Sample ResScan Report for VPAP Adapt SV

[JohnBFisher]

Okay, as promised here are a couple other detailed graphs showing leak vs. pressure. Again, it appears that during REM sleep my apneas improve. Again, without the sleep study, I can not be certain, but this trend surfaces night after night after night ...

Leak vs. Pressure - 01 of 02:


Leak vs. Pressure - 02 of 02:


And to show the history of leaks:


From how I feel and comparing it to the leak rate, I know that I feel best if the leaks are minimal. The higher the leak rate the less "well" I feel the following day.

[dsm]

From my amateur status, that data looks like the machine is struggling under the load of leaks. When my Adapt SV leak data looks like that it has typically been a very bad night.

Also, based on what I saw of Muffy's earlier post on stable respiration, the machine might not to 'normalizing' your respiration ?

Just a 0.2 cents worth.

DSM

[Muffy]

Again, it appears that during REM sleep my apneas improve. Again, without the sleep study, I can not be certain, but this trend surfaces night after night after night ...

Not only do I not think that you can differentiate NREM from REM in the data you have presented, you can't even determine if you're asleep or not. And based on your history, that could easily be the more likely explanation.

Speaking of history, I'm about halfway through your posts (reading backwards to forwards) and in re:

viewtopic.php?f=1&t=47704&p=432318#p432318

note that the total mortality of seasonal influenza is at least 3.5 times higher than H1N1, so before people start screaming "OMG, the plague is here!", they should realize "It's been here!"

Talk about dial wingin', I'd really like to see how CDC calculates mortality.

Your new data continues to show that overall things are awful.

As you know, we all do that as we fall sleep. Sleep onset central apneas is really, really normal. What is not normal is when it is so frequent that it causes constant problems with falling asleep.

One could easily argue that attacking sleep onset centrals is totally inappropriate under any circumstances.

Do you have the blood gas results and the complete PFT (all graphics, especially the Flow/Volume Loop)?

Muffy

[JohnBFisher]

... Not only do I not think that you can differentiate NREM from REM in the data you have presented, you can't even determine if you're asleep or not. And based on your history, that could easily be the more likely explanation. ...

Emphasis mine. ... Interesting. You may well be right. In fact one thing my sleep specialist / neurologist noted was that with neurological problems that impact the brain stem, sleep architecture "falls apart". He used as an example Parkinsons, and Alzheimers. Though it was clear he meant anything that would impact the brain stem, such as Sporadic OPCA. (Which might be MSA, since there is no hereditary connection and some autonomic nervous system issues exist).

This will be something I bring up with him when I see him toward the end of February.

... Speaking of history, I'm about halfway through your posts (reading backwards to forwards) and in re:

viewtopic.php?f=1&t=47704&p=432318#p432318

note that the total mortality of seasonal influenza is at least 3.5 times higher than H1N1, so before people start screaming "OMG, the plague is here!", they should realize "It's been here!"

Talk about dial wingin', I'd really like to see how CDC calculates mortality. ...

Yes, it's been here. I do not disagree that folks blew this one (and perhaps myself) out of proportion. However, avoiding either the seasonal or H1N1 flu shot - especially with anyone added health problems, such as diabetes - is foolish and perhaps dangerous for others.

And I did find something on how the CDC calculated H1N1 mortallity. And if you read between the lines the numbers are "sloppy" guess work. Not all states required H1N1 testing. The H1N1 testing was quite unreliable (both false positives and false negatives). So, I am fairly certain the numbers for H1N1 deaths included garden variety seasonal flu and/or other things completely.

Still, unless there is a history of problems with the seasonal flu vaccine, getting a flu vaccine should be a no-brainer for everyone.

... Your new data continues to show that overall things are awful. ...

No disagreement here. However, this "awful" is SOOOO much better than BEFORE without the ASV unit.

... One could easily argue that attacking sleep onset centrals is totally inappropriate under any circumstances. ...

