Just had new sleep study

And after loosing around 75lbs since the last one last year guess what? I need more pressure and am being put on a Resmed Vpap Auto 25. IP of max 18, EP of min 10.

I called Dr. Krakow's clinic and got in there Monday nite and had a study. I've known since '98 that I had central apneas but no one has treated them. My sleep has gone to hell, and I figured it was because there was less of me that needed inflated....wrong.

Also going to the SwiftFX full face mask. I even shaved my beard off at 3:00 in the morning to try and get the full face mask to work for me. The last 2.5 hours of sleep were the best I've had in a long time.

I'll post more on this when I know more.


JeffH

Hey Jeff,
Congratulations on getting that good sleep. Dr. Krakow is a firm believer in high pressure and bi-level - titrating out all flow limitations. I'm glad his approach is good for you!
O.

JeffH wrote:And after loosing around 75lbs since the last one last year guess what? I need more pressure and am being put on a Resmed Vpap Auto 25. IP of max 18, EP of min 10.

I called Dr. Krakow's clinic and got in there Monday nite and had a study. I've known since '98 that I had central apneas but no one has treated them. My sleep has gone to hell, and I figured it was because there was less of me that needed inflated....wrong.

Also going to the SwiftFX full face mask. I even shaved my beard off at 3:00 in the morning to try and get the full face mask to work for me. The last 2.5 hours of sleep were the best I've had in a long time.

I'll post more on this when I know more.


JeffH

OoooooooK.
Seems like a contradiction to me that treating Centrals requires a pressure that high. But, whatever.......

Be sure you get a copy of your sleep study.

Good luck.

Den

Hope you get good sleep, Jeff.

And yes...as Den suggested... please do get a copy of the entire report of your sleep study...not just a one page summary. The graphs and charts would be very interesting to see if you'd be willing to post them here on cpaptalk.

Thanks so much for the update!

Wulfman wrote:

OoooooooK.
Seems like a contradiction to me that treating Centrals requires a pressure that high. But, whatever.......

Be sure you get a copy of your sleep study.

Good luck.

Den

Not if they're post arousal central apneas, and the arousals were caused by flow limitations.

Additionally, you can see Jeff is now on 2 cms less for every exhale (he had fixed 12 previously), and was given a pretty big difference between IPAP and EPAP - another thing typical of Dr. Krakow's approach.

Jeff, you wrote this in a previous post:

JeffH wrote:Over the last month I haven't slept worth a damn. Lots of insomnia or really short nights of sleep. Last nite I didn't sleep a wink. Got to thinking about this this morning (that's all I do is think about this...LOL) and realized that I have been getting those pesky "burst of air" in my mouth that are waking me up. I also have lots of belly pain that messes with my sleep.

Those pesky air bursts are what started happening to me after I lost weight. Did the new setting eliminate those pesky air bursts?
I'm nou sure I undersood the mask switch, was that from a Swift to a FFM?
Thank you,
O.

My mistake on the mask. It is the Quatro FX not Swift FX.

I don't have the machine yet and yes I saw on the sleep study software the next morning that the centrals were before arousals and they caused arousals.

JeffH

JeffH wrote:My mistake on the mask. It is the Quatro FX not Swift FX.

Thank you.

I don't have the machine yet and yes I saw on the sleep study software the next morning that the centrals were before arousals and they caused arousals.

JeffH

That's going to be very interesting. Please let us know what they tell you about those central apneas. Will you bee needing an S/T mode on the machine, or did they solve it with plain bi-level?

O.

I'm not sure, but I don't think any autotitrating bilevel machine from any of the manufacturers would offer timed backup capability. I think "timed" is available only in some bilevel machines that don't have an autotitrating feature.

VPAP™ Auto 25
http://www.resmed.com/us/assets/documen ... er_eng.pdf
Doesn't mention anything about "timed" being a feature.


The one made by ResMed with timed BPM (breaths per minute) capability is this one:

VPAP™ III ST-A
http://www.resmed.com/us/assets/documen ... er_eng.pdf

Will be very interesting to see the entire sleep study report.

Hi,
I read about those pesky burst of air that wake you up. This sounds like what is happening to me. I had a sleep study done 1 year ago but no central sleep apnea, but I think I do, why is it hard to detect central sleep apnea? what should I do?
thanks

If you get an ASV machine don't get the VPAP III ST A- the A stands for alarms and with the alarm feature it does not give AI, or AHI. AT least in units for the USA. Found out by disappointing personal experience. The doc ordered it because it's the only machine that goes to a pressure of 30, not to use the back up rate. Turns out I couldn't ( or rather my mask couldn't) handle a presssure that high so it was a unhappy experience to not be able to tell if higher pressures were working.

