CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

[blizzardboy]

Show me the PFT!

With the normalization of the -HCO3, the likelihood of finding abnormalities on PFT is small.

However, those desats with your centrals appear to be somewhat greater than expected. Perhaps diffusion on PFT may reveal something.

BTW, you don't live (or were tested) at elevation, were you (I mean like about 5000 feet)? Although Australia looks pretty flat to me.

Hi Muffy, Tested at sea level. Are you thinking that reduced diffusion rate of O2 from alveoli into arterial blood might be causing accelerated desat during my centrals? Cheers,

[Muffy]

Show me the PFT!

With the normalization of the -HCO3, the likelihood of finding abnormalities on PFT is small.

However, those desats with your centrals appear to be somewhat greater than expected. Perhaps diffusion on PFT may reveal something.

BTW, you don't live (or were tested) at elevation, were you (I mean like about 5000 feet)? Although Australia looks pretty flat to me.

Hi Muffy, Tested at sea level. Are you thinking that reduced diffusion rate of O2 from alveoli into arterial blood might be causing accelerated desat during my centrals? Cheers,

It's a thought. But since the drops don't go below normal, one might ask if they really need fixing.

I see you're still playing with the ASV.

How's that working out for you?



Looks pretty ugly to me.

Muffy

[Muffy]

BTW, I've taken the liberty of creating a hypnogram of your nasal pressure waveform during spontaneous breathing (no CPAP) in the diagnostic:



Look familiar?

Muffy

[blizzardboy]

The cheapest you might be able to get away with is about $2000 (14,500$ Canadian). Even if those things could guarantee accuracy, precision and repeatability (like +- 0.01), you have to measure blood, arterial at that, and besides, those probes are only designed to test water. Once you introduce proteins, they all screw up (although presently testing one that costs ~$500 for a correlation study, and while it's closer, it still doesn't provide clinically useful information).

Thanks for that Muffy. I was hoping that urine pH might correlate closely to arterial pH given the high flow of arterial blood to the kidneys. Oh well, nice thought.

Hence why I am focused on an explanation for joint pain centred on respiration and blood gases.

By what mechanism?

I'd be looking more for a change a sleep habits (like lying flat on your back all night).

When you hear hoofbeats, don't think gila monsters.

Mechanism...BB calls out to The Web for an answer...because...aahh...well you see there's hypercapnia and pH and HCO3 and kidneys and carbonic acid and tendons and blood and cells and chloride ions and ventilation and pain and...I think the chemical formula is hypercapnia+pH(7.4)+ventilation->HCO3+pain+tendons...then add chloride ions and then, hey presto, my pain disappears.

Muffy, to be honest I don't have a clue. I am a hermit crab hunting through odds-and-ends trying to find one that fits!

Do you think that altered body position habits resulting from CPAP useage could explain painful and swollen hands and feet in the morning? I don't have any tingling or numbness in my members. I have no back pain...shhhh...what was that noise?

[blizzardboy]

I see you're still playing with the ASV...How's that working out for you?...Looks pretty ugly to me.

Yes I am still on the ASV but am not fiddling with settings, just EEP=10 PS=3.8->8.8 for now. I think I am doing pretty well for now - I am managing to get fitter and working earnestly at lifestyle improvements. The DLs look as unstable to me now as they did at the start! If my instability-that-begets-instability is going to be smoothed out by the connivings of the ASV algorithm then I am certainly going to have to be a good and patient boy.

[blizzardboy]

BTW, I've taken the liberty of creating a hypnogram of your nasal pressure waveform during spontaneous breathing (no CPAP) in the diagnostic...Look familiar?

Very interesting...yes, it looks like a seismogram!

[jnk]

BTW, I've taken the liberty of creating a hypnogram of your nasal pressure waveform during spontaneous breathing (no CPAP) in the diagnostic...Look familiar?

Very interesting...yes, it looks like a seismogram!

Is that the wav file to Comfortably Numb?

[unadog]

Look familiar?

So the ASV ain't doing nothing to him - he is doing that to the ASV?

Does that qualify as PB? I don't quite get the timeline - 12 breaths ... Is the Respironics ASV a better fit for that than the ResMed?

Do we then ask about BB's heart health? I don't recall that part of the history.

Makes more sense than Gila monsters. BB, did you have data from the Respironics ASV? Did it show periodic breathing?

Michael

[jnk]

. . .

That is really a nice summary Jeff! Certanly more succinct than mine! And all of this tine I thought you were just whacko from living in the city too long .....

I do believe in doing constructive things just to keep positive - for tge placebo effect - if need be. Acupuncture, massage, feldenkrais is good . . .

Thanks.

And yes, I am whacko and have lived in the city too long. But that doesn't stop me from writing succinct summaries of my off-the-wall opinions. Not yet, anyway.

