Morbius, would you take a look

jannicatt is very worried about her 89-year-old husband and posted some SleepyHead screenshots on this page:

viewtopic.php?f=1&t=105968&st=0&sk=t&sd=a&start=30

We've been trying to help but I don't know what to make of his flow rate graph. She is asking why it looks so blunted in places (last two screenshots).

kaiasgram wrote:She is asking why it looks so blunted in places (last two screenshots).

Well, a problem is only a problem if it's a problem.

Perhaps he does have nocturnal hypoventilation (which tends to worsen in REM, and maybe that's final REM period), but he'll need to get an ABG (to see what the pCO2 is) at the pulmonologist as well as PFT and nocturnal oximetry with a real oximeter (not one of those 1% resolution things).

If the entire baseline saturation drops, that would be a indication to get more aggressive with the therapy.

OTOH, you got some crazy pressures there already, and perhaps his pCO2 is fine (or at least within acceptable limits).

Mucho thanks.

What do you mean to "get more therapy"? More pressure? I am concerned what I can do until we get him into a pulmonologist. Any suggestions?

What is meant "Some crazy pressures here". Some that need changing to help him???

jannicatt wrote:What is meant "Some crazy pressures here". Some that need changing to help him???

I'm sorry you're not getting any answers right now, and I feel your frustration...

I *think* that there's a thought that the excessive leaks may be part of why the machine is showing the low flow rates, though we only have two days to look at.

I'd suggest that the first thing to do is try and control the leaks.

there are a few times when he stops breathing, according to the data, but it's not very often. that level of stopping breathing happens to many of us, the cpap helps a lot, but it doesn't prevent everything.

Thanks for responding and understanding my frustration. I will work on the leak tonight but I didn't realize that was bad on a Respironics. Hopefully we can make it better.

jannicatt wrote:I am concerned what I can do until we get him into a pulmonologist. Any suggestions?

Yes, but it is a reiteration of advice previously given:

If you are concerned that your 89 year old husband is not breathing, either go to the ED or call 911.

That said, IIWY I would avoid DWing until you figure out what (or even if) the issue is, because:

You can't come up with an answer unless you know what the problem is.

Morbius wrote:

jannicatt wrote:I am concerned what I can do until we get him into a pulmonologist. Any suggestions?

Yes, but it is a reiteration of advice previously given:

If you are concerned that your 89 year old husband is not breathing, either go to the ED or call 911.

I wonder if it's not important to go back and examine her concerns, looking at the data. if he's having apneas, the occasional central, as shown in the data, is it a concern? pretty much all of us with SDB stop breathing at times, and nobody says boo, because that's just how it goes.

based on the chart of may 26, I think most everybody would have said "hey, that's pretty good AHI, not perfect, but good."

however, this was started off with a concern of her husband not breathing. ... while being treated for sleep apnea.... and all the 'GO TO THE DOCTOR IMMEDIATELY" advice was given when no charts where shared. now that the charts have been shared, showing an ahi of 2.97 and below, should that urgent advice be reconsidered?

jannicatt: "DWing" refers to changing the pressure(s) on the machine.

Morbius wrote:You can't come up with an answer unless you know what the problem is.

So let's think about this.

Given this example:

• Is it obsrtuctive?
• Is it central?
• Is there a little flow limitation?
• Is it hypoventilation?
• Is it normal irregularity associated with REM?
• Is it breathing reduction associated with aggressive BiPAP and leaks?

Should we ask her to throw in the FL graph?

The whole file would be better. Then we can blow up the breaths and look for other instances of LFB.

Morbius wrote:The whole file would be better. Then we can blow up the breaths and look for other instances of LFB.

We were in PM contact last night -- if she doesn't check in here soon I'll let her know about your suggestion/offer. Thanks.