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Chest/Lung Restriction - Impact on CPAP use?
#31
RE: Chest/Lung Restriction - Impact on CPAP use?
(08-15-2021, 07:46 AM)Sleeprider Wrote: Did the 2018 sleep study evaluate your therapy under CPAP  pressure (titration)?  Central apnea can appear in sleep studies or as treatment emergent. We can see the flow rate line in your graph has periodic breathing typical of individuals with hypcapnea related centrals.  This tends to be a feedback loop as the individual swings from hyper ventilation to hypoventilation depending on the CO2 levels in the bloodstream.  This can often be reduced by turning EPR off or to a low setting to reduce respiratory ventilation. You need to try to get more hours on the CPAP, probably without EPR to determine if this is a trend. If the CA events continue, you will require a titration that evaluates CPAP and bilevel ASV to find what works.

So, I have two questions:

1) Where do you think I should start with the pressure setting and EPR?

2) I just want to be 100% sure that it's safe for me to proceed. I'm concerned that I won't be able to breathe out properly against an increased pressure. Is that possible?

To recap my issues are

A) ENT scoped recently and told me airway partly closed due to long term esophageal reflux (likely nasopharyngeal)
B) ENT scoped recently and told me airway partly closed due to excess bone growth in my cervical spine (this is characteristic of severe cases of Ankylosing Spondylitis). Note that I have limited range of motion in my neck.
C) Although it doesn't feel terrible, I know I have limited chest expansion due to fusion in my thoracic spine and rib cage (again, typical of Ankylosing Spondylitis). I have an upcoming appt with an Pulmonologist
D) I am not overweight
E) When I fall asleep in a chair sitting upright, or fall asleep supine, I almost immediately choke/stop breathing and wake up.
F) Deviated septum - docs say not too bad. I broke my nose twice a long time ago

Thanks for your help
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#32
RE: Chest/Lung Restriction - Impact on CPAP use?
First, read my last post, then ask again. You have CPAP therapy-onset central apnea as demonstrated by your titration study. You need ASV.  Based on what I see, you probably feel better with CPAP, even though your event rate is higher, because you need some form of positive pressure to maintain reasonable oxygen perfusion.  Unfortunately, that PAP causes centrals. The solution is ASV.  This is your ticket to ASV:

[Image: attachment.php?aid=34824]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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Soft Cervical Collar
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#33
RE: Chest/Lung Restriction - Impact on CPAP use?
This is probably not necessary, but here is my Wellue Ring data corresponding with the Oscar chart for the hour and fifteen minutes that I posted earlier.

I'm reading your last two posts now. Thx


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#34
RE: Chest/Lung Restriction - Impact on CPAP use?
Okay, I read your two posts thoroughly and I think I have a decent handle on what you're saying (even if I don't understand 100%).

It will likely take a while for me to get the ASV machine. This will be somewhat complicated because I will be moving from state to state and then possibly back to the original state. I can try to shift timing to get the best healthcare I can.

So, here are my questions:

1) I'm reading that you think I might feel better (in the short term before getting an ASV) using the CPAP. What pressure settings should I try, given that (as I'm reading your posts) higher settings will trigger more centrals, but could decrease my oxygen saturation? Also, it sounds like I should turn EPR off, is that correct? 

My inclination is to start with a relatively low pressure, because I temporarily tried turning EPR off with a fixed pressure of 7 or 8 (can't recall which) and it felt pretty difficult to exhale.

2) I just want to make sure you had a chance to read about the physical abnormality issues I listed in a prior post. I've never heard of CPAP being unsafe at low pressures and don't expect you to advise me on that. This is likely just my unreasonable anxiety.

3) Long shot, but just to get me feeling better in the short term, I read a bit about high flow nasal cannulas for SA. Any reason to think this might help me in the short term? I don't even know if this is something that's available. Note that I suspect even a slight decrease in my SA might be enough to stop my morning migraines.

4) In the state I'm going to, I'll be in a major US city. I lived there previously and I will have more medical options there. I could also potentially extend my stay there to maximize the medical opportunities. I previously had a DISE scheduled there with the top sleep surgeon. Unfortunately I woke up that morning with an excruciating migraine and had to cancel because I needed to take my med.  I MAY have the option to do the DISE now. But I'd like to know if you think the DISE would even yield useful info ... I'm not thrilled about taking the Covid-19 risk. I'm currently unvaccinated due to auto-immune suppression and still weighing my options. I wear a P100 half mask respirator most places I go, but I don't think the doc can look down my throat with it on. Smile

5) Maybe difficult to answer, but who do you think is more likely to read the data the way you read it and ask insurance for an ASV ... A top doctor in a major city, or a flunky doctor in a small city?

