Heart went into bigeminy due to these events. ER visit.

I have AFIB caused by sleep apnea, treated with Multaq. Never had an incident since last year, until this past friday. I woke up early in morning, my heart went into ventricular bigeminy. I called 911, because it didnt feel like AFIB, and I felt light headed. It lasted about 5 minutes and by the time EMS arrived, it resolved. I was still taken to the ER to get checked out. I used a Kardia Mobile device to record my event, and showed it to the doctors. He confirmed PVC's or bigeminy. So I looked at my AirCurve logs, and it showed I had a lot of leaks, with UA's. Basically OA's, since I know my tongue collapses at night. I need to get these under control, but don't know how to do it. I fit my AirTouch F20 mask the same every night, but some reason it leaks after I go to sleep. I think from the side of my mouth.

What I'd like to know though, is why does the Flow Rate show this weird breathing pattern? Take a look at these charts. See how the breath starts big, then diminishes, then starts with another big breath again? This has happened in the past on some nights, especially during leaks. I also wear a ResMed Narval CC dental appliance with my FF AirTouch mask.

WarpedTrekker wrote: ↑

Mon Oct 08, 2018 10:23 pm

What I'd like to know though, is why does the Flow Rate show this weird breathing pattern? Take a look at these charts. See how the breath starts big, then diminishes, then starts with another big breath again?

You're having a series of arousals caused by the obstuctive events... your airway starts closing of, your breathing flow volume diminishes, till you're in apnea, you gasp for breath, take a few recovery breaths, and the cycle repeats...

Your pressure's too low, and the machine is lowering it further, to try and get your mask to seal... so you don't have enough pressure to prevent the events.

palerider wrote: ↑

Tue Oct 09, 2018 12:54 am

WarpedTrekker wrote: ↑

Mon Oct 08, 2018 10:23 pm

What I'd like to know though, is why does the Flow Rate show this weird breathing pattern? Take a look at these charts. See how the breath starts big, then diminishes, then starts with another big breath again?

You're having a series of arousals caused by the obstuctive events... your airway starts closing of, your breathing flow volume diminishes, till you're in apnea, you gasp for breath, take a few recovery breaths, and the cycle repeats...

Your pressure's too low, and the machine is lowering it further, to try and get your mask to seal... so you don't have enough pressure to prevent the events.

ok thanks palerider. I tried to get answers from my sleep doctor, but he kept saying im doing fine since AHI low. I need to find another sleep doc. So should I raise my MAX IPAP above 15? It had started around 13 and been slowly increasing that already. I'm wondering if this dental appliance is causing more obstructions? But it does help with my recessed jaw and USUALLY my mask fits better and doesnt leak as much.

Can these arrousals also contribute to night sweats, or also cause me to have to work harder to breathe?
I went to a new sleep doctor yesterday, that has some type of breathing probe he inserts into your throat at night, to measure airway resistance. He claims it can check to see how much resistence and how much force I'm using to breathe at night. I don't know whether to believe him or not, because no other sleep doc around here, uses it.

Do you use the "Ramp" function of your Machine?

When you go to Fit your mask... Do you use the "Mask Fit" option? which should let you fit your mask at full pressure? Or are you fitting your mask during RAMP time... "If you use it"

It could be that your fitting your mask at a lower pressure - and when your machine rases that pressure later on - the additional pressure inflates the seal of the mask more and changes how it rests on your face and then it leaks. If you haven't already you want to make sure you're fitting your mask - while laying down as close to the position you'll do most of your sleeping. At the maximum pressure, your machine will reach in a given night.

Fitting your mask at a lower pressure is just a recipe for disaster as it will almost always leak later on when the pressure changes, which will then wake you up, maybe though not enough for you to remember.

If you've already fitted your mask at max pressure and still having leaks, then please disregard the above advice.

You could be looking at a different issue, Like rolling over in your sleep and pressing the mask against your pillow or something like that.

The only reason I'm thinking it's a pressure/fit problem is it appears that when your machine hit the pressure ceiling and held there... That's when the leak rate went up and you started having considerably more leak problems than before.

If your not having any problems with Swallowing air - I'd look at raising your max pressure or turning off the limit altogether, Your machine is raising the pressure... see where it wants to go. If your overall numbers and results improve - it may be you just needed more pressure to protect you during some parts of the night, like REM Sleep. I'd also raise your starting pressure by a few notches at least. Start somewhere like 9 or 10... It looks like now your starting off at 7 and the machine is going up from there right away.

