CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

[blizzardboy]

I tend to over analyze everything too...DO NOT DOUBT YOURSELF...you are a trouble shooter at heart, you look in depth...you might want to step back and take a break...Go to whatever settings worked best last time...stick to it for a few days... throid meds here we come...stay vigilant

Hi echo, Such sage advice and from someone who would seem to well understand my thirst for problem solving! I do find it hard to accept that a problem can't be solved. I have solved many complex problems over the years so I have learned this by experience. I am pretty happy with how things are progressing with my treatment strategy. I am a notorious self doubter.

BTW, as an aside, my GP said that nurses in the 70s used to abuse thyroid treatments in order to lose weight by boosting metabolism.

[blizzardboy]

BB, might wanna check red blood cell count, RDW, and hemocrit as they are elevated in people fight oxygen deprivation (living at altitude, have apnea events with desaturations). Mine are still at the top of the range and I started CPAP therapy Aug 20, '07...some of us recover more slowly than others

hi Muse-inc, good point. My bloods script has already been written so these tests might have to wait until the next lot. Wow, recovery takes time.

Cheers,

[blizzardboy]

I hate to hear these sorts of comments by doctors. I absolutely cannot stand to hear any variation on "you're overanalyzing", "chill out", etc. (although admittedly no one has ever told me my brain is different than usual... does she have imaging to back up that statement?!). When she offers her psychological explanations and advice, tell her she's practicing outside her area of competence.

Hi SU, What is there more important to muse over than our health, I ask? Would I be accused of over-analysing if I was designing financial software or a new missile system?

What makes you think you have reflux?

More that I interested in the possibility that Silent Reflux (aka Ninja GERD) is the cause of my respiratory instability.

GERD should be discussed with a gastroenterologist. If you discuss it with a sleep doctor, they will tell you that if you have aerophagia, you have reflux, so sleep on a 30 degree wedge and take PPIs. Now sleeping on a wedge is not a bad idea for an apnea patient anyway, and certainly can't hurt you, and there's not a lot of risk associated with taking PPIs. Will you know if the PPIs make you feel better if you have "silent GERD", though? I think it's hard to tell if they help when there are no symptoms (i.e., what would be your dependent/outcome variable?).

Can't see a gastro person without a referral from my GP! I raised the aerophagia->reflux issue with my GP as I just can't see how it would not happen - if my airway is splinted open then probably also my stomach sphincter. I think I am now sold on the idea of sleeping inclined going hand-in-hand with CPAP in my case due to the considerable presence of gas gut.

As far as finding a metric for reflux improvement, well to my untrained eye I can't see how I can tell the difference between reduced OSA and reduce reflux due to sleeping inclined. What a shame that all the data is encrypted so I can't muck around with it, just look at pretty pictures.

[dsm]

My guess is that in particular the low EEP=8 was causing a chain reaction of results.

Have a think about that experiment of 3.2 PS then 3.4 PS to see which way your HI score trends.

I think I am sold on EEP=8 being too low. Interesting to see last night that I had a decent stable patch (2320-0000) while in the recliner: http://users.adam.com.au/sixsome/ASV/0510/050310/ and my AHI=1.2 was good. I will fiddle with PS min to see if there are changes. I think I am also sold on reclining giving me more stable respiration. I feel good today. Plenty productive at work. Now to find a wedge...

Your Pressure Support improved greatly yet again and by a big margin. That sort of result is excellent.

I think you can still improve on the leak data & think you said you have an anti-leak strap on the way.

What an outstanding set of improvements ! - that sort of data in your charts is to die for
The stability and steadiness in *all* the charts is immediately evident when compared to all the others.
Also, looking at that data incl RR - I'll take a punt & say you had no twinges nor signs of cramping ?

Very impressive - lets hope they stay with you

Cheers

DSM

[blizzardboy]

Your Pressure Support improved greatly yet again and by a big margin. That sort of result is excellent.

I think you can still improve on the leak data & think you said you have an anti-leak strap on the way.

What an outstanding set of improvements ! - that sort of data in your charts is to die for
The stability and steadiness in *all* the charts is immediately evident when compared to all the others.
Also, looking at that data incl RR - I'll take a punt & say you had no twinges nor signs of cramping ?

Very impressive - lets hope they stay with you

Good to hear DSM! Your thoughts give me more idea what I need to be looking out for to find improvements, thank you. No, no twinges or cramping that I noticed. I have a strap on order.

Cheers,

[-SWS]

So, DSM- as I follow your above comments it appears that you view machine behavior (pressure support response) as the single most important ASV measurement toward gauging effectiveness----at least in this case. That might very well be the case for any given patient. But I happen to think often times that is not the case when it comes to ASV. I'll post published evidence later supporting that's not always the case...

Blizzardboy, of the various measured ASV parameters---some being machine-response parameters and others being biological-response parameters---does machine pressure-support behavior, indeed, seem to best reflect your following-day sense of well being? If so, then that's what you need to primarily focus on. However, there's plenty else going on in that data besides pressure support fluctuations...

Last night I increased PS_min to 4 & PS_max to 9 leaving Epap=10 in an attempt to increase ventilation. Interestingly I had my fastest hyperventilation stage to date. I peaked out at about 35 breathes/min after about 1-2 of sleep and my breathing looked less stable that last night. I was surprised to see such a shift with only a 1 cmH20 increase of the PS range.

