New to this- Husband vpap III 5 days but not taking breaths

Guest · Post by **Guest** » Mon Mar 10, 2008 7:25 pm

Of course, this is not the first time this sort of thing has happened on the message boards: someone repeatedly demonstrates a lack of understanding of their own machine, and yet is more than happy to home-titrate others.

Now while the Resmed doctors clearly won't recommend ASV for every one, Banned is more than happy to do so. So if you run out and buy yourself one of those panacea-model ASV machines, then Banned will be more than happy to remotely titrate you on yours!

I'm thinking Banned has more than earned the ASV Perseverance Award.

.

-SWS · Post by **-SWS** » Mon Mar 10, 2008 7:26 pm

That was me guested above

Banned · Post by **Banned** » Wed Mar 12, 2008 4:43 pm

SWS and dsm,

So we think hubby may have a shallow-breathing issue that may be more pervasive than his 'startling awake' episodes. Therefore the Respironics BiPAP Auto may be the better choice?

Banned

dsm · Post by **dsm** » Wed Mar 12, 2008 4:49 pm

[quote="Banned"]SWS and dsm,

So we think hubby may have a shallow-breathing issue that may be more pervasive than his 'startling awake' episodes. Therefore the Respironics BiPAP Auto may be the better choice?

Banned

Banned · Post by **Banned** » Wed Mar 12, 2008 5:07 pm

dsm wrote: I don't think I said Casiesea's husband specifically had a shallow breathing issue. He seems to have centrals (although doc#2 has other thoughts).

I had linked to a post mentioning my conversation with a Resmed doc & was thinking of another person on this forum who clearly (to me) has a shallow breathing challenge. It seems Vpap SV would not suit this other person (nor is it likely to be best for me, though I'd like to try one).

Hi dsm

I understand you did not say he had a shallow-breathing issue. I guess I was looking more to see if you thought it could be the issue, and maybe Doc #2 is right, is all. I'd be happy if shallow-breathing was the problem and the BiPAP Auto is the cure. I always focused on the 'Startling awake' which would seem more a periodic breathing issue (like I had, but i would wake up gasping for air). I never did understand if when he 'startled awake', was he out of air (breath)? I guess we'll know when Casiesea posts the data from the BiPAP Auto data.

Banned

dsm · Post by **dsm** » Wed Mar 12, 2008 5:38 pm

Banned,

I think Casiesea's husband has a serious issue that Casi is very effectively bringing to the attention of whoever she can (thats dedication).

His situation really needs focused attention from a good RT & clearly doc #1 was a bit of a no show in that department.

I do agree with SAG that letting us amateurs use him as a guinea pig is not good despite our best intentions. When he was on a Vpap III, I was very confident I could improve on the #s Casi was reporting & that happened.

SAG has insights in regard to Casi's husband that go beyond anything we can put forward. I am confident SAG would provide exactly the sort of focus he needs.

Re doc #2, I can see the logic of his apparent interpretations of the data. It is a worry that the docs differ so much.

But, in an earlier post SAG commented about the Vpap SV titration showing no centrals. Now what did strike me about that comment, is that the Adapt SV is expert at controlling centrals (what it was designed for) & I would expect that number (centrals) to be zero because the machine was doing its job well. So, in my book centrals are still high on the list of issues & my view may not go along with doc #2's view. But it behooves me as an amateur to give him the professional, the benefit of any doubt.

DSM

Casiesea · Post by **Casiesea** » Wed Mar 12, 2008 7:15 pm

I guess I am actually learning some of this. Last week, reading SWS's and SAG's post was like reading greek. Today, I went back to read them again and understood (at least partially) what they were saying. Maybe I will actually learn this stuff!

Let me address the "Startles awake" episodes. He DID NOT gasp for air when he startled. His breathing would slow, then stop completely, he would startle (usually 10-30 seconds after last exhale), then start breathing again (at a faster rate from what I remember at least). I do not ever remember him gasping for air.

His leak rate is down to 3L/m. RTherapist said anything under 20L/m was fine. He still has periodic startles, again, while breathing. Although, they are no where near as dramatic as they were before.

Rested- I appreciate your pm (I just finished reading it..lol). I will get back to you soon.

Thank you all so much for everything!

-SWS · Post by **-SWS** » Wed Mar 12, 2008 7:29 pm

Banned wrote:SWS and dsm,

So we think hubby may have a shallow-breathing issue that may be more pervasive than his 'startling awake' episodes. Therefore the Respironics BiPAP Auto may be the better choice?

Truth be told I don't know the answer, Banned. In that other thread we talked about how challenging syllogisms can be. Regarding complex analysis in general: syllogisms (factor analysis in general) tend to fall short because factor analysis often falls woefully short of salient factors.

