Data shows increase in activity

Hi, all. It’s been awhile since I've been on the forum. Hope you’re doing well with your therapy and with life in general.

I was doing quite well with my therapy for a long time, but this has been a rough year for me, medically. Among other things, my data went a little awry (and I felt it) a few months ago. Told my PCP about it, as I haven’t had a sleep doc in years, and she insisted that I have another sleep study. As it’d been four years since my last, I acquiesced and said okay. My data had not indicated (to my eyes, anyway) that I needed to change my settings. But why my data suddenly indicated more activity was a mystery to me, and I figured they get more detailed info during a study. So I had the sleep study done in July, hoping they'd find something I had missed. They recommended that I change my settings to accommodate higher pressures, which I did, and my therapy’s been good again since then.

Fast-forward to now. One of my medical maladies required surgery just over two weeks ago. My therapy’s been off since, and I’m having to nap frequently. I’m sleeping about the same amount as I usually do (some nights more), so it’s not for lack of sleep that I'm experiencing daytime sleepiness. My usual (good therapy) data shows a normal AHI of under 2 every night, no periodic breathing, and almost 100% patient-triggered breaths. Since my surgery, my AHI can be anywhere under 10, there's lots more PB, and my patient-triggered breaths are down.

If you asked me how I’m sleeping and I had no data to review, I’d think I was sleeping pretty well for what I’ve gone through recently. As far as I know, the pain isn’t keeping me awake or making me restless. But the data shows how many more events I’m having (mostly hypopneas, but also CAs and OAs and periodic breathing), and the % of patient-triggered breaths has declined. The leaks are good, so I know it’s not that. I also don't seem to be hitting the ceiling on my IPAP pressure, so I don't think an adjustment is warranted. (But that's what I thought before my recent sleep study, too; I never saw data indicating that I approached the previous IPAP ceiling, either, but my data indicated that I was back to normal sleep with the new higher settings.) I’m waking often in the morning with dry mouth, but I'm still wearing the Hybrid, so I’m not losing therapy air via mouth-breathing; I’m just uncomfortably dry.

I’m not sure what, if anything, I can/should do to improve my sleep while I recover from the surgery. My new settings (EPAP 10-17, IPAP 10-25, PS 0-15) seem to be adequate, but maybe more oxygen would be a benefit? I use an O2 concentrator with my ASV at 1L per minute (prescribed a years ago). I don’t know if upping the setting (it can go from 1-5 LPM) would help alleviate the sudden uptick in events and/or the frequency in my periodic breathing. If I don’t change the settings or the amount of O2 I’m getting, what else might I change?

Perhaps I should leave everything alone, nap as needed, and just wait until my body has recovered more from the surgery? I don’t like having to nap, but I can when I need to, so it’s not imperative that I do something to solve the current problem. I just hate being tired during the day and seeing this awful data. Napping has been a luxury for me, and now it’s a necessity. I hope it’s only temporary.

I’m putting this out there to see what others think. Here's the data from a couple of typical nights lately:





Opinions/thoughts/ideas? TIA

FYI, I deleted the other identical post. My pc is acting up this afternoon.

I don't know what pain medications your taking but when I had a knee implant put in my left knee Sept. 9th my pain medications caused a jump in my AHI. When I came off of the pain medication it came back to where it should be before my surgery.

squid13 wrote:I don't know what pain medications your taking but when I had a knee implant put in my left knee Sept. 9th my pain medications caused a jump in my AHI. When I came off of the pain medication it came back to where it should be before my surgery.

Thanks for pointing that out, Squid. Soon after the surgery, I thought the pain med I'd been prescribed (generic oxy) was probably the culprit early on, and I stopped taking it. It's now two weeks later, so the meds aren't responsible for my continuing crummy data. I wish it was that simple.

Thanks.

P.S. I don't know why my equipment isn't showing up in my post; I checked my profile, and it's in there. I made sure to "Submit" it again, so I guess it's a glitch. *shrug* In any event, I'm using the ASV from Respironics (the 950, I believe it is) with an F&P humidifier and the Hybrid mask.

