DISCUSSION ON HIGH VB% on Encore Analyzer

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
-SWS
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by -SWS » Tue Dec 09, 2008 12:29 pm

Mike, I'm thinking this part of SAG's unfolding discussion is going to be worth exploring in relation to your highly unusual VB patterns:
above linked article wrote:The changes in the transcutaneous carbon dioxide tension (TcCO2) were defined for different breathing patterns. During prolonged spiking episodes the TcCO2 increased significantly and differed statistically from the TcCO2 changes of normal breathing and periodic breathing patterns (episodes of apnea and hypopnea). The rise in TcCO2 during prolonged spiking episodes might suggest that prolonged spiking is representing another type of breathing disturbance during sleep differing from periodic breathing patterns.
If you look at the late-2007 date of that article, you'll notice that it's virtually brand new research. The above finding potentially represents yet another newly discovered pathology or SDB phenotype. And if SAG is in the process of getting that kind of equipment set up in his lab to discern similar prolonged TcCO2 spiking patterns, this part of the discussion is unfortunately going to take a while to unfold. I'm also wondering about the above prolonged TcCO2 spikes possibly occurring in yet other potential cases of less-than-frank or "almost-PB-like" oscillations around here. Perhaps these TcCO2 findings may turn out to be relevant to OutaSync's, DSM's, Echo's, or even Frequen's somewhat atypical SDB cases.

Very shortly after CSDB was announced in 2005 as a third and altogether separate SDB phenotype (Harvard-based research by Gilmartin, et al), SAG's center was already diligently investigating and selectively incorporating certain elements among all new CSDB findings into their own diagnostic and treatment protocols. By contrast, well more than a couple years after that 2005 landmark finding, some sleep labs had yet to incorporate any CSDB findings into their diagnostic and treatment protocols.

Anyway, this facet of the discussion may take a while to unfold because it's virtually unexplored medical territory. And yet, by its very TcCO2 oscillatory nature, it may turn out to be uncannily central to you and those high VB patterns. But that's just my layperson's take.

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echo
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by echo » Tue Dec 09, 2008 6:57 pm

Vewwwwwwy intewesting!

Does the article also mention a hypothesis for the physiological mechanism of this CO2 instability? (or is only the abstract online? sorry i am being lazy).

is SAG taking reservations for his Sleep Center?
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OutaSync
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by OutaSync » Tue Dec 09, 2008 9:23 pm

Echo,

Maybe SAG will give us a two-for-one deal at his sleep center!

Bev
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1

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StillAnotherGuest
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Can A Leopard...

Post by StillAnotherGuest » Wed Dec 10, 2008 6:24 am

-SWS wrote:And if SAG is in the process of getting that kind of equipment set up in his lab ... this part of the discussion is unfortunately going to take a while to unfold.
Right, more like a major overall just to get all this junk to work even before any data whatsoever, no matter how anecdotal, can be offered. Much of this monitoring will relate to examining autonomic (subcortical) arousal, and in order to remain OnT with this discussion, look for respiratory instability rather than scorable central or obstructive events per se (cause if it ain't an event, the field in general really doesn't care about it)(for that matter, neither does an APAP, except one that monitors VB). However, simple respiratory instability should be exactly what the VB Control Layer is looking for.

In general, what typically happens to pCO2 and VT during these transition states can be seen in

Image

Note how this phenomenon occurs within just a few breaths, so will avoid the minimum time criteria to mark them as respiratory events, bypass those Event Control Layers and end up in the VB Bucket (or that's the SAGpothesis, anyway).

A number of methodologies need to be examined to be able to figure out what will reliabily predict VB, because these variables may not be seen in all measures of autonomic activation (it may not be seen, for instance, in measuring R-R interval, but may be visible in PTT and/or PAT).
Browser wrote:SAG - I hate to be a jerk or anything but if you aren't going to contribute anything useful to this thread,why don't you start your own thread and you can carry on all you wish in it.

Thank You,
Mike
I apologize for wasting your time and will comply with your wishes.

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SAG
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Aromatherapy may help CPAP compliance. Lavender, Mandarin, Chamomile, and Sweet Marjoram aid in relaxation and sleep. Nature's Gift has these and a blend of all four called SleepEase.

-SWS
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by -SWS » Wed Dec 10, 2008 11:14 am

Browser, I think at this point we have two concepts kicking around: 1) GERD, and 2) pCO2 and VT variability. Both topics can warrant an in-depth discussion relative to your health IMO.

I think GERD is almost certainly one of your health factors that requires much better all-around management on your part. However, I am personally having a hard time understanding why anybody's GERD should consistently cause sustained 40% to 70% breath variability rates. So here's my take so far: GERD is very much on topic for your health, but probably off-topic relative to a high VB discussion. I agree with SAG that what he is getting ready to research in his lab stands an excellent chance of being scored as VB by the Respironics APAP.

