BiPap and restricted chest wall

I’ve been on BiPap for about 25 years due to central or possibly mixed sleep apnoea due to neuromuscular impact on my breathing with polio I also have serve scoliosis with a spinal fusion and rod involving all thoracic.

Over the years my pressures have been higher than for most and am on pressure support mode. They recently suggested I up my pressures from 27/5 to 28/7 and I already have a back up of 18 Ti 1.4). Thus because my oximetry has shown a few dips increasing <88 sone less.

I have always been concerned that I would to better in a volume mode of sone sort due to stiff chest and scoliosis and my own respiratory muscles are very weak - and FVC of <1 litre bit no longer disease so not COPD just respiratory insufficiency from polio - my FVC since a teenager was never higher than 1.4 litres.

I am curious if anyone else is similar or has some insight as to the value of changing modes rather than just upping the pressures each time on one overnight oximetry! The mask leaking and mouth obviously gets harder as pressure get so high and at 72 in 5 years I may be over the top re pressures !

Bump.
Maybe someone who knows more than I do (not unusual) will see this.

There are 2 parts to breathing-- ventilation (movement of air through the lung which transports O2 and CO2) and oxygenation (oxygen travels from alveoli to capillaries).

Would need to see some downloads, and perhaps an ABG result, to determine how much ventilation you're doing and consider if supplemental oxygen might be a better way to do this.

If this is purely a ventilation issue, then raising EPAP would offset any gains accomplished by raising IPAP.

Rubicon wrote: ↑

Sat Sep 02, 2023 3:53 am

If this is purely a ventilation issue, then raising EPAP would offset any gains accomplished by raising IPAP.

Meaning the raising EPAP from 5 to 7 will offset any gains accomplished by raising IPAP from 25 to 28.

Who are the "they" that suggested the change?

They - are the respiratory medics - I am not confident that without proper download of all the issues not just SpO2 and pulse that just upping the EPAP and IPAP by 2 does anything useful - especially as said they cancel each other out. My SpO2 is more or less >90 soar from odd dip to 85 or very brief 81 lasting 15-20 seconds. Also given my very weak hands I’m not sure the pulse ox finger readings are not just artifacts if my circulation is my fingers !! Arghhhh

If your providers use the finger pulse-ox, then you can probably trust it.
I would not be surprised if you were suffering from anxiety.
Ask for help with that.

Your are correct I am suffering from anxiety- but with they are not using a Mai/finger sensor but a rubber ring around the finger like the ViHealth product. Also I still get woken and have to consciously instigate my breathing as feels central sleep apnoea episode.

Given my cO2 is normal (5.2) but my HCO3 Is 28 mmol/L I am obviously compensating a lot.

But yes the anxiety is a factor