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Bipap & Tachycardia
#1

Until recently I was using a S10 for her auto cpap. I was having trouble with lots of Central Apnea's. So my doctor had me undergo a titration study for a standard -s Bipap. the pressures came out as 18/12 but they noted that I had Tachycardia and needed to be evaluated. I am also now on 2L of oxygen prescribed 24/7 because my oxygen levels drop below 85. I tend to mouth breathe so I use a full face mask. One the first night of use, I had over 3 hours of Tachycardia of about 130 bpm. My chest was hurting and was scared it might be a Heart Attack, which it was not. We got up, I went on my oxygen and we headed to the hospital. After checking in for Emergency, about half an hour had gone by, and my Tachycardia had returned to normal. They ran blood work which showed that I had not had a Heart Attack within a week. Contacting my Doctor, I got permission to make changes myself, knowing how to get into clinical setting and having a D50+ oximeter. I ended up with pressure of 18.4 over 14.4 but occasionally I still get fast heart rate while hooked up to my Bi pap machine. It seems from checking the internet that tachycardia is mostly to high a CO2 level in the heart, or not enough O2 getting to the heart. Then I started wondering about mask types. Full face mask you breathe out and in both inside the same mask. Which means some exhaled air makes it into the next intake for the lungs. Also a large amount of air is going out air holes in the mask. Which makes me wonder how much of my O2 is going out the holes without my get it.
I currently use two types of masks, the ClearView full face mask and the Resmed Marage mask. But I like the ClearView the best, but I am very concerned now about my Fast Heart rates. I hope someone on here can help me.
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#2
What kind of event rate are you getting on bilevel? Here is the problem; a BiPAP S with fixed EPAP/IPAP does not have the ability to actually address central apnena. The pressure support may be more comfortable, but it can also cause CA by lower CO2 and respiratory drive. If you have centrals, the only machine actually able to induce a breath is the ASV, which usually has an auto EPAP and pressure supports from 2-18. Some people may resolve on simple bilevel, but not very many complex apnea patients control CA with that strategy. However, it is frequently required that a patient "fail" at BiPAP before they can be titrated and obtain ASV through insurance. It sounds to me like you might be on that path.

Don't wait long to bring this problem to your doctor's attention, and be aware, he is probably expecting you to fail BiPAP, which is a prerequisite to ASV.
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#3
My AHI's are actually not bad with the Bipap. Centrals are only a couple of times a night now. Obstructive's usually 2-3 a night. and some Hypo's. Dropping pressure just 1 CM however and everything jumps sky high. I do feel better with the Bipap than even with my s10 for her. A couple of hours now and I feels better than 8-10 hrs with other machine. My heart rate now is my concern. My flow limits are zero. Snore pretty much zero, Resp Rate generally 16-18 with Max peaks about 40 min low about 10. Tidal Vol is around 700, Min Vent is in the neighborhood of 10 with peaks and valleys. Exp time is between 1.5 to 4 with average around 2. Insp time is around 0.8 to 1.5 The last week, all AHI's were below two.
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#4
Hi Marthajoy7,
WELCOME! to the forum.!
Much success to you with your CPAP therapy and getting it fine tuned to meet your needs.
trish6hundred
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#5
(02-28-2016, 09:54 AM)Marthajoy7 Wrote: My AHI's are actually not bad with the Bipap. Centrals are only a couple of times a night now. Obstructive's usually 2-3 a night. and some Hypo's. Dropping pressure just 1 CM however and everything jumps sky high. I do feel better with the Bipap than even with my s10 for her. A couple of hours now and I feels better than 8-10 hrs with other machine. My heart rate now is my concern. My flow limits are zero. Snore pretty much zero, Resp Rate generally 16-18 with Max peaks about 40 min low about 10. Tidal Vol is around 700, Min Vent is in the neighborhood of 10 with peaks and valleys. Exp time is between 1.5 to 4 with average around 2. Insp time is around 0.8 to 1.5 The last week, all AHI's were below two.

Sounds like this is going to work out for you. The stats you cited are excellent. It's kind of the nature of OA that dropping pressure below the threshold that holds the airway patent, will increase OA. Hypopnea and flow limits tend to be addressed by pressure support (the difference between IPAP and EPAP.). I had the impression that you had many more events that would explain the low SpO2. Your tidal volume is impressive and event rate low, so I just don't know how that would happen.

As far as how much exhaled air is inhaled, it is very little. The amount of air passing through the system is about 3 times your tidal volume, and so most of your exhale is exhausted immediately. O2 enrichment is going to be very minimal with all the biPAP dilution.
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#6
(02-28-2016, 05:34 PM)Sleeprider Wrote:
(02-28-2016, 09:54 AM)Marthajoy7 Wrote: My AHI's are actually not bad with the Bipap. Centrals are only a couple of times a night now. Obstructive's usually 2-3 a night. and some Hypo's. Dropping pressure just 1 CM however and everything jumps sky high. I do feel better with the Bipap than even with my s10 for her. A couple of hours now and I feels better than 8-10 hrs with other machine. My heart rate now is my concern. My flow limits are zero. Snore pretty much zero, Resp Rate generally 16-18 with Max peaks about 40 min low about 10. Tidal Vol is around 700, Min Vent is in the neighborhood of 10 with peaks and valleys. Exp time is between 1.5 to 4 with average around 2. Insp time is around 0.8 to 1.5 The last week, all AHI's were below two.

