jnk wrote:If you are seriously considering that, the following beautifully-worded post by -SWS might be the one I might choose to print out to show my doc, since, in my opinion, it contains the most pertinent information:
-SWS wrote:tvmangum wrote:I am wondering if this has something to do with my heart defect. In case I've never mentioned it, I have a congenital heart defect (bicuspid aortic valve), left bundle branch block and aortic insufficiency. BTW, my "sleep doc" is a cardiologist within the local cardiology practice that I go to. It was my cardiologist at Duke that pushed me to get the original titration study pushed up several weeks to get the benefits of CPAP.
It does appear that the spikes do sometimes occur in cycles.
What I have highlighted in red above can cause episodic spikes in central dysregulation. If that's what's happening, then you may actually be experiencing central apneas and/or periodic breathing on those nights when your home-measured AHI happens to spike. And if a central problem of that nature happens to be inherently episodic (even episodic as a matter of progressive/transitional heart disease) then that issue may not have conveniently manifested during your PSG.
If that's really what's happening in your case, then an ordinary CPAP or APAP machine may not be the best machine for you. You may be better off with one of the adaptive/auto servo ventilation type machines.
{note from RG...I snipped the URL -- leaving it in kept giving me an Internal Server Error when I try to "submit" my post}
Above Resmedica article wrote: Patients in advanced stage of left heart insufficiency frequently have central disturbances of respiratory regulation during sleep.
Please don't interpret that as a scare tactic from me. Only to say that your suspicions may be warranted. Perhaps you have episodic central dysregulation because of that congenital left heart insufficiency.
What jnk suggested several posts back -- printing out that particular post of -SWS's -- to discuss with the cardiologist/sleep doctor, is close to what I'd do if I were tvmangum.
jnk brought out a very good point about doctors and "
Someone on the internet said..." coming out of the mouth of a patient. That can be such a turn off to some doctors that their mind closes and all they can think about is shooting down whatever you're bringing up, and admonishing you about trying to get medical information off the internet.
I think that instead of handing him -SWS's post right away, I'd first hand him a printout of the ResMed article -SWS linked to in his post. After the doctor reads the ResMed article, try a few questions. Keep the -SWS post in reserve, as a last resort to pull out if (at the end of the conversation) the doctor doesn't think there's any benefit in at least
trying an SV (adaptive servo ventilator) type of machine with you.
With a little bit of luck, and a bit of preparation by you,
tvmangum, the doctor may "get it" at your first mention of the possibility of "
episodic central dysregulation" related to your heart problem.
What you'll be trying to convey to the doctor is this (as I understand it...my very limited understanding, at best!) --
"Could my heart problem be causing random episodes of central dysregulation in my breathing during sleep? Episodes of central apneas and hypopneas that don't happen every night, and may not have happened on the night of my sleep study?"
If you hear a "That's possible..." from the doctor, then proceed...
"Since the autopap can't recognize centrals and might be marking those episodes as obstructives, could that possibly account for the huge spikes in my AHI on some nights during this autopap trial, but not on other nights?"
Hopefully, you get another, "That's possible..."
Then try this:
"In case centrals are happening episodically, would a trial with a machine that can handle both obstructive events and central events...an adaptive servo ventilator, like the ResMed VPAP SV be possible?"
-SWS wrote:Rested Gal, maybe you can rescue your verbose friend once again with a summary/explanation that is easier for newcomers to digest?
You give me
much more credit than I deserve. Plain vanilla, garden variety OSA in an otherwise healthy individual is about all I can barely put my mind around. And you know me...sock it by raising the minimum pressure if that's all it is!
I do understand this much...that if tvmangum's problem
is episodic central dysregulation in nature, it's a moving target indeed, and no amount of pressure tweaking with regular cpap, autopap, bipap would help. Hope his doctor will give serious consideration to that possibility. If central dysregulation is not the problem, then jnk's suggestion and mine (until we saw the insightful "what if" that -SWS wisely raised) of using a higher minimum pressure with the autopap would be good to try.
But, as -SWS said, if episodic central dysregulation due to the heart problem
is the
underlying cause of random
episodes (some nights they happen, some nights they don't) of AHI spikes with autopap, trying to get rid of those with more minimum pressure isn't really going to get anywhere. Too much of a moving target, and a target (centrals) that autopaps are not designed to deal with anyway. SV machines are the ticket for that.