6) Can I reasonably rent an ASV? I'm okay with throwing a bit of money at this if I can feel better quickly.

7) I suspect my SA may have worsened since 2018. My neck may have more bone growth and my nasopharyngeal reflux may have done more tissue damage. Is it worth the Covid risk to do another sleep study, either in lab or in home? My ENT already requested s new one from insurance. I'm guessing it's not worth doing, since it sounds like I'll need the ASV regardless. Again, not excited about the Covid-19 risk in the lab.

8) If I can't tolerate CPAP short term (until I get the ASV) would it potentially help me at all to just wear a chinstrap without the CPAP? Again, the migraines I get most mornings are a real pain, and I think even a small decrease in SA might reduce or eliminate the migraines.

Sorry, long post! Thx for your help!
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#35
RE: Chest/Lung Restriction - Impact on CPAP use?
Quick and dirty: if your insurance is paying, you'll need evidence the ASV will treat. You need Dr. Dolittle to order you a titration with ASV pressure set involved in the mix. You get on that and you're producing evidence it'll work.

Hand the doc your symptom and complaint stack of stuff. Then ask for Titration involving ASV. Then by and by, you'll have one. You'll request the ResMed AirCurve 10 ASV. Good luck, any questions I'll pass on what I learned.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#36
RE: Chest/Lung Restriction - Impact on CPAP use?
PS the SpO2 report states your low was 87, but your less than 90% was less than a minute. Looks OK to me as is.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#37
RE: Chest/Lung Restriction - Impact on CPAP use?
All I know, is that your AHI was over 60 at CPAP 0 or without therapy, and this resulted in 7-minutes out of over 4-hours at less than 88% oxygen. That's not so good. As CPAP pressure was added from 6.0 to 10.0 cm, your best results appear to be at 8-cm pressure. It's not great, but it seems okay with AHI of 7.0. We only have 40 minues of test time, so lots of room for error. The only chart we have seen is a brief sleep at 7-16 pressure with EPR 3. Based on your titration, I'd like to see a fixed pressure of 8.0 with EPR off.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#38
RE: Chest/Lung Restriction - Impact on CPAP use?
Okay! I will work on getting some more data with fixed pressure of 8.0 with EPR off.

Thanks again, and I'll check back in soon.
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#39
RE: Chest/Lung Restriction - Impact on CPAP use?
Hi again. I don't know if I got enough data to even make it worth posting this time. I planned to take a long nap with the CPAP because I was really tired, but I didn't even make it half an hour.

I started at pressure of 8 with EPR off, as you suggested. When my 02 dropped down the first time, my Wellue ring started vibrating at O2 of 87 %. It was scary and so I reasoned (maybe incorrectly?) that it was happening because it was difficult to breathe out against the pressure.

So I turned EPR to 1 and managed to fall back asleep. This time I must have slept thru the Wellue Ring vibrating at 87 % because you can see my O2 went down to 80%. I woke up again then (scared again) and I'm not sure if I went back to sleep after that.

At some point after having woken up I couldn't get back to sleep again, so I gave up. I actually did feel kind of rested and alert, but maybe it was a placebo?

Anyway, I guess I need to know what makes sense to try next as far as pressure. I was really hoping to get at least some benefit from CPAP before I get the ASV.

Another thing I want to mention. I tried CPAP 2-3 years ago with a FFM. I don't recall waking up scared like this. Maybe because I could breathe thru my mouth? But also possible my sleep apnea has worsened since then?

I also suspect I've got something going on during the day. I did suffer a complete mental collapse around the time that my autoimmune condition flared up and I lost a ton of range of motion in thoracic and cervical. I wonder how much this might be related to both nigh time and day time breathing. Hope I'm making sense.


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#40
RE: Chest/Lung Restriction - Impact on CPAP use?
There shouldn't be much to scare you when it comes to pressure. Actual pressure in PSI is 0.113787 at 8 cmH2O.

EPR 1 still shows.

SpO2 was at less than 90 for 1 minute. I'd think this says possibly the Apnea drops your percentage down and needs PAP to do its job. It's not at a bad level, but it is dropping from something.

You will be hard pressed to get a night in on ASV if you can't endure 8 on CPAP for 30 minutes. Not talking down to you, but a need to face things as they are. Yes the ASV can be tamed down and still effectively treat CA and other Apnea, but it's not going to be straight 8 and EPR 1.

If you want something to be afraid of, OK here's one, 13 CA within 27 minutes, and about 9 Obstructive Apnea in that same time.

If you feel better with full face masks go get one now. You're in need of getting used to this small amount of pressure or you'll never get a single night on ASV, or even CPAP.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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