Echo, when I read the following abstract statement, my take is that not only is the mechanism of dyscontrol not fully understood yet, but that the extent of sleep or even wake-related pathology---if any---is also undetermined:
The rise in TcCO2 during prolonged spiking episodes might suggest that prolonged spiking is representing another type of breathing disturbance during sleep differing from periodic breathing patterns.


A quick comment for the general audience about the Emfit mats used in the original research. The Emfit mats provide a signal voltage in response to any pressure. They are so signal-sensitive to pressure that they can pick up on the level of gas tension that occurs as the carbon dioxide is dissipated outward from those parts of the human body that are in contact with the Emfit mat. The original researchers came up with the idea that prolonged increases or spikes in that measured CO2 gas tension just might somehow correlate to sleep disordered breathing events. When they statistically analyzed those gas tension spikes, they noticed that the gas-tension patterns occur one way for normal breathing, another way for classic periodic breathing, and yet an altogether different way for unusually variable breathing that is currently not categorized as being related to sleep disordered breathing.

That means it's time to have a much closer look at what may be going wrong in human respiration for some of us during sleep. SAG's center is getting ready to replicate and add to this research. That process is guaranteed to take a looong while. But that TcCO2 and Vt variability type relationship to both sleep and general pathology may very well turn out to be important. SAG, thanks for posting that chart and for explaining to us what you are investigating. My attention is riveted.

Browser, would you prefer to have this part of the discussion here or in a separated thread?

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MrSandman
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Re: STOP PONTIFICATING

Post by MrSandman » Wed Dec 10, 2008 11:24 am

StillAnotherGuest wrote:
-SWS wrote:And if SAG is in the process of getting that kind of equipment set up in his lab ... this part of the discussion is unfortunately going to take a while to unfold.
Right, more like a major overall just to get all this junk to work even before any data whatsoever, no matter how anecdotal, can be offered. Much of this monitoring will relate to examining autonomic (subcortical) arousal, and in order to remain OnT with this discussion, look for respiratory instability rather than scorable central or obstructive events per se (cause if it ain't an event, the field in general really doesn't care about it)(for that matter, neither does an APAP, except one that monitors VB). However, simple respiratory instability should be exactly what the VB Control Layer is looking for.

In general, what typically happens to pCO2 and VT during these transition states can be seen in

Image

Note how this phenomenon occurs within just a few breaths, so will avoid the minimum time criteria to mark them as respiratory events, bypass those Event Control Layers and end up in the VB Bucket (or that's the SAGpothesis, anyway).

A number of methodologies need to be examined to be able to figure out what will reliabily predict VB, because these variables may not be seen in all measures of autonomic activation (it may not be seen, for instance, in measuring R-R interval, but may be visible in PTT and/or PAT).
Browser wrote:SAG - I hate to be a jerk or anything but if you aren't going to contribute anything useful to this thread,why don't you start your own thread and you can carry on all you wish in it.

Thank You,
Mike
I apologize for wasting your time and will comply with your wishes.

Image

SAG
Gee Whiz SAG, why didn't you just get to the point in the first place? I don't expect VB to be brought up after my PSG tonight and although I plan to bring it up to the technician I doubt they will know what I am talking about - maybe I will be surprised? You are way more advanced than your average duck.
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MrSandman
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by MrSandman » Wed Dec 10, 2008 11:44 am

-SWS wrote:Browser, would you prefer to have this part of the discussion here or in a separated thread?
Having it here is fine now that I know what we are talking about. Maybe I should fly out to SAGS clinic if they take CIGNA open access? I would be willing to send SAG my entire study results as soon as I can get my paws on it. Sag, if you need a study subject with known VB issues let me know and maybe we can work something out?

I switched to a Swift LT and really like it since years ago I used the Adams circuit due to facial hair concerns and preferred it. My VB is still in the 50-60% range but my leak line is odd with the Swift LT. I also noticed that "don't laugh" if I put on the Swift LT and block the exhaust port and blow or suck through the tube there isn't much resistance or suction created. With every other mask I have used this would either make it bellow out or draw in or when hooked to the machine and blocking the exhaust port and holding breath you could hear the machine change in pitch. With the Swift LT I get no such change in pitch. So I wonder where the pressure is because there is no audible leaks. This makes me wonder if this is normal for this interface or if it is faulty and also if any data can be trusted?

Mike
MrSandman - Send me a dream...

Hey, I wanted a cool name related to sleep...

