Events are on the increase.

talk to doc:

http://www.ncbi.nlm.nih.gov/pubmed/21206741

or ASV

Gillian wrote:Sorry Deltadave but I'm not familiar with what you are talking about, I only have basic skills. Not too bad at following instructions though if you want to explain further.

Load the SD card into your computer and find these files:



Put them in a folder and upload them to a document server (Google Docs, Dropbox, etc.). You'll get a link to access those files.

I think breath-by-breath analysis is necessary, but it certainly sounds like you need to be on the fast track to ASV.

Can you get the new CS-2 there?

I give up on this case

ditto

very sorry to hear about the RA. I have family members with it and i know how painful it is. Everyone is my family - but me - has/had a serious autoimmune illness ( MS, RA, Crohn's, Psoriatic Arthritis, vasculitis). I just have run of mill severe hip osteoarthritis and that is enough to cause intolerable pain most days ( luckily my doctors are all very tough and stoic about tolerating MY pain so i don't have any reasonable pain killers). NSAIDS work about as well as M & Ms in killing the pain

I was wondering if your doctors have considered an ASV machine given your centrals

Also, maybe this will help:

J Clin Sleep Med. 2009 Feb 15;5(1):63-4.
Acetazolamide as an adjunct to CPAP treatment: a case of complex sleep apnea in a patient on long-acting opioid therapy.
Glidewell RN, Orr WC, Imes N.

Abstract
A 41-year-old white woman on long-acting opioid therapy was diagnosed with moderate obstructive sleep apnea. On initiation of continuous positive airway pressure (CPAP), she manifested severe central apnea that was unresponsive to supplemental oxygen and interfered with CPAP titration. Acetazolamide, 250 mg, nightly at bedtime was initiated, and CPAP titration was repeated. On acetazolamide, optimal CPAP pressure was obtained with no manifestation of clinically significant central respiratory disturbance. This case suggests that acetazolamide may be an effective adjunct to positive airway pressure therapy in patients on long-acting opioids. A need exists for examination of acetazolamide in this capacity

Thanks Todzo for the link. I am trying to get an earlier appt (now march) with sleep doc.

Deltadave, thanks for the instructions. If I can't do it, my husband will be able to when he gets home. What do I then do with the files? Just post them here? With respect to the CS -2 I will do some research. My sleep doc initially wasn't keen on what he called the hellish expensive machines with no proof they work. Obviously I had no idea at the time but now realise that I have to dig deeper.

Thanks Johnthomasmacdonald for your comments. My sister and I both got RA relatively young. She died at 59 from liver cancer associated with her treatment. Encouraging. The opioids though I take for Complex Regional Pain Syndrome. (similar to the pain felt by amputees in the lost limb). I did read about ACetazolamide and made a note to discuss with the doc. I'll read up some more, thanks for putting me on to it.

Avi123. I replied to you in the other thread.

Thanks again everyone.

Gillian wrote:Deltadave, thanks for the instructions. If I can't do it, my husband will be able to when he gets home. What do I then do with the files? Just post them here? With respect to the CS -2 I will do some research. My sleep doc initially wasn't keen on what he called the hellish expensive machines with no proof they work. Obviously I had no idea at the time but now realise that I have to dig deeper.

Or just PM the link to those you wish to view your material. Sometimes folks don't want to get too public with their stuff, and I understand that.

Taringa reminds me that your (Aust) version of ASV is also called VPAP Adapt. Perhaps the question to ask would be:

Does this thing have the new PaceWave technology?

http://www.resmed.com/au/products/asv_b ... clinicians

That said, your sleep doc's point is well-taken. ASV machines are over-prescribed by people who have NFI how they work. And in your case, it may not, so IIWY I'd be sure to either get this on a trial basis and/or get an in-lab titration.

Specifically, if you're having chain centrals you're going to be the Poster Girl for ASV. If you're having respiratory depression, then perhaps an ST machine would be a much better fit (and we can still use new stuff, like the ResMed iVAPS option: http://www.resmed.com/au/products/s9_vp ... clinicians).

Depends what your Minute Ventilation is doing.

BTW you might want to plant the seed of monitoring your ETCO2 when/if you go back for re-titration.

A review of the data does not appear to show hypoventilation, so an ASV approach should reap some significant benefit.

That said (I've taken to saying "that said" a lot. Blame -SWS), one should have a good idea just what one should be fixing here.

I believe all the events are central in nature. While the machine is probably correctly identifying obstructive events (indicated by the absence of ballistocardiographic artifact-- more on that later), they would better be better described as "closed airway centrals". The short cycle pattern (~60/minute) and apnea length (~15 seconds) implies no circulatory delay. Respiratory rate and depth are irregular, apparently from opiate effect.

But is the irregularity toxic? Do the events cause desaturations and/or arousals? The lack of compensatory response following events seem to imply that the events could be benign (and you're simply "breathing funny" because of the opiates), thus raising the question "Sure it looks bad, but does this need to be fixed?" Going one step further, do you even need to be on CPAP at all? Was CPAP initiated because of irregular breathing?

However, since VPAP Adapt is minute ventilation-based, it should smooth this right out:

Hi
Thanks for looking at the data. The initial tests were done due to my husband hearing all the gasping and choking at night. Also fatigue etc which up til then had been put down to RA , CRPS and fibromyalgia. Home sleep study showed severe apnea (A+H 54.6 with centrals 16.6 and mixed 3, OA 10.6, H 24.4) OD events were 64.7/h. After the 6 week trial, OA came down but not centrals. I have never seen any breathing graphs before now so irregular breathing has never been mentioned before. Sleep doc believed that even though no real change in fatigue side of things, OAs decreasing was a good reason to stay on CPAP and see him in 6 months (march).

I feel a lot better knowing that you don't think anything too bad is going on. However, do you think I should be asking for further testing to check breathing? Possible ASV?

Thanks so much for what you have done so far, you have relieved my mind immensely. There is nothing worse than not knowing.
Have a good night
Gillian

Gillian wrote:However, do you think I should be asking for further testing to check breathing? Possible ASV?

Absolutely to both. If those events are causing arousals and/or desaturations, a few of those nights are darn near as bad as pre-CPAP.

However, it would seem that ASV will fix everything in short order.

See if you can get a hold of an oximeter and do an overnight data collection.

Hi Deltadave
I have an overnight oximetry booked for March, just before I sleep the sleep doc. I'll try and move that appointment forward tomorrow.

Thank you so much again. I feel far more relaxed about all this now that you have looked at my data.

I'm let you know what happens. Have a great Christmas/holiday period.

Gillian

Gillian wrote:I'll try and move that appointment forward tomorrow.

Excellent. We may also be able to glean arousal information from the heart rate in the download, microanalyzing "R-R Interval".

I feel far more relaxed about all this now that you have looked at my data.

Too early to be "relaxed", but you should be "confident" that answers will be uncovered shortly.

Have a great Christmas/holiday period.

Maybe next year.

Hi
Earliest appointment 13 Feb, better than end of March anyway.

We are going away in our caravan for a while, good weather at this time of year.

I'll be posting again after Feb13!


Thanks so much
Gillian

Gillian wrote:Earliest appointment 13 Feb, better than end of March anyway.

For an oximetry? That's unacceptable!

Oh well, seems like so many things these days are beyond one's control.

If I don't see you again, good luck!