Another sleep apnea "victim"

SuperDave · Post by **SuperDave** » Thu Jan 24, 2019 6:01 pm

Thanks again for comments and suggestions. Primary Physician is in the process of evaluating CHF. Was able to schedule with Sleep Doc for next Monday to discuss bilevel treatment so far, periodic breathing, and central/complex apnea.

After the successful night at 9.65 AHI, next two nights were 15.47 and 13.47. Centrals for the 3 good nights were 1.04, 3.09, and 2.38. OAs and hypops were higher.

Pugsy · Post by **Pugsy** » Thu Jan 24, 2019 6:04 pm

You can try either more EPAP and/or increasing the max IPAP for those OAs and hyponeas.
More pressure may or may not cause more centrals. Might get lucky and the centrals stay nice and low.

SuperDave · Post by **SuperDave** » Thu Jan 24, 2019 6:09 pm

kinda reluctant to change anything for several more days... not sure why things suddenly got better but one change was increasing deadspace with taping over the vent beneath the gel pillows. The elimination of the loud wind escaping thru the vent has definitely led to less arousals from the noise.

SuperDave · Post by **SuperDave** » Thu Jan 24, 2019 6:19 pm

here's an excel spreadsheet of bilevel treatment to date

palerider · Post by **palerider** » Thu Jan 24, 2019 6:27 pm

SuperDave wrote: ↑
Thu Jan 24, 2019 6:09 pm
kinda reluctant to change anything for several more days... not sure why things suddenly got better but one change was increasing deadspace with taping over the vent beneath the gel pillows.

Well, you see, the main drive for you breathe is to get rid of co2 in the blood,,, getting oxygen in seems to be just a side benefit.

If your co2 is too low, then you just don't breathe as much. plugging the lower port, increasing the dead space, means you're breathing back in a little more of your co2 (you normally breathe back some, since the bronchi and trachea is 'anatomical dead space', where no gas exchange happens... you're just increasing that.... this makes your co2 levels a little higher, and increases your respiratory drive.

This cuts down on the undershoots you were having, which were causing those repeated apneas, that the machine was misclassifying as obstructive, and giving you all that CSR like breathing flow.

bonjour · Post by **bonjour** » Thu Jan 24, 2019 9:03 pm

You are heading down the right path now but wow.
This is what Medicare looks at to justify.

http://www.apneaboard.com/wiki/index.ph ... P_Machines

Here is a summary of it.

Pugsy -- nice analysis

Complex Sleep Apnea
For Complex Sleep Apnea the Medicare requirements for issuing an ASV machine.

Titrate to minimize OSA, that is the obstructive AHI to less than 5 per hour. This typically is raising EPAP or pressure until obstructive AHI is less than 5 per hour, we expect this to make the Central and Complex Apnea worse thus failing the current treatment

Record the central apnea-central hypopnea index (CAHI) (looking for greater than or equal to 5 per hour and greater than 50% of total AHI)

Document the presence of at least one of the following symptoms: These symptoms are specifically noted by Medicare. These are key symptoms that we look for by asking "How do you feel?". Do not limit your answers to the following and do not fabricate the answers.
Sleepiness, "How do you feel?"
Awakening short of breath, "How do you feel?"
Difficulty initiating or maintaining sleep, "How do you feel?"
Frequent awakenings, or "How do you feel?"
Nonrestorative sleep, "How do you feel?" Nonrestorative sleep is defined as the subjective feeling that sleep has been insufficiently refreshing
Snoring, Can be documented on Sleepyhead
Witnessed apneas (from your sleep study)

For Central Sleep Apnea the Medicare requirements for issuing an ASV machine.

Document a central apnea-central hypopnea index (CAHI) is greater than or equal to 5 per hour also apnea-hypopnea index (AHI) greater than 5'

Document The sum total of central apneas plus central hypopneas is greater than 50% of the total apneas and hypopneas

Document the presence of at least one of the following symptoms: These symptoms are specifically noted by Medicare. These are key symptoms that we look for by asking "How do you feel?". Do not limit your answers to the following and do not fabricate the answers.
Sleepiness, "How do you feel?"
Awakening short of breath, "How do you feel?"
Difficulty initiating or maintaining sleep, "How do you feel?"
Frequent awakenings, or "How do you feel?"
Nonrestorative sleep, "How do you feel?" Nonrestorative sleep is defined as the subjective feeling that sleep has been insufficiently refreshing
Snoring, Can be documented on Sleepyhead
Witnessed apneas (from your Sleep Study)