As for alternative, I got to the point at one time of doing the old 'spit on a Q-tip then eat-a-bag-of-dirt' stuff for a while. Told my doc I was doing it because I thought I was suffering from an acute placebo deficiency. You know, he doesn't even blink when I say weird stuff like that anymore. He can be a really tough audience sometimes. At least I can still crack up the nurses. It's easy with a gown on.

The other day when I went in, the triage gal asked what brought me in that day. I told her that I was simply concerned about how everyone was doing at the doc's office since I hadn't seen them in so long and so I was just there to say hi and catch up on how THEY were doing. I thought she was going to drop her clipboard. A few weeks ago the doc was giving me stitches on my shoulder after removing a basal-cell carcinoma (I didn't hear about sunblock until I moved to New York), so I asked the doc if he could try to make the scar really ugly and manly looking since that would be cheaper than a tattoo, and who knows, maybe one day I'll be in good enough shape to take my shirt off in public somewhere. Again, not even a grin from the doc. They need a laugh-track installed in that place.

jeff

[blizzardboy]

Is that the wav file to Comfortably Numb?

Hi jnk, Might just be that my brain is generating CN-waves having listened to the aforementioned so many times in my youth...by joves I think you might just be on to something...BB starts spectral analysis of EEGs to search for signatures of other PF melodies...

[blizzardboy]

BB, did you have data from the Respironics ASV? Did it show periodic breathing?

Hi unadog, Here are the summaries: http://users.adam.com.au/sixsome/Bipap%20SV/. the Bipap ASV has indicated a bit of CSR. I could possibly get detailed files from the DME, if available. Cheers,

[blizzardboy]

As for alternative, I got to the point at one time of doing the old 'spit on a Q-tip then eat-a-bag-of-dirt' stuff for a while. Told my doc I was doing it because I thought I was suffering from an acute placebo deficiency. You know, he doesn't even blink when I say weird stuff like that anymore. He can be a really tough audience sometimes. At least I can still crack up the nurses. It's easy with a gown on.

[blizzardboy]

I see you're still playing with the ASV. How's that working out for you?

I had one last test that I have been wanting to run for a while now. So last night I went to sleep with fixed CPAP=4 (minimum support) to see what the Adapt SV made of my air flow in conditions as close as possible to ambient i.e. naturally ventilated only. I also ran the pulse oximeter last night (unfortunately I accidentally stopped logging after 0430). I snored initially (wife had to wake me at 1045) and eventually awoke at 0130 sweaty and feeling very unrested. At his point I terminated the fixed CPAP as I could tell that I would be a wreck by the morn and continued on ASV at my old settings (I changed masks at 0430 due to being grumpy with a leak ). I wonder what, if any, clinically-significant information can be gleaned from this data: http://users.adam.com.au/sixsome/ASV/0610/060210/. Cheers,

[dsm]

I see you're still playing with the ASV. How's that working out for you?

I had one last test that I have been wanting to run for a while now. So last night I went to sleep with fixed CPAP=4 (minimum support) to see what the Adapt SV made of my air flow in conditions as close as possible to ambient. I also ran the pulse oximeter last night (unfortunately accidently stopped logging after 0430). I snored initially (wife had to wake me at 1045) and eventually awoke at 0130 sweaty and feeling very unrested. At his point I terminated the fixed CPAP as I could tell that I would be a wreck by the morn and continued on ASV at my old settings (I changed masks at 0430 due to being grumpy with a leak ). I wonder what, if any, clinically-significant information can be gleaned from this data: http://users.adam.com.au/sixsome/ASV/0610/060210/. Cheers,

BB

4 CMs has to be a mistake for almost anyone with SDB. What I 1st notice tho (as have said before), when you lower your EEP below a particular threshold, you hyperventilate repeatedly.

DSM

PS did you ever do a trial with CPAP and pressure set to 11 CMs ? (just wondering as I can't recall what cpap tests you tried)

PPS I admire the way you have remained so good natured thru all these posts - 10 points

[blizzardboy]

4 CMs has to be a mistake for almost anyone with SDB. What I 1st notice tho (as have said before), when you lower your EEP below a particular threshold, you hyperventilate repeatedly.

Hi DSM, No, 4cmH2O was intentional as I was trying to simulate ambient conditions i.e. no pressure support; unassisted ventilation. Of particular interest to me is that I awoke sweaty using this setting. I think it is also interesting that my baseline resp rate drops (hypoventilation) when I am (effectively) unventilated. I think it is also worth noting that my SPO2 report from last night (http://users.adam.com.au/sixsome/ASV/06 ... 60210a.JPG) indicates that my O2 sat drops maybe only 1 or 2% when unventilated compared to being on ASV.

did you ever do a trial with CPAP and pressure set to 11 CMs ?

No, but I did try 12.8cmH2O fixed CPAP: http://users.adam.com.au/sixsome/ASV/0510/050410/. Cheers,