Guest

Re: STOP PONTIFICATING

Post by Guest » Wed Dec 10, 2008 8:00 pm

Browser wrote:
StillAnotherGuest wrote:
-SWS wrote:And if SAG is in the process of getting that kind of equipment set up in his lab ... this part of the discussion is unfortunately going to take a while to unfold.
Right, more like a major overall just to get all this junk to work even before any data whatsoever, no matter how anecdotal, can be offered. Much of this monitoring will relate to examining autonomic (subcortical) arousal, and in order to remain OnT with this discussion, look for respiratory instability rather than scorable central or obstructive events per se (cause if it ain't an event, the field in general really doesn't care about it)(for that matter, neither does an APAP, except one that monitors VB). However, simple respiratory instability should be exactly what the VB Control Layer is looking for.

In general, what typically happens to pCO2 and VT during these transition states can be seen in

Image

Note how this phenomenon occurs within just a few breaths, so will avoid the minimum time criteria to mark them as respiratory events, bypass those Event Control Layers and end up in the VB Bucket (or that's the SAGpothesis, anyway).

A number of methodologies need to be examined to be able to figure out what will reliabily predict VB, because these variables may not be seen in all measures of autonomic activation (it may not be seen, for instance, in measuring R-R interval, but may be visible in PTT and/or PAT).
Browser wrote:SAG - I hate to be a jerk or anything but if you aren't going to contribute anything useful to this thread,why don't you start your own thread and you can carry on all you wish in it.

Thank You,
Mike
I apologize for wasting your time and will comply with your wishes.

Image

SAG
Gee Whiz SAG, why didn't you just get to the point in the first place? I don't expect VB to be brought up after my PSG tonight and although I plan to bring it up to the technician I doubt they will know what I am talking about - maybe I will be surprised? You are way more advanced than your average duck.
SAG can me solve this puzzle - say yes.
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MrSandman
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Riddle me this Batman

Post by MrSandman » Thu Dec 11, 2008 1:00 pm

Wow - so that was the "hidden" message? Way over my oxygen deprived head... Sorry if you feel that way SAG. I was just getting tired of my threads being taken in other directions. I really didn't realise that what you were posting was going to somehow relate to my VB% post. I guess you are one of those rare people who are so smart that you don't realise you are talking over the average person. Maybe I am just "that" stupid. I think I am going to call you the :

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dsm
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by dsm » Thu Dec 11, 2008 1:11 pm

-SWS wrote:Mike, I'm thinking this part of SAG's unfolding discussion is going to be worth exploring in relation to your highly unusual VB patterns:
above linked article wrote:The changes in the transcutaneous carbon dioxide tension (TcCO2) were defined for different breathing patterns. During prolonged spiking episodes the TcCO2 increased significantly and differed statistically from the TcCO2 changes of normal breathing and periodic breathing patterns (episodes of apnea and hypopnea). The rise in TcCO2 during prolonged spiking episodes might suggest that prolonged spiking is representing another type of breathing disturbance during sleep differing from periodic breathing patterns.
If you look at the late-2007 date of that article, you'll notice that it's virtually brand new research. The above finding potentially represents yet another newly discovered pathology or SDB phenotype. And if SAG is in the process of getting that kind of equipment set up in his lab to discern similar prolonged TcCO2 spiking patterns, this part of the discussion is unfortunately going to take a while to unfold. I'm also wondering about the above prolonged TcCO2 spikes possibly occurring in yet other potential cases of less-than-frank or "almost-PB-like" oscillations around here. Perhaps these TcCO2 findings may turn out to be relevant to OutaSync's, DSM's, Echo's, or even Frequen's somewhat atypical SDB cases.

Very shortly after CSDB was announced in 2005 as a third and altogether separate SDB phenotype (Harvard-based research by Gilmartin, et al), SAG's center was already diligently investigating and selectively incorporating certain elements among all new CSDB findings into their own diagnostic and treatment protocols. By contrast, well more than a couple years after that 2005 landmark finding, some sleep labs had yet to incorporate any CSDB findings into their diagnostic and treatment protocols.

Anyway, this facet of the discussion may take a while to unfold because it's virtually unexplored medical territory. And yet, by its very TcCO2 oscillatory nature, it may turn out to be uncannily central to you and those high VB patterns. But that's just my layperson's take.
SWS,

Very interesting line. CO2 imbalance/issues have certainly got my attention. Had another 'good' night on the Vpap SV - again seemingly shallow sleep but last night no arm wrestling with the machine. Up early & off down the road for exercise. That feeling of 'leadness/heavyness' not present, just alertness.

DSM
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dsm
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by dsm » Thu Dec 11, 2008 1:16 pm

1st question re TcCO2...

What is the significance of a rise in TcCO2 (carbon dioxide tension) in anyone ?