My ideas are just opinion, with your heart condition and other considerations, their others on this forum with more understanding and knowledge than me. I welcome them to correct anything I've said if I'm wrong.

I'm always willing to learn as well.

I wish you well and hope your able to work out what's going wrong right away.

Rest well,

Gryphon

Some sleeps doctors work with patients that have muscular dystrophy. People think it is all about the legs, but in fact, affects every single muscle including those in the throat. Now, I'm not saying that this is your problem, but just pointing out that perhaps this sleep doc has a different approach given your situation because of different experience/training.

WarpedTrekker wrote: ↑

Tue Oct 09, 2018 6:52 am

ok thanks palerider. I tried to get answers from my sleep doctor, but he kept saying im doing fine since AHI low.

There's more to sleep disturbances than just the AHI...too bad your doctor doesn't know this.

WarpedTrekker wrote: ↑

Tue Oct 09, 2018 6:52 am

I need to find another sleep doc.

Or just DIY.

WarpedTrekker wrote: ↑

Tue Oct 09, 2018 6:52 am

So should I raise my MAX IPAP above 15? It had started around 13 and been slowly increasing that already. I'm wondering if this dental appliance is causing more obstructions? But it does help with my recessed jaw and USUALLY my mask fits better and doesnt leak as much.

Yes, set maxipap to 25, see what happens. Raise the minepap, it's hard to get an clear idea what it should be with your scrunched strips (remove the respiration rate, it doesn't do anything useful, and it just makes the others smaller and harder to read). but maybe... minepap of 10...

WarpedTrekker wrote: ↑

Tue Oct 09, 2018 6:52 am

Can these arrousals also contribute to night sweats, or also cause me to have to work harder to breathe?

Yes. night sweats are one of the side effects of sleep disordered breathing.

WarpedTrekker wrote: ↑

Tue Oct 09, 2018 6:52 am

I went to a new sleep doctor yesterday, that has some type of breathing probe he inserts into your throat at night, to measure airway resistance. He claims it can check to see how much resistence and how much force I'm using to breathe at night. I don't know whether to believe him or not, because no other sleep doc around here, uses it.

It's a legitimate thing.

I'm thinking about easing my max ipap from 15. But a little hesitant. But after looking at my last sleep study done back in February, it said they started me on CPAP and that failed. Then started BIPAP titration at 14/10 and ended with final pressure 16/12 that eliminated all events. The sleep study says my most appropriate setting is 14/10. This was obviously using EPR 4. But that was giving me centrals and felt uncomfortable so I adjusted down to 3. The interesting thing is if they titrated me at those high numbers in the first place, why is this doctor starting my machine at lower numbers? This has been like this since February except I did increase starting pressure a little and the max ipap was I think 14 at one time. Also most of the night, I'm fine at lower pressures. So not sure why all of the sudden it raises up high on some nights. Most nights I'm stuck at the lower pressures all night.

I have adjusted my mask with the Mask Fit option and it always showed a good fit. I also do use ramp mode, but don't fit my mask during ramp. Only with the mask fit option. I do feel like I may swallow some air at night. Because in the morning, I burp and fart a lot. lol! I'm planning to have a septoplasty/turbinate reduction later this month, so hopefully once that is healed up I will breathe better thru my nose.

WarpedTrekker wrote: ↑

Tue Oct 09, 2018 4:48 pm

I'm thinking about easing my max ipap from 15. But a little hesitant.

Why?

WarpedTrekker wrote: ↑

Tue Oct 09, 2018 4:48 pm

But after looking at my last sleep study done back in February, it said they started me on CPAP and that failed. Then started BIPAP titration at 14/10 and ended with final pressure 16/12 that eliminated all events. The sleep study says my most appropriate setting is 14/10. This was obviously using EPR 4. But that was giving me centrals and felt uncomfortable so I adjusted down to 3. The interesting thing is if they titrated me at those high numbers in the first place, why is this doctor starting my machine at lower numbers?

Incompetence? ignorance? Think's he's got a "better way"? who knows.

Even worse last night. Instead of increasing max pressure, I adjusted my dental appliance forward to see if it would help obrsturctions. It was worse last night for some reason! My stomach and chest hurt bad early last night when I woke up after all those obstructions

I am now this morning trying to contact my sleep doctor about this to see if i can get another sleep study. Only thing is, this particular sleep doctor doesnt really work with people that have dental appliances. He doesn't believe in them. I called his nurse, and they claimed my insurance DENIED another sleep study and that I would need to pay $650 out of pocket for a sleep study!