SuperDave · Post by **SuperDave** » Thu Jan 24, 2019 9:52 pm

thanks, bonjour. thats a great wiki. might come in handy at my next dr. appt.

esel · Post by **esel** » Fri Jan 25, 2019 5:36 am

Pugsy wrote: ↑
Thu Jan 24, 2019 9:29 am

esel wrote: ↑
Thu Jan 24, 2019 9:19 am
You may want to recheck your blood pressure. I know two people starting CPAP for sleep apnea and it solved their high blood pressure. Both no longer need the medicine.
Well...it doesn't always work out that way. Now you know someone who still needs BP meds even after 9 years of optimal sleep apnea treatment. Me.
Lots of causes for high blood pressure and sleep apnea just one of the many.

You are right. It was just a thought any reduction on med's is worth it. Sadly it didn't work out for you.

Pugsy wrote: ↑
Thu Jan 24, 2019 9:29 am
esel wrote: ↑
Thu Jan 24, 2019 9:19 am
So far I would not worry too much about the central events. In your polysomnography there is only one central and 4 mixed. It is possible that the CPAP treatment is inducing them. In my sleep study I had lots of OA and with CPAP they turned into centrals.

esel wrote: ↑
Thu Jan 24, 2019 9:19 am
They may decrease as your body gets used to the treatment.
This advice is potentially dangerous....
Nearly 2 years on cpap....the body never got used to it.
And most recently since Nov last year...hasn't changed....the body still hasn't got used to it.
Sometimes it just won't get used to it no matter how long you give it and in the mean time way too many centrals to ignore and way too much other ugly breathing to ignore.
He need proper medical care NOW...not later.

Oups, he sure needs better medical care NOW. So far the settings or XPAP are not right and his body cannot get used to it.

Here he get's the best advice's with you... like you gave me

He also needs to see and check up with doctors as suggested.

I switched to ASV and it sure took care of events. On CPAP I easily score over 1/2 an hour of total time in apnea with mostly centrals which I did not have in a polisomnography without CPAP. On VPAP I am mostly below 5 min.

cpap2.JPG

For me XPAP is not really working. Sleeping with or without it has no effect on how well I sleep nor on how well I feel over the day.
However I am way less often sick and the hose length defines my battle field reach at night. I move a lot in my sleep even in REM. In REM it is more of a problem as I can act on my dreams and fight back. I once in a while discover a blue spot on arms or legs and have no idea how I got it.

Thank you for posting the video https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be

Complex Sleep Apnea is more fun, has more factors to play with.

SuperDave · Post by **SuperDave** » Sun Jan 27, 2019 3:24 pm

Getting close to the sweet spot. Last night was pretty good with AHI=5.6. Machine settings were Imax 20, Emin 13.5, PS 0

palerider · Post by **palerider** » Sun Jan 27, 2019 4:02 pm

SuperDave wrote: ↑
Sun Jan 27, 2019 3:24 pm
Getting close to the sweet spot. Last night was pretty good with AHI=5.6. Machine settings were Imax 20, Emin 13.5, PS 0

What's that AHI made up of? Huge improvement.

SuperDave · Post by **SuperDave** » Sun Jan 27, 2019 5:32 pm

CA 1.26, OA 2.51, H 1.83. AHI=5.60

palerider · Post by **palerider** » Sun Jan 27, 2019 5:33 pm

SuperDave wrote: ↑
Sun Jan 27, 2019 5:32 pm
CA 1.26, OA 2.51, H 1.83. AHI=5.60

Wow, that's a *huge* improvement on the CAs... OAs getting there.

SuperDave · Post by **SuperDave** » Sun Jan 27, 2019 5:53 pm

throw out the OAs & Hypops after 6:28am when I was waking up, and the AHI was even better.

SuperDave · Post by **SuperDave** » Thu Jan 31, 2019 8:45 am

My Ahi has been staying around 10 the last few days. I had a head cold and cough the first few days, started getting better, then relapsed this week while baby-sitting 5 grandkids who all have colds and flu. (Havn't had even one night yet on the PRS1 when fully healthy.) Thinking I should shake the lingering cough and sniffles in another week, at which time the current therapy could possibly get back to AHI of 5 or better. Do you think I should try to tweak the current bilevel settings a little more, or just be satisfied with where the therapy is at now. (grammar?) Thoughts & comments welcome.

Pugsy · Post by **Pugsy** » Thu Jan 31, 2019 8:55 am

I think you are going to need more EPAP baseline...no matter what. Sick or not.

Another sleep apnea "victim"

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