ETA: Strange, but after I posted this, my equipment appeared. *shrug*

I don't know a lot about bipaps but I do know about surgery! You do need to just let your body recovery. If it means napping for awhile, my advice is to listen to your body.

What type of anesthetic did you have? If it was general, then napping is quite normal. That can be the hardest part of the surgery. The stress on your body, from the surgery, can also tire you out a lot.

You have seen your doctor so I would suggest, from my experience with surgeries, to just take the time to let your body recover.

Since you can nap, I think you should. It always took me months to get over the anesthetic. The surgery took 6 - 8 weeks to recover from.

All the best and take it easy!

Hi. Good to "see" you again, but sorry to hear you are going through some health issues. I'll let those who know the ASV respond to treatment issues. Just mentioning that any time I've had general anesthesia the lethargy lingered for weeks. Felt like I was trudging through deep mud just do my daily routine. Not sure what kind of anesthesia you had. Hope your symptoms are transient and your recovery swift.

BB,
I also had surgery fairly recently. Endoscopic gall bladder removal. There were only three tiny incisions but the abdominal discomfort from being inflated like a balloon during the procedure caused me severe pain afterwards. I was unable to take a deep breath and had perilously low O2 levels. I know my sleep was poor but I don't have any data to confirm details. Lasted quite awhile.

Here's a thought: Did your surgery cause you to change sleep positions...which we all know can effect OSA.

And regarding your O2 usage. Patients with severe COPD should be careful about using a level above 2L unless carefully monitored. But if you aren't in that category, bumping up your O2 could help smoothing over the increased apneas thus minimizing desats.

Good luck and hope you're back to normal soon,
Jamis

BleepingBeauty wrote: P.S. I don't know why my equipment isn't showing up in my post; I checked my profile, and it's in there.

The links to equipment that cpap.com no longer sells seem to be broken and that's why your PR S1 950 doesn't show up. Only the links for the 960 in your model line shows up. At first this was more of a sporadic issue but now it seems to be very wide spread.
I haven't seen a link to any discontinued (no longer sold) product be active in quite a while.
Not long ago I had someone point out to me that my Tap Pap was not showing up...and it was because I was linking to the first product sold and not the most recent Tap Pap model. You are probably going to have to add it to your comments section if you want it to show up. I don't think the absence is temporary.

On another note. Good to see you here again. You've been missed. You know I don't do much ASV report stuff because we have John and SWS to field those issues but I am more inclined to just say give things a bit more time for you to heal up from the surgery.
I know when I had my broken wrist and that surgery my reports were whacko for a lot longer than I ever took the pain pills. I always figured I would just blame trying to sleep with my arm in that cast along with the discomfort from the stabbing pins that would poke me out of the blue. They hurt like a SOB.

2 weeks really isn't very long when it comes to surgery and anesthesia and the body needing to heal and regroup.
Looking at the clusters though...makes me wonder if sleeping position is maybe a small factor. Any change along those lines that you can think of?

Edit: I see Jamis was wondering about sleeping position also.

*Waving hello* to Hawthorne and Kathy. Been a long time, and I'm glad to "see" you both, too.

It's interesting that both of you mention the anesthesia. I was under general anesthesia for about three hours, give or take. In the past when I've had general (years before I was diagnosed and began xPAP treatment), I remember feeling tired for awhile after the surgery. Just thought I was sensitive to the anesthesia back then. The reason I'm questioning its influence this time is two-fold: 1, way back when, I didn't have machine data and had no idea that I might be sleeping poorly, and 2, my mother (who was a nurse for some years) says the cause of my fatigue two weeks after surgery can't still be from the anesthesia. (And at the age of 56, I've finally learned not to argue with her. )

I guess I'll leave my settings and the O2 alone and just wait it out. Hope it's not much longer before I feel like me again.

Thanks for your posts.

Jamis and Pugsy, thanks. Sleep position might be an obvious culprit in many (if not in most) cases, but not this time. I'm a bad girl, as I've been sleeping on my back (almost exclusively) since I started therapy almost six years ago.