If you get lower apnea's with higher pressure, just adjust it higher if you're not getting more centrals from it being higher. Also if EPR is causing centrals (it did for me) turn off EPR... EPR is a comfort thing mostly and I only noticed the pressure discomfort for about 2 weeks once I turned it off. I have a base of 14.2 CM pressure now and it feels just like breathing normally. YMMV but I think if lung health is good EPR is not much of a comfort provider and can be problematic at best.

Also use the mask fit option as others have suggested to get rid of those leaks. I also find taking a benedryl at night has drastically reduced my apnea's YMMV but if your apnea's are at least partially related to inflamation that could help.

I'm also not sure why you think another sleep study is necessary, it sounds like a waste of time and money to me. mask fit, pressure etc, are probably more likely to resolve these problems. Of course I can't recommend not going to the doctor when heart issues are there, but resolving these apnea's is the thing most likely to help.

Magnesium in the morning also greatly helped with my SVT (Super Ventricular Tachycardia). I believe taking it at night can be problematic because it may relax the throat muscles too much.

WarpedTrekker wrote: ↑

Wed Oct 10, 2018 8:38 am

Even worse last night. Instead of increasing max pressure, I adjusted my dental appliance forward to see if it would help obrsturctions.

And, there's your result, machine pegged at 15 for long periods while you have repeated apneas...

I already stated i use the mask fit option. As you see above in my last screenshots my leaks were not that out of control. It was within normal and my machine showed a happy face. I use Klonopin to sleep. It doesn't affect my AHI.
I have never been told by a doctor that apneas can be caused by any type of inflammation. Interesting.

Anyway I'm having to pay $650 for a sleep study Tonight! Because I'm tired of this affecting my heart. Insurance won't pay for another study this year. I wanted to wait until after I have my nasoplasty in two weeks but I can't take it anymore waking up like my chest is burning and going to explode and it feels like my heart is overworked. Even with AHI 7.12. So I don't see how others get through the night with even higher AHI.

My doctors nurse though is a damn idiot. When I told her I was in the ER because my heart went into bigeminy rhythm, she asked if any doctor told me it was related to sleep apnea. She and my sleep doctor don't believe that sleep apnea can cause heart problems? Ridiculous. I told her the cardiologist speicfally told me my heart went into that rhythm due to issues with my apneas that night.

So now I'm having to pay out of pocket for another study which may or may not help me. Then after I have nasoplasty, I'll need another one at that time too.

nicholasjh1 wrote: ↑

Wed Oct 10, 2018 9:41 am

Also use the mask fit option as others have suggested to get rid of those leaks.

Leaks are well within the acceptable range.

WarpedTrekker wrote: ↑

Wed Oct 10, 2018 11:17 am

So now I'm having to pay out of pocket for another study which may or may not help me. Then after I have nasoplasty, I'll need another one at that time too.

Then why are you doing it?

WarpedTrekker wrote: ↑

Wed Oct 10, 2018 11:17 am

I already stated i use the mask fit option. As you see above in my last screenshots my leaks were not that out of control. It was within normal and my machine showed a happy face. I use Klonopin to sleep. It doesn't affect my AHI.
I have never been told by a doctor that apneas can be caused by any type of inflammation. Interesting.

Anyway I'm having to pay $650 for a sleep study Tonight! Because I'm tired of this affecting my heart. Insurance won't pay for another study this year. I wanted to wait until after I have my nasoplasty in two weeks but I can't take it anymore waking up like my chest is burning and going to explode and it feels like my heart is overworked. Even with AHI 7.12. So I don't see how others get through the night with even higher AHI.

My doctors nurse though is a damn idiot. When I told her I was in the ER because my heart went into bigeminy rhythm, she asked if any doctor told me it was related to sleep apnea. She and my sleep doctor don't believe that sleep apnea can cause heart problems? Ridiculous. I told her the cardiologist speicfally told me my heart went into that rhythm due to issues with my apneas that night.

So now I'm having to pay out of pocket for another study which may or may not help me. Then after I have nasoplasty, I'll need another one at that time too.

PLEASE pay attention to PaleRider's advice! If it weren't for the experienced people on this forum, I would have QUIT CPAP months ago. They KNOW what they are talking about....UNLIKE sleep doctors who don't actually USE CPAP and have limited knowledge about the process!!!!!