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CSR - What causes & any concerns?
#31
Question 
(05-29-2017, 12:06 PM)richb Wrote: You have a sensitive "setting" in your CO2 feedback mechanism that triggers the CAs more quickly for you than most other people.  

Rich

Rich - thank you so much for that feedback - it triggered some added thought about being "my sensitivity" reacting with the machine so over the weekend I tried a number of "positional things" (sleeping positions) and found some interesting things:

1)  sleeping on my side seems to create PB/CSR events (always thought that this was the optimum sleep position)
2)  using the cervical collar does not help and creates more restless sleep (I use a contoured memory foam pillow to keep the head/neck in alignment)
3)  much better results sleeping on my back 

Does this make sense and/or have you heard this can make a difference?

[Image: lSbn14dl.png]
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#32
Anyone?

What is the possibility that the CSR/PB and the CAs are a function of a mask issue. Where the carbon dioxide is so diluted by a vented mask that there is less of a response to the brain -- and a breath is not triggered?

"Some patients are helped by unvented CPAP masks, which tend to raise the level of retained carbon dioxide in the blood. This in turn raises the blood’s acidity and that tends to damp down overbreathing. The elimination of overbreathing discourages the shallow underbreathing that typically follows in classic examples of Cheyne-Stokes breathing." https://sleepapnea.org/learn/sleep-apnea...eep-apnea/
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#33
(05-31-2017, 12:06 AM)srlevine1 Wrote: "Some patients are helped by unvented CPAP masks, which tend to raise the level of retained carbon dioxide in the blood. This in turn raises the blood’s acidity and that tends to damp down overbreathing. The elimination of overbreathing discourages the shallow underbreathing that typically follows in classic examples of Cheyne-Stokes breathing."  https://sleepapnea.org/learn/sleep-apnea...eep-apnea/

Thanks srlevine1 - some excellent information in the sleepapnea link above.....
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#34
no one should entice you into thinking there is something you can try to test greater CO2 retention in uncontrolled setting, one that does not include continuous monitoring of PaCO2.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#35
(05-31-2017, 05:58 AM)quiescence at last Wrote: no one should entice you into thinking there is something you can try to test greater CO2 retention in uncontrolled setting, one that does not include continuous monitoring of PaCO2.

QAL

Totally agree ... but it is a discussion topic for your doctor. Unfortunately, ABG measurements are not often compatible with testing xPAP parameters outside of a laboratory setting. And, I have yet to see a sleep study that actually did more than measure oxygen saturation levels with a pulse-ox. Perhaps you can provide further guidance how this type of testing might be accomplished?
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#36
I have seen sleep tests with  both oxygen and co 2 traces.  Probably more for studies versus patient titration.  I would guess it would take a really experienced doc or medical school to go down that path. You might do internet search on "permissive hypercapnia NIH dog". Yes, dog.

i think medical folks would rather get you ASV than monitor the permitted hypercapnia.

Enjoy.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#37
For something on a slightly different tack - how well you sleep and feel after sleep may have a lot to do with CO2 as well as O2. I stumbled upon https://www.ncbi.nlm.nih.gov/pubmed/22363318 which talks to REM inhibition when hypocapnia occurs in the NREM sleep preceeding REM.
This can be the major difference in quality of well being for those that have forced breathing timing with an ASV, which seeks to eliminate CA and can have unintended consequences of knocking out some or all of the REM sleep.
I learn a little every excursion into the NIH and PubMed archives!

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#38
QAL makes a good point here. During my sleep studies and titrations on traditional CPAP machines I experienced very little REM sleep. I think the desats during CA episodes were interfering with my sleep pattern. I feel much more rested on my ASV machine.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#39
richb, you worked so hard to get this sorted out, it is great that the result was not a lot of pressure, just well timed! we try so hard to push our way out of this. sometimes it is just the way we push, eh?

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#40
Saw my new sleep doc. today & posting this update for anyone interested:
1.)  PB and/or CSR not important unless both CA & OA are greater than 10 each an hour (still bothers me anytime total is over 5/hour)
2.)  No need to worry or involve the heart doc. unless the events are at least as in no. 1 above (looks like PB not bad enough to worry??)
3.)  Agrees that mine looks like complex apnea but as long as it can be held as low as it is now all is OK with APAP.  (agreed)
4.)  Believes decision is still out if ASV reduction of CAs with periodic breathing when CHF is present is a good option.  (agreed)
5.)  Believes it is fine for me to keep making my own pressure changes when self knowledge & control is good with some guidance.  (agreed)
6.)  Believes it is better to not make a lot of changes as it can create our bodies to not settle down into the best pattern.  (might be correct)
7.)  Believes that mask leakage is very important - can be more of the cause of events than we are aware of.  (agreed)
8.)  Believes we should not look at the hypopneas but just total AI as he believes the scoring (human or machine) leaves a lot to be desired.

Past few weeks I've been concentrating on sleep position/mask leaks first and min/max pressures second.  Now have leaks pretty well in control and using the following actions in achieving my results:
1.)  Keep the CA events 25% or less than the OA events.
2.)  Minimize the TTA (total time in apnea).
3.)  Try to keep PB/CSR at zero (none in the last 2 weeks & 1 in the last 30 days).

I've managed to now have occasional days with no CA and maintaining an average AHI of 3.25.  The doc. likes the present settings so I will leave them as is for now.

Here's a few charts to see the progression:  http://imgur.com/a/Lxmmd

Again, I cannot say enough how much I appreciate all the help and support from everyone on this forum.
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