Urgent advice needed - In hospital - Lots of CA's and respiratory feels depressed

palerider wrote: ↑

Sun Jun 17, 2018 2:48 pm

WarpedTrekker wrote: ↑

Sun Jun 17, 2018 2:27 pm

palerider wrote: ↑

Mon May 21, 2018 10:44 pm

WarpedTrekker wrote: ↑

Mon May 21, 2018 7:59 pm

Well I'm home, but still having major issues with my sleep. I'm not sure if it is anxiety, or what. But I had set my machine back to my normal values of minEPAP 5, PS3, MaxIPAP14. Whenever I fall asleep, immediately within a few seconds to a minute, my Contec SpO2 sensor alarm goes off!

but whatever was working the last few days, you should set the machine back to it... you may need more min epap, and less ps.

Here is a sample of what my breathing looks like, when I have these episodes. I basically start having mini-CA's until they get long enough to be classified as a CA.

I notice that you ignored my advice... The advice that *worked* for you in the hospital.

Oxygenation happens at EPAP, so raise that. ventilation, which can encourage centrals (and does in your case) happens with PS, so lower that.

WarpedTrekker wrote: ↑

Sun May 20, 2018 6:41 am

Well after adjusting pressure support to PS2 and MinEPAP 5,4 that helped for tonight, I got a few hours of sleep with no O2 drops, and instead of usually a 93-94% O2, I got between 95-97%.

You had something that was working better... and you immediately threw it away.

I'd suggest a minEPAP of 7, and PS of 2, and see what happens.

Also, please stretch out the graphs so that only the top 6 are showing, and thus not so scrunched up.

Well I didnt throw out everything. I kept MinEPAP 5.4. I just put my PS back to 3. Because the BIPAP locks down EPAP/IPAP together, and I didnt want the starting IPAP too high. Since in the past I would wake up with some type of anxiety feeling, when my settings were higher. Too high though, and CA's start occurring during the night.

But those starting CA's you see there....Those are what conern me most. Because during the day, I start feeling Unwell, with depressed respiratory and shallow breathing. Then at night, I just stop breathing, the second I fall asleep. Hell...last night, I was just laying there, not totally asleep and my O2 alarm went off and low as 84% or lower. But as I said, this only happens on days where I have this "unwell"/depressed breathing feeling.

I'm wondering if it is my med's causing it. Multaq, Bystolic, etc. But doctors say "no".

WarpedTrekker wrote: ↑

Sun Jun 17, 2018 9:00 pm

palerider wrote: ↑

Sun Jun 17, 2018 2:48 pm

I'd suggest a minEPAP of 7, and PS of 2, and see what happens.

Also, please stretch out the graphs so that only the top 6 are showing, and thus not so scrunched up.

Well I didnt throw out everything. I kept MinEPAP 5.4. I just put my PS back to 3. Because the BIPAP locks down EPAP/IPAP together, and I didnt want the starting IPAP too high. Since in the past I would wake up with some type of anxiety feeling, when my settings were higher. Too high though, and CA's start occurring during the night.

You raised ipap, by raising PS.

ipap=epap+ps.

palerider wrote: ↑

Sun Jun 17, 2018 9:13 pm

You raised ipap, by raising PS.

ipap=epap+ps.

Right. IPAP raises with PS raised. Isn't higher IPAP a good thing in some cases? Having a higher IPAP can help with OA's right?

I'll start changing to your suggested setting in small increments over time. I thought one purpose of BIPAP was to offer higher PS of 4+? But then that causes CA's in some people? Last night I had that same nervous/unwell feeling, before going to bed. I'm starting to think it is some type of PTSD/Panic Disorder and will discuss with my psychiatrist this week.

Doesn't reduced PS, cause shallower breathing, since there is less differnce in IPAP/EPAP?

I made slight adjustments, but still had some 30-35sec OA's. It says I had 24 SpO2 desat's, but I don't see how. Unless it is counting everything below the 96% baseline as a desat.

WarpedTrekker wrote: ↑

Mon Jun 18, 2018 7:43 am

palerider wrote: ↑

Sun Jun 17, 2018 9:13 pm

You raised ipap, by raising PS.

ipap=epap+ps.

Right. IPAP raises with PS raised. Isn't higher IPAP a good thing in some cases? Having a higher IPAP can help with OA's right?

