2'.

Hopefully Muffy may be willing to qualify what I have said as I am an interested amateur whereas Muffy is a dedicated professional who knows this area very very well.

DSM

[kingmaker]

Its just weird situation your going through...

[Muffy]

The only remarkable number for me was that my longest apnea incident was 114 seconds.

That was probably artifact.

If it wasn't, then it would be important to know if it was an "obstructive" apnea or a "central" apnea.

Muffy

[Muffy]

Were you ever a runner?

And if you were, then were/are you an insomniac (generally defined as "if you think you have a problem with sleeping, you do")?

Muffy

[zimlich@cox.net]

I heard from my Doctor's Office this morning and as I'm not having any trouble sleeping or with daytime sleepiness they said don't worry about it. I see him again next month, but if I start to feel bad in the meantime I'll move my appointment up.

I'd like to thank everyone who took the time to think about this and respond. Your help and support is most appreciated. I'm very serious about my treatment.

Mary Zimlich

[Muffy]

I'm very serious about my treatment.

Well, "IIWY", I think I'd really try to get a hold of all my data to try to figure out how the heck I went from disease that arguably may not have needed treatment:

My first sleep study in March of 2008 suggested mild sleep apnea with an AHI of 6 and AHI of 9 in supine position.

All the way up to very aggressive pressure therapy:

A BiPAP machine as I was at a pressure of 18 and still having about 25 AHI an hour.

that now gives you numbers that require treatment (which is kinda backwards when you think about it).

Muffy

[Muffy]

My first sleep study in March of 2008 suggested mild sleep apnea with an AHI of 6 and AHI of 9 in supine position.

In a review of the results, I would also look at the supine-nonsupine breakdown. For instance, if the positional split was 50-50, then the nonsupine AHI would be 3, and then side-sleeping would be a great option.

A BiPAP machine as I was at a pressure of 18 and still having about 25 AHI an hour.

Certainly a heckuvalot better than AHI 25 with "treatment".

Muffy

[NotMuffy]

My first sleep study in March of 2008 suggested mild sleep apnea with an AHI of 6 and AHI of 9 in supine position.

In a review of the results, I would also look at the supine-nonsupine breakdown. For instance, if the positional split was 50-50, then the nonsupine AHI would be 3, and then side-sleeping would be a great option.

A BiPAP machine as I was at a pressure of 18 and still having about 25 AHI an hour.

Certainly a heckuvalot better than AHI 25 with "treatment".

Muffy

Do you think this person is listening to you?

NotMuffy