CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

[dsm]

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. Cheers,

BB

I see the point re baseline RR dropping also.

DSM

[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?

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

Oh c'mon! You're not even trying!

Since we have the corresponding hypnogram from the diagnostic night, we now know what data can be discarded as being wake or probable artifact:



It is also important to note that the pressure waveform is a relative value whose gain can be manually increased or decreased (or done automatically, depending on what software you're using) in order to obtain a readable waveform. Consequently, low or high amplitude pressure waveforms do not necessarily indicate low or high tidal volumes. In the above example, during that low amplitude portion of the pressure waveform, your breathing was quite normal in appearance (aside from a little benign FL).

Muffy

[blizzardboy]

Since we have the corresponding hypnogram from the diagnostic night, we now know what data can be discarded as being wake or probable artifact...It is also important to note that the pressure waveform is a relative value whose gain can be manually increased or decreased (or done automatically, depending on what software you're using) in order to obtain a readable waveform. Consequently, low or high amplitude pressure waveforms do not necessarily indicate low or high tidal volumes. In the above example, during that low amplitude portion of the pressure waveform, your breathing was quite normal in appearance (aside from a little benign FL).

Hi Muffy, Thank you for the interesting diagram. Certainly helps to focus on what is happening during sleep rather than wake. So FL means:

• Fancy Lungwork
• Fibromyalgic Lapsing
• Free Love
• Other __________________ (write your answer in 300 words or less)

Cheers,

[jnk]

I think that is Flow Limitation, usually meaning the flattened waveform of Inspiratory Flow Limitation, but maybe not in this case (?) .

[blizzardboy]

I think that is Flow Limitation, usually meaning the flattened waveform of Inspiratory Flow Limitation, but maybe not in this case (?) .

Hi jnk, Aaah , ya, dat wood bee rite. Cheers,

[unadog]

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

His good memory, cognitive capability, and ongoing humor clearly indicate that HE IS FAKING IT!

He does not have SDB, he is not one of us, he is not irritible and stupid and cognitively damaged like I am! He is just here to mock our dim witted ways!

Sure, it is **easy** to be a "mr big fish smarty pants" in a small pond of intellectually crippled and morally lapsed apneacs - yeah ... um .... indignant ... well .... thanks for calling ... ambien ...

PS: I **used to** be smart you know! And thin ... and employed ... So there!

M.

[dsm]

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

His good memory, cognitive capability, and ongoing humor clearly indicate that HE IS FAKING IT!

He does not have SDB, he is not one of us, he is not irritible and stupid and cognitively damaged like I am! He is just here to mock our dim witted ways!

Sure, it is **easy** to be a "mr big fish smarty pants" in a small pond of intellectually crippled and morally lapsed apneacs - yeah ... um .... indignant ... well .... thanks for calling ... ambien ...

M.

Yup we bumblers just have to grumble on

D

[unadog]

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.

Jeff, the humans cannot read the thought waveforms like Muffy and the rest of us aliens.

You have to use that tongue/lips things they included in your flesh suit and make **audio** waveforms!

Or maybe they left that part off of your suit? Hmm, better submit a new picture to space command so that we can be sure you have all of the right parts .... might explain why CPAP isn't working ....

Good work with the cross dressing! That ought to confuse them!

[Muse-Inc]

I wonder if dosing with fairly large amts of say magnesium & calcium to move to more base and then high protein to move to acidic pH might help...only if that theory is supported by testing of course.

Attempting to control your pH through arbitrary ingestion of electrolytes is an excellent way to kill yourself.

Muffy

Ah Muffy, you're taking all the fun outta this! Over the course of a day I take 800 mgs of magnesium as I experienced several probs that my doc & I discussed before I started taking this amt to see if mag might be the root cause...appears to be in my case. I am also very sensitive to slight shifts in potassium so being on a diuretic is a huge challenge. I eat low sodium and now have low sodium issues...it's just one dam#ed thing after another. That's 3 of the 4 major elements that must remain in relative balance that I have probs maintaining...my quarterly bloodwork is carefully scrutinized. Shifts in the balance of these 4 and all biochemical hell breaks loose. Now that said, sounds to me that BB might also be sensitive to shifts in these...worth investigating IMHO.