My fear is that may be what's happening here. If there were only two salient factors involved here ('startling awake' episodes and shallow breathing), then factorization toward a best machine choice might be feasible in my mind. However, my gut feeling tells me there is more going on here. While I might have glanced at manufacturer literature and xPAP patents, I simply don't have the opportunity to see (let alone analyze) large-scale patient responses to these machines.

I will offer one thought that may not even be relevant here. When transitional cases of CSDB or central dysregulation occur, night-to-night symptoms and even PSG results may not be the same. In transitional cases especially, it is entirely possible to have two different PSG studies with two different doctors, and those doctors would independently see PSG results that can seem drastically at odds with each other.

One of the reasons I hope SAG makes it back into this thread is because I think he performs this kind of factor analysis exceptionally well. He sees the patient and equipment sides of the SDB equation again and again. And I have probably seen him straighten out challenging "PSG messes" more times than I can count.

P.S. I love that humorous tag line you recently put up, Banned. Great, great humor! .

-SWS · Post by **-SWS** » Thu Mar 13, 2008 8:48 am

Hang in there, Casiesea!!

SAG is currently in labor. But we may be able to get his expert opinions going in this thread postpartum.

In another thread SAG's wife wrote:This is SAGWife. SAG will not be posting this morning because he is busy giving birth to a ResContol II.

So what does a person hand out in a case like this? Cigars? CPAP filters?

dsm · Post by **dsm** » Thu Mar 13, 2008 2:33 pm

-SWS wrote:Hang in there, Casiesea!!

SAG is currently in labor. But we may be able to get his expert opinions going in this thread postpartum.
In another thread SAG's wife wrote:This is SAGWife. SAG will not be posting this morning because he is busy giving birth to a ResContol II.
So what does a person hand out in a case like this? Cigars? CPAP filters?

-SWS · Post by **-SWS** » Thu Mar 13, 2008 10:42 pm

Casiesea, page six of this Adobe PDF document (from Resmed) includes a case-study interview with patient Phil Lovell:
http://www.resmed.com/en-au/assets/docu ... 0933r1.pdf

Phil's interview describes his physiology and symptoms as episodic during a certain transitional period. In his case both arrhythmia and sleep disordered breathing happened to present rather dramatic yet episodic changes that he first observed by the way of drastic AHI changes (a case strongly supporting home monitoring of CPAP efficacy data).

So I'm wondering if your husband's physiology might have been a moving target during his multiple studies. Hypothetically: Might your husband present symptoms as an OSA patient during sleep study one, yet present as a CSA or CompSA patient during sleep studies two or three?

Or hypothetically: If your husband's symptoms are transient in nature, might optimal ASV settings on one night theoretically be suboptimal days or weeks later?

I suppose it's at least theoretically possible that your husband's multiple sleep study results may be at odds because of transitional physiology. I just don't know how improbable such highly transient symptomolgy might be. I'm not a health expert of any sort.

Banned · Post by **Banned** » Fri Mar 14, 2008 8:24 am

I still think before Casiesea packs up hubby's Adapt SV (and turns to the BiPAP Auto), she should try cranking up his MIN PS in very small increments.

Cheers

Banned · Post by **Banned** » Tue Mar 18, 2008 6:09 pm

Hi Casiesea,

Let us know how the 3-day home study on the BiPAP Auto goes. I, myself, have a 3-day home study on a BiPAP Auto SV at the end of April (I'm not sure how EPAP will translate to EEP). I'm still missing why people think a BiPAP Auto will necessarily alleviate some of the episodic periodic breathing your husband experiences that you said the Adapt SV did diminish, somewhat. Hmm..the Respironics BiPAP Auto SV can be used as a straight BiPAP, as well as a BiPAP Auto SV. Anyway, know your busy, but keep your fans out here informed when you can.

Banned

goose · Post by **goose** » Tue Mar 25, 2008 7:20 pm

Hey Casiesea,
Any updates on how your hubby is doing?? Curiously following along.....
Hope all is well
cheers
goose

Casiesea · Post by **Casiesea** » Sun Mar 30, 2008 9:15 am

Hey Guys!

Sorry about not responding, we took off on a little vacation to the mountains...no computers.

He is doing about the same. His leak rate seems to be higher and he is more restless while sleeping (i guess that could go together). I assume the machine knew we were at a diff elevation, right?

We have a bunch of messages from the Resp Therapists, so we will start returning calls tomorrow.

Thanks for thinking about us!

New to this- Husband vpap III 5 days but not taking breaths

Our SAG is Having a ResControl II!!!

Re: Our SAG is Having a ResControl II!!!

Transitional Episodic Presentations?