No disagreement. If my sleep onset centrals were periodic or not long lasting, I would not worry about them. However, they lasted long enough it would cut off my system if I use a SmartStop feature. That means they lasted over a minute in length on my Respironics BiPAP Auto M Series unit (in BiPAP only mode) when I used that unit.

Still, since this unit allows me to fall alseep without problems, I generally don't worry about any sleep onset centrals. When they are very bad, I (once a week) use a sleep medication (currently trying Lunesta, but might switch back to the generic for Sonata.

... Do you have the blood gas results and the complete PFT (all graphics, especially the Flow/Volume Loop)? ...

Muffy, I do have the blood gas results. I will post those in a bit. I do not have the complete PFT (even a summary). I will do what I can to obtain it. Though I know I should be able to obtain it, getting it and having the right to get it can be two different things. However, I will do what I can.

Thank you for your interest in this. Though I am sleeping better than I was, there is no doubt that I have a LONG, LONG way to go before I am happy with it. So, any input is welcome!

[JohnBFisher]

Muffy, as promised:

[Banned]

John,

Do you have a ResLink Module and Smart Media card?
Is there a reason you do not post all of your Adapt SV data?

Banned

[Muffy]

Muffy, as promised:

I think that metabolic alkalosis could explain a lot of that sleep-onset central issue. What is odd is that it is uncompensated (the pH is not normalized, which should happen relatively quickly). Did the ABG go smoothly, or was there some associated anxiety (hyperventilation during ABG could alter test results such that a compensated respiratory acidosis, which would be more in keeping with your neurologic disorder, might present as a metabolic alkalosis)?

Muffy

[JohnBFisher]

... Do you have a ResLink Module and Smart Media card? ...

Nope. Just a null modem cable. So, it takes more effort to pull the data.

... Is there a reason you do not post all of your Adapt SV data? ...

I can do so. And will do so later tomorrow, if you want.

[JohnBFisher]

... I think that metabolic alkalosis could explain a lot of that sleep-onset central issue. ...

That was my thinking from this. Though I admit, "I am but an egg" in my understanding of blood gasses.

... What is odd is that it is uncompensated (the pH is not normalized, which should happen relatively quickly). ...

Also my understanding. Even with my obesity, it did not quite seem to "add up".

... Did the ABG go smoothly, or was there some associated anxiety (hyperventilation during ABG could alter test results such that a compensated respiratory acidosis, which would be more in keeping with your neurologic disorder, might present as a metabolic alkalosis)? ...

Not particularly. I am a pretty calm person. [I deal with very stressful situations at work. I either remain calm or go quite mad ... Oh, wait! Maybe that did happen!! ]

No, seriously, it went fairly smoothly. The tech had problems with hitting the artery, but that's real normal for me (my veins and arteries always tend to roll about under my skin).

I had gone for a mile walk about 30 minutes prior to the ABG test. But from what I understand that's WAY too long before the test for it to impact the results.

Could my obesity trigger a combination of issues? That is combined with the neurological issues, I also tend to hypoventilate due to the obesity? But when I researched that path, the numbers it did not seem to make a lot of sense.

[Muffy]

I think identifying and correcting that metabolic component would be helpful (but it's undoubtedly not the root of all evil).

When was the ABG done and what kind of pressure support were you on at the time? Do you have serial (and recent) electrolytes (those and the PFT should help to determine if it's truly metabolic or really respiratory in disguise).

In the PFT, were there Respiratory Strength maneuvers, like measures of inspiratory and expiratory force?

Right about now, there's usually a poster that blames everything on VCD. Must be stuck in the snow somewhere.

http://chestjournal.chestpubs.org/conte ... 2.full.pdf

Muffy

[Muffy]

Right about now, there's usually a poster that blames everything on VCD. Must be stuck in the snow somewhere.

http://chestjournal.chestpubs.org/conte ... 2.full.pdf

BTW, that's why we should look at the Flow-Volume Loops. It may be fruitful to see exactly what your "snoring" is.

Muffy

[JohnBFisher]

Muffy, I had wondered if that might be a possibility. I've recently started to have some odd, and as yet, unexplained episodes. Two issues include swallowing and potential, periodic vocal stridor.