77Godspeed accidentally guested wrote:Hi,
I read about those pesky burst of air that wake you up. This sounds like what is happening to me.

77Godspeed, I went back to look at some of your previous posts when you were logged in with your registered name.

The "pesky airbursts" Jeff and ozij are talking about, and that you described in your previous post:
viewtopic.php?p=571655#p571655
Those are from CPAP air detouring into the mouth instead of being breathed straight down. A detour coming in from the back of the mouth because the tongue is not maintaining an airtight seal inside the mouth. That has nothing to do with whether a person has central apneas or not.

77Godspeed accidentally guested wrote:I had a sleep study done 1 year ago but no central sleep apnea, but I think I do

If the sleep study was a full PSG study in a sleep lab with a sleep tech in attendance, and the study didn't note central apneas or even if just a few showed up on it, you can be quite sure you don't have Central Sleep Apnea. If the titration phase of the sleep study (when CPAP was being used on you in the study) did not show a great number of central apneas popping up...again, you can be quite sure you don't have a problem with central apneas.

77Godspeed accidentally guested wrote:why is it hard to detect central sleep apnea?

It's not hard at all to detect central sleep apnea and central apneas during a sleep study. It's very easy for a PSG sleep study to detect central apneas. If your diagnostic/titration sleep study said central apneas weren't happening, or weren't happening in numbers more than a few, they didn't miss detecting them. You simply don't have them.

77Godspeed accidentally guested wrote:what should I do?

I'd say, keep using your CPAP and keep digging into this message board to find ways to make using it more comfortable. If you have problems using the machine or mask, or are not feeling better, you might want to start a new topic describing your problems. There are many people on here who will try to help you.

Jeff, hope you now have many uninterrupted sleeps.
Cheers
Nan

Jeff, I'd like to hear more of your experience at Dr. Krakow's sleep center. Do you live in Albequerque? I am contemplating getting a second opinion there for fine tuning UARS treatment but I would be coming there from Colorado.

And for anyone who wishes to respond:
I have listened to his interview with Dr. Parks and have read quite a lot on cpaptalk about uars and flows (a lot of which I don't understand). I was about to post a question about whether or not one can "titrate" pressures at home in order to correct flow from observation of the Resmed flow charts. It doesn't sound like a "do it yourself" project. Dr. K said that he would not rely on the flow graphs to ascertain that the pressures are adequate. This is all for treating UARS, AHI is not an issue.

The other thing I am concerned about if I go there is that I might be sent home with pressures that my tummy couldn't tolerate (aerophagia). Right now I am at a "self titrated" pressure of 7.8 with EPR of 2 and doing better. A pressure of 9 got me pretty gassed up.

Another related question: I just started using a "boil and bite" mouthguard and am pretty astounded at how it seems to really seal leaks at the base of my tongue. Would that alone prevent the aerophagia?

Any and all comments would be appreciated!

Bright Choice wrote:Another related question: I just started using a "boil and bite" mouthguard and am pretty astounded at how it seems to really seal leaks at the base of my tongue. Would that alone prevent the aerophagia?

Might. You could find out pretty quickly if you'll crank the pressure up again.

The boil'n'bite alone won't prevent aerophagia, however, if the reason you get aerophagia is from cpap air that's going straight down (as it should) but is also pushing past the esophageal sphincters. And those could be damaged/weakened by years of untreated or undertreated acid reflux. GERD or acid reflux seems to be pretty common in people with OSA. And there's such a thing as "Silent GERD" in people who don't have any of the usual symptoms of "acid reflux."

http://www.sciencedaily.com/releases/20 ... 080008.htm

"These are patients without significant heartburn symptoms, who are experiencing acid reflux during sleep," explained William C. Orr, Ph.D. of Lynn Health Science Institute in Oklahoma City, OK. "'Silent reflux' may be the cause of sleep disturbances in patients with unexplained sleep disorders."

"All patients with sleep apnea should be evaluated for gastroesophageal reflux," said J. Barry O'Connor, M.D., of Duke University Medical Center, one of the investigators.

_________________________________


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576329/

Aerophagia and Gastroesophageal Reflux Disease in Patients using Continuous Positive Airway Pressure: A Preliminary Observation
Nathaniel F. Watson, M.D.1 and Sue K. Mystkowski, M.D.2
1Department of Neurology, University of Washington, Seattle, WA
2Department of Medicine, Division of Pulmonary and Critical Care, University of Washington, Seattle, WA

Conclusions:
These results imply aerophagia is associated with GERD symptoms and GERD related medication use. This finding suggests a relationship between GERD related LES pathophysiology and the development of aerophagia in patients with SDB treated with CPAP.