Sounds like this is going to work out for you. The stats you cited are excellent. It's kind of the nature of OA that dropping pressure below the threshold that holds the airway patent, will increase OA. Hypopnea and flow limits tend to be addressed by pressure support (the difference between IPAP and EPAP.). I had the impression that you had many more events that would explain the low SpO2. Your tidal volume is impressive and event rate low, so I just don't know how that would happen.

As far as how much exhaled air is inhaled, it is very little. The amount of air passing through the system is about 3 times your tidal volume, and so most of your exhale is exhausted immediately. O2 enrichment is going to be very minimal with all the biPAP dilution.

Any ideas on why lowering my Epap causes my heart to go into tachycardia. I would think that lower Epap would help with oxygenation. But at 18/12 I needed to go to the Hospital, Heart rate of 130 for 3 hours and BP of 160/100. I was almost too scared to even try using it again. Went back to 17/13 as my apap had been 17/14. Did my own titration to get me to 18.4/14.4. But I am scared to Drop EPAP lower. At least till I can figure out what is going on.
Let me add a little more. With my old Apap, when I started using oxygen 24/7 my Centrals pretty much disappeared. So I figured it was the oxygen going into the mask that was helping me. Could it be that it was using oxygen the rest of the day is what improved my Centrals? If that is the case, maybe I do not need the concentrator feeding into my climate control hose. That would make it way easier if we ever get to travel again. The sleep study said that at 18/12 my oxygen level was 93, but my body seems to like 95-97 better. With the apap, I found if my oxygen was above 95 I did not have any apnes'a. But Below that level, and all forms of apnea's would show up. Oh, at 17/13 my AHI's were above 50. at 18.4/14.4 sometimes my AHI's are below 1.0.. What a drastic change. With Apap going up to 18, increased my Central Apnea's, which is why I backed it back down to 17. I would like to get to where I do not need oxygen plugged into BiPap but scared to remove it. Almost feel like I should put canula on before putting on mask to keep dilution of oxygen down. thank you to all those that help on here.
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#7
No, that is not in my experience. Have you tried reducing the difference between IPAP and EPAP (pressure support)? I get more CA if the pressure support is too high. The other night I lowered it from 4 to 3.6, and it helped a lot. On a BiPAP S that would be EPAP +3.5 = IPAP.

Martha, you need to update your profile to show your current machine. It's pretty confusing to be discussing a BiPAP with a Resmed Airsense 10 Autoset in your profile. From your first post in this thread. I assume you are using a PRS1 BiPAP Pro 560, or a Dreamstation BiPAP Pro. Resmed would be Aircurve 10 S or S9 VPAP S.
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#8
(02-28-2016, 06:16 PM)Sleeprider Wrote: No, that is not in my experience. Have you tried reducing the difference between IPAP and EPAP (pressure support)? I get more CA if the pressure support is too high. The other night I lowered it from 4 to 3.6, and it helped a lot. On a BiPAP S that would be EPAP +3.5 = IPAP.

Martha, you need to update your profile to show your current machine. It's pretty confusing to be discussing a BiPAP with a Resmed Airsense 10 Autoset in your profile. From your first post in this thread. I assume you are using a PRS1 BiPAP Pro 560, or a Dreamstation BiPAP Pro. Resmed would be Aircurve 10 S or S9 VPAP S.

Sorry, I will look and try and find how to change the data. I am now using the AirCurve 10 Vauto that also has the S setting, which is what they set it to. Also have the climate hose that has an oxygen adapter as part of the hose, and connects right at the output of the machine.
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#9
(02-28-2016, 07:32 PM)Marthajoy7 Wrote:
(02-28-2016, 06:16 PM)Sleeprider Wrote: No, that is not in my experience. Have you tried reducing the difference between IPAP and EPAP (pressure support)? I get more CA if the pressure support is too high. The other night I lowered it from 4 to 3.6, and it helped a lot. On a BiPAP S that would be EPAP +3.5 = IPAP.

Martha, you need to update your profile to show your current machine. It's pretty confusing to be discussing a BiPAP with a Resmed Airsense 10 Autoset in your profile. From your first post in this thread. I assume you are using a PRS1 BiPAP Pro 560, or a Dreamstation BiPAP Pro. Resmed would be Aircurve 10 S or S9 VPAP S.

Sorry, I will look and try and find how to change the data. I am now using the AirCurve 10 Vauto that also has the S setting, which is what they set it to. Also have the climate hose that has an oxygen adapter as part of the hose, and connects right at the output of the machine.

No, I have not gone lower than 4 for PS as I thought that would be putting me closer to the problems I had with my APAP. It was not just the centrals that would bother me, but also when I would get apnea's that went bang bang bang right after each other, not allowing my body to recover between them. That is why I used machine in auto mode, but now with the tachycardia happening, I am scared to give it that control.
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#10
I use the same machine, but I think the nature of your problems, and reaction to therapy changes are beyond my experience. You seem to be on the right track with the changes, and working with your doctor. Your therapy settings can be accessed by pressing the home button and control knob at the same time. Then click the control knob on my options and you will see all the mode, pressure, timing, and other options. It might be useful to document them as a baseline. You can also check if Essentials or Plus is highlighted. This only affects the therapy results display you can see on the machine. You want that set to Plus.
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