I'll start changing to your suggested setting in small increments over time. I thought one purpose of BIPAP was to offer higher PS of 4+? But then that causes CA's in some people? Last night I had that same nervous/unwell feeling, before going to bed. I'm starting to think it is some type of PTSD/Panic Disorder and will discuss with my psychiatrist this week.

Doesn't reduced PS, cause shallower breathing, since there is less differnce in IPAP/EPAP?

I made slight adjustments, but still had some 30-35sec OA's. It says I had 24 SpO2 desat's, but I don't see how. Unless it is counting everything below the 96% baseline as a desat.

It's like I'm talking to a brick wall.

You had something that was working, and decided to change it, and then wondered why you were having *the same problems again*.

I've said that more EPAP = more oxygenation, but you haven't changed that.

I've said that more PS = more CO2 blowoff, which can lead to centrals, so you drop ps by 0.2? instead of going back to what was working.

If you've got obstructives (and low saturation) RAISE THE EPAP.

Yes, reduced PS causes shallower breathing, more NORMAL breathing, and that, in your case, will reduce centrals, which is what you've been complaining about.

Maybe someone else can get through to you. *throws up hands*

palerider wrote: ↑

Mon Jun 18, 2018 9:38 am

WarpedTrekker wrote: ↑

Mon Jun 18, 2018 7:43 am

palerider wrote: ↑

Sun Jun 17, 2018 9:13 pm

You raised ipap, by raising PS.

ipap=epap+ps.

Right. IPAP raises with PS raised. Isn't higher IPAP a good thing in some cases? Having a higher IPAP can help with OA's right?

I'll start changing to your suggested setting in small increments over time. I thought one purpose of BIPAP was to offer higher PS of 4+? But then that causes CA's in some people? Last night I had that same nervous/unwell feeling, before going to bed. I'm starting to think it is some type of PTSD/Panic Disorder and will discuss with my psychiatrist this week.

Doesn't reduced PS, cause shallower breathing, since there is less differnce in IPAP/EPAP?

I made slight adjustments, but still had some 30-35sec OA's. It says I had 24 SpO2 desat's, but I don't see how. Unless it is counting everything below the 96% baseline as a desat.

It's like I'm talking to a brick wall.

You had something that was working, and decided to change it, and then wondered why you were having *the same problems again*.

I've said that more EPAP = more oxygenation, but you haven't changed that.

I've said that more PS = more CO2 blowoff, which can lead to centrals, so you drop ps by 0.2? instead of going back to what was working.

If you've got obstructives (and low saturation) RAISE THE EPAP.

Yes, reduced PS causes shallower breathing, more NORMAL breathing, and that, in your case, will reduce centrals, which is what you've been complaining about.

Maybe someone else can get through to you. *throws up hands*

Maybe I misunderstood. So I will try to understand again.
1. PS=more CO2 blowoff, which can lead to centrals. So...instead of PS3, or PS2.8, I should drop it even further to PS2?
Does "drop" mean a lower number?

2. EPAP. I will try increasing the EPAP by one or two points then.

You have posted some nights where your median minute ventilation is around 10.0 which is a lot - I believe "normal" is between 6 and 8. So either you are sick, or you are being over ventilated. Changing PS from 3 to 2.8 is a waste of time.

I would try a PS of 2.0 or even 1.0 and also raise your EPAP somewhat until your obstructive apneas are all but eliminated. Without an open airway nothing else is going to work properly. I would try PS 2.0 with min EPAP of 6cm h2o for a night and see what happens.

Sure the guideline suggested protocols usually say for bi-level, start with a PS of 4cm h2o, but every person is different and that is exactly why you don't titrate a human like a text book as if it's a predetermined formula. They surely can't account for any medicines you may be on, and the interactions between them and any type of positive airway pressure that's applied at night. Any type of PAP applied, whether CPAP or Bi-level, has effect on the the body.

WarpedTrekker wrote: ↑

Tue Jun 26, 2018 7:13 am

Maybe I misunderstood. So I will try to understand again.
1. PS=more CO2 blowoff, which can lead to centrals. So...instead of PS3, or PS2.8, I should drop it even further to PS2?
Does "drop" mean a lower number?

2. EPAP. I will try increasing the EPAP by one or two points then.

1) yes, drop = lower = less. a PS of 2, perhaps 1, perhaps 0, until your centrals resolve. If they don't resolve with lesser pressure support, then other alternatives may have to be investigated.

2) yes.