________________________________


The Signs and Symptoms of Silent Acid Reflux
http://acidrefluxdefeated.com/the-signs ... id-reflux/

silent acid reflux can also cause choking, coughing, and other throat related issues. Although commonly referred to as silent reflux, the actual term for this particular form of acid reflux is Laryngopahryngeal reflux (LPR).

What is LPR? Laryngopharyngeal reflux is similar to gastroesophageal reflux disease (GERD) in that it occurs when the lower esophagealsphincter (LES) weakens and opens, allowing acid to reflux into the esophagus. However, the main difference is that the primary symptom of GERD is heartburn, while the primary symptoms of LPR typically occur in the throat.

Most people are aware that acid reflux usually occurs when the LES,the lower sphincter in the esophagus located between the esophagus and stomach, malfunctions. However, what is not as commonly known is the esophagus actually has another sphincter called the upper esophageal sphincter (UES). The UES is located where the esophagus meets the throat. When both the LES and UES fail, silent acid reflux is the result.

What is the difference between LPR and GERD? As was previously mentioned, LPR results when stomach acid makes it past both of your sphincters and pools in your throat, or reaches your mouth or the back of your nose. GERD is when acid makes it past the LES and remains in the chest and does not pass through the UES.

The most common symptom of GERD is heartburn, which occurs after a person has experienced repeat episodes of reflux, and the acid has burned away the protective lining that coats the esophagus.Although some LPR sufferers experience heartburn, this isn’t a common symptom, because the refluxed digestive juices do not remain in the esophagus long enough to cause damage. This is often why LPR is referred to as silent acid reflux, because most people don’t associate the symptoms they experience from laryngopharyngeal reflux with acid reflux.

What are the symptoms of LPR? Symptoms almost always occur in the throat and are usually felt because, unlike the esophagus, there is no protective lining in the throat.

Common symptoms that may be experienced include:

o Chronic cough

o Asthma-like symptoms

o Regurgitation

o Sour or bitter flavor in the mouth

o Frequent need to clear the throat

o Consistent mucous in the throat

o Burning sensation or pain in the throat

o Sore throat

o Hoarseness and possible loss of voice

o Difficulty swallowing

o Post-nasal drip

o Pain in the ear and/or consistent ear infections

o Nausea

o Heartburn

A silent acid reflux sufferer may experience some or all of these symptoms.

Bright Choice wrote:Jeff, I'd like to hear more of your experience at Dr. Krakow's sleep center. Do you live in Albequerque? I am contemplating getting a second opinion there for fine tuning UARS treatment but I would be coming there from Colorado.

No, I live in Oklahoma. I just called them up and asked if they took Medicare and they did. Got in in about 10 days from the first call. Sleep tech I had was great...a guy named Gabe. He worked with me thru the nite to help me finally get some good sleep. I was surprised that I needed as much pressure as I ended up with, but going from nasal pillows to a full face mask makes the extra pressure more tolerable. Tonight will be my first night on this machine. I still don't have my Quattro FX mask, I'm going to use my GF's FFM. Hopefully this is my first night of good sleep with my centrals controlled in a long time.

And for anyone who wishes to respond:
I have listened to his interview with Dr. Parks and have read quite a lot on cpaptalk about uars and flows (a lot of which I don't understand). I was about to post a question about whether or not one can "titrate" pressures at home in order to correct flow from observation of the Resmed flow charts. It doesn't sound like a "do it yourself" project. Dr. K said that he would not rely on the flow graphs to ascertain that the pressures are adequate. This is all for treating UARS, AHI is not an issue.

The other thing I am concerned about if I go there is that I might be sent home with pressures that my tummy couldn't tolerate (aerophagia). Right now I am at a "self titrated" pressure of 7.8 with EPR of 2 and doing better. A pressure of 9 got me pretty gassed up.

Dr. Krakow isn't a big fan of the software we all use. He said it's best use is to check for leaks. I think he's probably right because I was showing a really low AHI, but was having a ton of central apneas that of course didn't show up on ResScan or Encore Pro. Hooked up to all the crazy wires that they use in a real sleep study tell them so much more that what we are getting from our software. I'll never "trust" it as much again.

Another related question: I just started using a "boil and bite" mouthguard and am pretty astounded at how it seems to really seal leaks at the base of my tongue. Would that alone prevent the aerophagia?

I was getting this a higher pressures with nasal pillows, but a change to a full face mask made the higher pressures more tolerable.

Any and all comments would be appreciated!

I'd say go for it. He's a nice, caring doctor with a good staff. Also, he doesn't prescript straight cpap to anyone. It's Bipap or greater to all his patients.