Jamis, sorry to hear you had to have surgery recently, too. Mine was abdominal, as well, so I know the pain you speak of re: the gas they use to inflate the belly during surgery. I didn't have trouble breathing (even deep breathing) afterwards, thankfully, but the pain from the gas was real. Took a few days for it to dissipate, finally. I may try a higher concentration of the O2, as I don't have COPD or any other respiratory problems. Thanks.

Pugsy, thanks for the info on the broken links. I may have to put the equipment in my signature. Good to know. Sorry about your wrist surgery; I've had both of my shoulders operated on in the past few years, and I suffered poor sleep after each of them; but they were short surgeries, and I didn't blame my poor sleep on the anesthesia either time. I didn't have a cast, but lots of packing and a sling I had to wear 24/7 for weeks, not to mention pain. This recent surgery has been a bit better, pain-wise, and I've been able to sleep in my bed in relative comfort since the day after, when I came home. (Before the surgery, I'd set up my back-up machine and bedding in the livingroom, just in case I couldn't sleep in bed. I utilized my back-up machine after each of the shoulders were done.)

The biggest problem for me pain-wise has been getting in and out of bed, but the pain has lessened every day. The general fatigue and the crappy data just annoys me.

You may want to get a recording pulse oximeter to add to your arsenal. That way you will know if our O2 is down and compare it to your other data.
Sorry I can't help much with ASV. I am in my first week with my new machine and still figuring out which way is up myself.

Have had some excellent help from RobySue and Pugsy will know what I am doing in a fraction of the time it took when I first got my S9 Autoset.

bwexler wrote:You may want to get a recording pulse oximeter to add to your arsenal. That way you will know if our O2 is down and compare it to your other data.
Sorry I can't help much with ASV. I am in my first week with my new machine and still figuring out which way is up myself.

Have had some excellent help from RobySue and Pugsy will know what I am doing in a fraction of the time it took when I first got my S9 Autoset.

Thanks. Good suggestion. I actually have a recording pulse oximeter, but it was a bit temperamental the last time I used it, so I kinda packed it away. May dig it out, though, and see what it tells me.

Hi BB, good to see you but sorry you're having these medical issues. It sounds like the after effects of surgery and hopefully things will get better soon. As for the O2, when Mike was started on it at 2L I asked the Dr if he could just use 1L to start with and he said (I'm paraphrasing), "with 1L you might as well not bother, it will have no effect". In his case he was diagnosed with occasional Afib and since using 02 since March 2012 he's had no episodes. You might want to check with your Dr to be sure. Keep us posted, wishing you well.

Hey BB!!

Thanks for the update. You've gotten a lot of good input so I'll just add that I agree with what everyone else is saying.

Wishing you a speedy recovery and hoping your sleep comes around sooner rather than later.

Keep the board posted, k?

You've been missed here.

BleepingBeauty wrote:... They recommended that I change my settings to accommodate higher pressures, which I did, and my therapy’s been good again since then.

Fast-forward to now. One of my medical maladies required surgery just over two weeks ago. My therapy’s been off since ...
...
Perhaps I should leave everything alone, nap as needed, and just wait until my body has recovered more from the surgery? ...

Sorry I did not see this sooner. I've had some issues that are slowing my ability to read and find posts.

While I don't like to do this personally, I suggest patience. My guess - and it's just that - is that your surgery has impacted your ability to get deeper sleep. As a result, you may be going though more frequent arousals. Which of course means you are also facing that sleep / wake barrier, when we all have an increase in central events. And going through that change from wakefully to sleep and back again will increase your periodic breathing and central apneas.

Of course, if you are taking anything stronger than Tylenol for the pain you might be seeing a side effect of the pain medication. Any opiate based (or even derived) medication tends to depress the central nervous system. Which will also increase periodic breathing and central apneas.

If this is due to pain, there is little that you can do to make it much better than anything you are doing now. If you have more pain killers to take more of the edge off of the pain it often leads to poor sleep.

But if this continues to be a real problem after a couple months, do go back and talk with your doctor. Hopefully a few extra naps will help in the mean time. So, best wishes on your recovery.