Is the point that it affects energy levels or fitness ?

Tks

DSM

I found this and some other refs that basically say that TcCO2 is the partial presence of CO2 in the blood ?
http://medical-dictionary.thefreedictio ... s+analysis
http://medical-dictionary.thefreedictio ... de+tension (def of carbon dioxide tension)
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MrSandman
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by MrSandman » Thu Dec 11, 2008 1:22 pm

DSM - The hospital had my last three studies and I asked about my weight and was surprised because I thought I weighed under 200 back then.

1988 - Got out of the marines - 160
1989 - Gained weight to 170 - Started waking up exhausted and having many other issues - Prescribed Elavil for depression/ocd(Gained 34 pounds in 6 months) Switched to Prozac
1990 - Called up for Desert Storm - 204
1990 - Back home - 184
1991 - 213 (AHI = 20)
1999 - 215 (AHI = 37)
2007 - 235 (AHI = 107) - This was from an non-certified lab,not this hospital
Last night - 250 (Don't know yet)

MUST LOSE WEIGHT !!!

I thought some people may find this timeline of interest...
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dsm
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by dsm » Thu Dec 11, 2008 1:39 pm

Browser,

This issue of weight loss & the ability to lose weight & the will to do it all seem tightly intertwined
with how CPAP therapy is going.

Prior to going on the Bipap Auto SV my weight was under 89 Kg, but on that machine I increasingly
liked sleeping as it seemed so much deeper & more restful, but I stopped my daily exercise. Have
just switched over to a Vpap Adapt SV, which always has me feeling like I am not in deep sleep &
often just lying there awake, but I am again able to with very little effort & the will get up
early & exercise. I prefer te Bipap Auto SV but the Vpap Adapt SV seems to provide better alertness
& energy levels ?.

Back to your data ...
I noticed a significant drop in weight after Desert Storm. Was that just a case of being in a hot
climate & losing weight - or life in the marines ?

DSM

#2 Also, what ever occured in 1989 is the primary clue - what caused the waking exhausted ?
It implies some sort of respiratory change !.
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MrSandman
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by MrSandman » Thu Dec 11, 2008 2:55 pm

Well DSM - The weight loss was due to the Marines trying to whip me back into shape and doing a pretty good job of it. I really didn't think they would want me back since I was on Prozac but they treated that more like me trying to get out of doing my duty. I showed up. Many didn't. But they didn't want to know about my condition. I took a nice supply of Prozac with me and was feeling pretty good back then.

I got married in 1989 a couple months after all this crap started. I attributed it to sleeping with another person for a change. I just didn't know what was going on. I was gaining a little weight and my allergies were really bad here compared to California. I also had a deviated septum and a growth that filled my entire sinus eventually and had several surgeries to remove this growth and correct the septum.

So what changed:
1) Slowly gaining weight
2) Allergies got very severe
3) Sleeping with 2nd person in bed(Wife)
4) Inverted papilloma growing in my sinus and deviated septum(Eventually right nostril totally blocked)Constant sinus infections during this period and antibiotics.
5) Began waking feeling worse than when I didn't sleep
6) Migraines and fibromyalgia
7) Intrusive unwanted thoughts / excessive worry / depression / breakdown
Worked and went to school full-time and only missed one day of work somehow - drugged myself to sleep every night(Elavil) - Sleeptalked - sleepwalked - had episodes of sleep paralysis(scarey!) - Saw things that weren't there - I attributed all of these strange things to the Elavil. Was probably Elavil and apnea.

I WANT MY LIFE BACK !!!!!!!!!
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dsm
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Re: DISCUSSION ON HIGH VB% on Encore Analyzer

Post by dsm » Thu Dec 11, 2008 3:30 pm

Browser

There are some points you raise that I can empathize with ...
- had my nose operated on at age 14 (deviated septum sounds familiar as the reason)
- always had sinus difficulties & nasal troubles

Getting anxious etc: seems to me to be a natural follow on to respiratory problems (such as untreated OSA).

If you were reasonably normal as a kid ('normal' can be hard to define ), then any later emotional / anxieties
/ depressions etc: can possibly be respiratory related. I believe respiration can be messed up in two main ways
- external influencers (like environment: pollution, climate, nasal defects)
- internal influencers (like emotional health: abusive childhood, 'double-bind' stress, stressful relationship(s), etc: )

Further to the internal influencers, Kids learn to cope with fear & stress by holding their breaths or manipulating
their breathing. Reducing respiration minimizes/reduces the fight/flight triggers that may be presented in bad
life situations. This manipulation usually caries on into adult life.

But there usually seems to be a balance of physical as well as internal factors - rarely just one or the other.

DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)