[SleepingUgly]

Deleting my Ambien-induced nonsense.

[blizzardboy]

His good memory, cognitive capability, and ongoing humor clearly indicate that HE IS FAKING IT!

He does not have SDB, he is not one of us, he is not irritible and stupid and cognitively damaged like I am! He is just here to mock our dim witted ways!

Sure, it is **easy** to be a "mr big fish smarty pants" in a small pond of intellectually crippled and morally lapsed apneacs - yeah ... um .... indignant ... well .... thanks for calling ... ambien ...

PS: I **used to** be smart you know! And thin ... and employed ... So there!

Hi unadog et al, What can I do? They told me I needed a mask, they sold me a mask, I wore the mask...I am not sure what I am doing wrong...maybe you can help me...I've got it! Please examine this photo of me taken just after I have woken up after a night on the mask and maybe you can find a clue as to where I am going wrong. Here is the photo: Cheers, BB PhD BSc(Hons) FoS

[Muffy]

I wonder if dosing with fairly large amts of say magnesium & calcium to move to more base and then high protein to move to acidic pH might help...

Attempting to control your pH through arbitrary ingestion of electrolytes is an excellent way to kill yourself.

...my quarterly bloodwork is carefully scrutinized. Shifts in the balance of these 4 (Mg, Ca, Na, K) and all biochemical hell breaks loose.

What, we're saying the same thing.

Correcting electrolytes is only helpful if it is the electrolytes that need correcting (with the possible exception of K in diabetic ketoacidosis).

The only reason pH was brought up was because one bb lab value was (once) elevated (especially considering his age). The logic (or lack thereof)(let's call it a hypothesis instead) would be elevated -HCO3 > elevated pCO2 > chronic respiratory acidosis > more ventilatory attack > a lot of people say that don't work anyway. However, it could just as easily have been some sort of -ion loss or +ion gain (hey, maybe bb's bulimic for all we know)(or is addicted to Rolaids)(although his Ca would screw up first) but that hypothesis would be elevated -HCO3 > chronic metabolic alkalosis > need another support board.

At any rate, under any circumstance adding more Ca would make it worse, and

Severe metabolic alkalosis (ie, blood pH >7.55) is a serious medical problem. Mortality rates have been reported as 45% in patients with an arterial blood pH of 7.55 and 80% when the pH was greater than 7.65.

I don't think you could shove in enough Mg to really accomplish anything (except maybe ameliorate RLS and PLMs. Mg doesn't accumulate all that well)(unless it's the hydroxide compound. Then you're back in the SMA loop)(or if it's the sulfate compound. Then your breathing stops)(OK, don't go crazy with the Mg, either).

If he has a tendency to CHF (the entity that MI seems to refer to), jacking up the Na sends you to the ED for a hefty dose of rapid-acting diuretic. Then that will suck out a bunch of electrolytes. You could try making up the difference by shoving in more Rolaids, but that, unfortunately, doesn't have the electrolyte you need (K) but does have the ones you don't.

Of course, eating Rolaids would be treating something you don't have, anyway.

Unless he is bulimic, has the world's worst GERD, and his K has dropped outta sight.

But don't guess wrong with the K.

At about K >8.0 meq, your heart stops.

Attempting to control your pH through arbitrary ingestion of electrolytes is an excellent way to kill yourself.

Attempting to control your pH through arbitrary ingestion of electrolytes is an excellent way to kill yourself.

Attempting to control your pH through arbitrary ingestion of electrolytes is an excellent way to kill yourself.

Muffy

[Muffy]

Y'know, I don't really ask a lot of questions around here, but can I ask one now?

Muffy

[jnk]

Y'know, I don't really ask a lot of questions around here, but can I ask one now?

Muffy

OK. But hurry. You only have 122 posts left.

jeff

[ozij]

Y'know, I don't really ask a lot of questions around here, but can I ask one now?

Muffy

OK. But hurry. You only have 122 posts left.

jeff

....before your CPAP turns into a pumpkin.