Well, BiLevel modality (constant pressure support greater than 0) is inherently destabilizing for some patients: http://chestjournal.chestpubs.org/conte ... 1.abstract

There's a chance you'll discover that your PS minimum setting (delivered as your constant or base PS throughout the night) needs to be minimized. I was surprised that your Respironics BiPAP autoSV trial did not run the manufacturer-recommended CPAP modality as base modality (minimum PS=0)----with selective ASV modality enabled on top of that CPAP as your base modality. Or perhaps they attempted to experimentally run that way and it's just not reflected in the PSG report.

[jnk]

Just as a side note, I would like to give a quick thank-you to bb and everyone in this thread who discussed thyroid stuff. I asked my doc about it today, and he just wrote up an order for me to get tested. My TSH was 4.98 back in 2004 and I haven't been screened since then.

And now back to our regularly scheduled program.

[echo]

Just as a side note, I would like to give a quick thank-you to bb and everyone in this thread who discussed thyroid stuff. I asked my doc about it today, and he just wrote up an order for me to get tested. My THS was 4.98 back in 2004 and I haven't been screened since then.

And now back to our regularly scheduled program.

[blizzardboy]

Blizzardboy, of the various measured ASV parameters---some being machine-response parameters and others being biological-response parameters---does machine pressure-support behavior, indeed, seem to best reflect your following-day sense of well being? If so, then that's what you need to primarily focus on. However, there's plenty else going on in that data besides pressure support fluctuations...

Hi -SWS, Could you please write down a list of everything you see in my data? Make for a good read!

Well, BiLevel modality (constant pressure support greater than 0) is inherently destabilizing for some patients: http://chestjournal.chestpubs.org/conte ... 1.abstract

Thanks for the link.

There's a chance you'll discover that your PS minimum setting (delivered as your constant or base PS throughout the night) needs to be minimized. I was surprised that your Respironics BiPAP autoSV trial did not run the manufacturer-recommended CPAP modality as base modality (minimum PS=0)----with selective ASV modality enabled on top of that CPAP as your base modality. Or perhaps they attempted to experimentally run that way and it's just not reflected in the PSG report.

I don't think too much thought was put into my Bipap SV settings, just the DME matching the Adapt SV titration values.

So now to my latest experiment...in spite of echo's advice to chill for a while, curiosity following -SWS's thoughts on fixed CPAP I slept in the recliner last night on CPAP fixed to P=12.8cmH2O. I based my choice of pressure on what I thought was treating the majority of my OSA events the night before.

Here are the results: http://users.adam.com.au/sixsome/ASV/0510/050410/. Interesting for me to see the nature of my unstable breathing with PS=0, particularly the obvious negative correlation between resp rate and tidal vol seen in epoch b as well as the big variations in resp rate. Oh how I wish I could unpack my blessed Resmed data to play with - why exactly is again that my data is not available to me? I am sure there must be something in the Rescan EULA that commits me to eternal separation from my numbers. Just pretty pictures for you little one (Resmed God in deep authorative voice.)

[blizzardboy]

Just as a side note, I would like to give a quick thank-you to bb and everyone in this thread who discussed thyroid stuff. I asked my doc about it today, and he just wrote up an order for me to get tested. My THS was 4.98 back in 2004 and I haven't been screened since then.

Yah, all the way with jnk! All the best with your tests.

[dsm]

So, DSM- as I follow your above comments it appears that you view machine behavior (pressure support response) as the single most important ASV measurement toward gauging effectiveness----at least in this case. That might very well be the case for any given patient. But I happen to think often times that is not the case when it comes to ASV. I'll post published evidence later supporting that's not always the case...

SWS

Nup ?.

was merely observing & commenting. Please lets not get into another round of "DSM I am saying you said ..." - threads have a habit of going downhill fast once that game gets started.

Cheers

DSM

[echo]

BB, glad you're still experimenting

I was in one of my 'projecting' moods I think, I'm so tired of being tired and tired of trying to figure out why I'm tired.

But hey, YOU GO FOR IT!

[unadog]

quick thank-you to bb and everyone in this thread who discussed thyroid stuff. I asked my doc about it today, and he just wrote up an order for me to get tested. My THS was 4.98 back in 2004 and I haven't been screened since then.

Check your AM body temp for a few days too, just to see what you get. Sort of like oximetry to go with AHI readings.

Took my son in today. Doc ordered a sleep study, along with a blood test for thyroid. Getting to be standard!

Good luck.
Michael

[-SWS]

So, DSM- as I follow your above comments it appears that you view machine behavior (pressure support response) as the single most important ASV measurement toward gauging effectiveness----at least in this case. That might very well be the case for any given patient. But I happen to think often times that is not the case when it comes to ASV. I'll post published evidence later supporting that's not always the case...

was merely observing & commenting. Please lets not get into another round of "DSM I am saying you said ..." - threads have a habit of going downhill fast once that game gets started.

I really don't appreciate your derogatory "games" comment one bit, DSM. No need to worry about downhill trends in this thread: I'm through querying or even commenting about your posts in this thread, DSM.

My apologies to readers and blizzardboy for the disruption...

[dsm]

So, DSM- as I follow your above comments it appears that you view machine behavior (pressure support response) as the single most important ASV measurement toward gauging effectiveness----at least in this case. That might very well be the case for any given patient. But I happen to think often times that is not the case when it comes to ASV. I'll post published evidence later supporting that's not always the case...

was merely observing & commenting. Please lets not get into another round of "DSM I am saying you said ..." - threads have a habit of going downhill fast once that game gets started.

I really don't appreciate your derogatory "games" comment one bit, DSM. No need to worry about downhill trends in this thread: I'm through querying or even commenting about your posts in this thread, DSM.

My apologies to readers and blizzardboy for the disruption...

Mutual !

DSM