I know that I am having more problems swallowing. I need to be careful when I swallow water, otherwise I end up coughing and sputtering. I mentioned this to my sleep specialist / neurologist, who ordered speech therapy & a swallow test. Unfortunately a local hospital mangled the scheduling. I will see about having it done by another hospital after my next visit with my neurologist.

And I've had apparent episodes of vocal stridor. It's not consistent. But every now and then I open my mouth to speak and my voice is high and squeaky. I can usually clear my throat and it clears up. But I wondered if it might be another possible sign of autonomic dysfunction.

Oh, I do NOT want that, if that's the case! It would not bode well. Sigh!

I'm not sure if the PFT would show any vocal cord dyskinesia, if it is there, since that particular symptom is not consistently apparent. It was not an issue on the day I had the ABG and PFT tests.

At the time of the ABG test, I was still using my BiPAP unit at a pressure setting of 9/13. I assume that was what you mean.

Anyway, I will try to get the FULL information from the PFT, but it may take a couple of weeks. As I mentioned, having the right to have something and getting it are two different things.

In the mean time, later today I will post both my ASV report from the last night and the previous night. I also have the Pulse Ox report from last night to compare to the data.

[-SWS]

Right about now, there's usually a poster that blames everything on VCD. Must be stuck in the snow somewhere.

http://chestjournal.chestpubs.org/conte ... 2.full.pdf

Muffy

Hey, I resemble that hyperbole!

...But I didn't get stuck in the snow. I got stuck with the flu right after a nice vacation in the warm, sunny climes. Needless to say I'm catching up with client-based work in slow motion right now. I'm following this and other threads as well.

John, we have at least one centrally dysregulated poster on this message board with concomitant VCD. Meet dllfo:
search.php?keywords=vcd&terms=all&autho ... mit=Search

[JohnBFisher]

... But I didn't get stuck in the snow. I got stuck with the flu right after a nice vacation in the warm, sunny climes. Needless to say I'm catching up with client-based work in slow motion right now. I'm following this and other threads as well. ...

Bummer! Hope you feel better soon. And I hope the workload is not too overwhelming. Last time I took a vacation for one week (without computer or smartphone) I had over 1,000 email messages to wade through. Sheesh!

... we have at least one centrally dysregulated poster on this message board with concomitant VCD. Meet dllfo:
search.php?keywords=vcd&terms=all&autho ... mit=Search ...

Thank you. I will read through those posts to see if possible ideas surface that might help me and that might help others.

Speaking of helping others, I think I will try to put together a couple Wiki articles for this forum. These include:

• The nuts and bolts of backup power for xPAP therapy
• Understanding Central Sleep Apnea

We constantly get plenty of questions about backup power and it might be good to consolidate the advice into one place. Ditto on questions about Central Sleep Apnea.

[-SWS]

John, those intended Wiki additions sound like great contributions!

The long story short with dllfo is that aside from having VCD, he also had an extremely difficult-to-diagnose tear or hole in the heart. That condition might have been congenital. Dllfo shared with us that he was born with an enlarged heart. He thinks he might have also had at least some sleep-related central breathing problems as an infant or child---based on his own mother's observations. However, he also stated that he believes he had no significant sleep-related breathing problems for the next 55 years.

Here is a summary of heart-related post by dllfo:
viewtopic.php?f=1&t=29015&p=253468&hilit=+heart#p249862

And this is the time frame documenting when he traveled to NJC where the heart problem was finally discovered (never revealed by repeated gamuts of local tests):
viewtopic.php?f=1&t=21213&p=183393&hilit=+heart#p183393

More heart-relevant posts by dllfo:
search.php?st=0&sk=t&sd=d&keywords=%2Bh ... thor=dllfo

The excessive daytime tiredness, mystery desaturations, and perhaps some central dysregulation were fixed by the heart surgery. However, dllfo must still manage his concomitant VCD. He must also continue using his ASV to address outstanding obstruction and central dysregulation.