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[Diagnosis] Massive bradypneas, scared
#11
RE: Massive bradypneas, scared
I think that noone can explain what happened while you were "intoxicated", and what machine interpreted at that time.

Perhaps less of "drinking like crazy" will eliminate the BND instances?
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#12
RE: Massive bradypneas, scared
I'm going to assume your machine is not malfunctioning. The combination of your extremely low respiration, chaotic breathing pattern and apparent alcohol induced hypoventilation is a serious problem.

Go to your doctor. Your tidal volume has now fallen to 160 which is off-the charts low. I don't know the reason for your hypoventilation, but for a problem like this, a VPAP ST or BiPAP ST which has a timed backup rate to trigger higher inhale pressures and improve your ventilation will support respiration when you don't. This may be serious problem. Even your flow rate leading towards the BND event is chaotic. Get some help, get a pulmonary function test, and get a sleep test using CPAP and BiPAP to determine if BiPAP ST is what you need. You need to stop drinking in excess until you fix this. There is no reason not to believe what we are seeing in these charts and your respiration is apparently very suppressed. It isn't particularly good even when you don't drink. Your anxiety over results yesterday may actually have been for good cause. You cannot continue to have such suppressed respiration without serious consequences.
Sleeprider
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#13
RE: Massive bradypneas, scared
I think you should consider getting a recording oximeter to see if your blood oxygen saturation (SpO2) is following what we're seeing on CPAP. Sustained levels below 90% are considered serious and below 88% can qualify for oxgen or other therapy. The CMS-50F Pulse Oximeter is about $100 and comfortably fits on your wrist. The CMS-50DL is an inexpensive but accurate fingertip pulse oximeter at $30 USD. Both are compatible with Sleepyhead. If your SpO2 indicates desaturation as these CPAP data suggest, you need to take expedited action.
Sleeprider
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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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#14
RE: Massive bradypneas, scared
(09-18-2018, 08:36 AM)Sleeprider Wrote: I think you should consider getting a recording oximeter to see if your blood oxygen saturation (SpO2) is following what we're seeing on CPAP.  Sustained levels below 90% are considered serious and below 88% can qualify for oxgen or other therapy. The CMS-50F Pulse Oximeter is about $100 and comfortably fits on your wrist. The  CMS-50DL is an inexpensive but accurate fingertip pulse oximeter at $30 USD. Both are compatible with Sleepyhead.  If your SpO2 indicates desaturation as these CPAP data suggest,  you need to take expedited action.

Sleeprider, many many many thanks for all your help. I feel so down since monday.

One very important information I need to add on: on march 2018, it was on a wednesday, I was home and haven't been drinking for 2 or 3 weeks prior to that. 
I was at bed since 10pm and around midnight, I still couldn't sleep. I suddenly started sweating, and had to go straight to the toilets. After that, I wanted to drink a lot of water. I started having hallucinations and de-realization disorder, and did my very first panic attack ever. Extreme pain in my chest, and I could not breathe. I was able to get a cab (I live alone), reached the A&E, I could not walk nor talk aynymore and I had convulsions for 1 hour on the hospital bed.
My blood pressure was extremely high (200/120 if I recall), and I had arrythmia. 

Blood check, ECG, CT scan, treadmill, everything was fine. Then, they kept me a second night, did a sleep study. After that, I had to be in MC for 2 weeks, because I was extremely week. I continued having some lighter panic attack/hallucinations until the sleep study results came 4 days later, giving the news.

Since I am using the CPAP, I never ever had other panic attacks, expect yesterday, after 2 consecutive day of heavy drinking.

I am more than willing to buy a recording oximeter because I am scared about what is happening to me. I agree about the alcohol part, but if it happens again while I am out of all this, I really have another issue happening at random.

PS: This my have nothing to do with this, but I am 170cm, 70kg.

Thibault
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#15
RE: Massive bradypneas, scared
Note that there are two models of CMS-50D figertip clamp oximeters: the CMS-50DL, which SleepRider mentioned, is NOT a recording oximeter. The CMS-50D+ IS a recording oximeter, and the latest version uses a micro USB connector and a special label-and-don't-lose-it cable.

The CMS-50F and CMS-50I are both wrist-worn with a fingertip sensor- the CMS-50F records a single session, and the CMS-50I can record and save multiple sessions.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#16
RE: Massive bradypneas, scared
Here is a good article to help you understand Tidal volume https://www.ncbi.nlm.nih.gov/books/NBK482502/
Also see the basic information on Wikipedia https://en.wikipedia.org/wiki/Tidal_volume

Tidal volume for healty individuals should be approximately 7 mL/kg of ideal body weight. You seem to be of normal or near ideal body weight at 70 kg, and it's a simple matter to calculate that your tidal volume target is closer to 490 mL than the 160 to 260 we are seeing in your charts. I can allow for 260 to 350 which suggests some impairment or error, but this most recent result was just plain alarming to me and practically defines hypoventilation. Obesity is a commonly associated with hypoventilation, but a few individuals can express life-threatening hypoventilation as a result of alcohol use https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885790/ Please consider this information and consider consulting with a doctor on this. You may have a serious condition that requires you to refrain from alcohol.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#17
RE: Massive bradypneas, scared
(09-18-2018, 10:00 AM)Sleeprider Wrote: Here is a good article to help you understand Tidal volume https://www.ncbi.nlm.nih.gov/books/NBK482502/
Also see the basic information on Wikipedia https://en.wikipedia.org/wiki/Tidal_volume

Tidal volume for healty individuals should be approximately 7 mL/kg of ideal body weight.  You seem to be of normal or near ideal body weight at 70 kg, and it's a simple matter to calculate that your tidal volume target is closer to 490 mL than the 160 to 260 we are seeing in your charts.  I can allow for 260 to 350 which suggests some impairment or error, but this most recent result was just plain alarming to me and practically defines hypoventilation.  Obesity is a commonly associated with hypoventilation, but a few individuals can express life-threatening hypoventilation as a result of alcohol use https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885790/   Please consider this information and consider consulting with a doctor on this.  You may have a serious condition that requires you to refrain from alcohol.

Sleeprider,

Things start to make even more sense now. While I was still in France, in 2010, I suddenly gained on weight 12kg in 2 months, for no apparent reason! I was then 82kg.
From that moment, I started snoring a log, and my ex girlfriend wanted me to go to see someone to stop the snoring. I was 20 years old.
I was feeling depressed very often, I went to see a neurologist which found out I was having ADHD and wanted me to take Ritaline, which I refused!

6 months later, I was 90kg, and I stayed at that weight for 4 years, feeling very often down, drowsy, light headed, short breath (impossibility to breathe at 100% at all) over day, headache and of course sleepy over day... Now, I know what it was!

When I moved to Singapore in 2014, I suddenly lost all these kgs without doing anything and went back to 70kg. 

This obesity hypoventilation syndrome definitely looks like something I should dig into, because it really looks like my story. I don't want to say we found out, it would be too easy, but I think you got something here and I don't know how to thank you.

Shall I go to see a pulmonary specialist, neurologist, or who else to explain this?
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#18
RE: Massive bradypneas, scared
Any physician, sleep specialist and a pulmonologist sounds like the best choice. I think you need to consider a sleep study focused on your tidal volume, minute vent and SpO2 results, that evaluates CPAP vs VPAP ST/AVAPS. Your problem is not apnea, it is potentially hypoventilation, and your doctor should not be looking at conventional sleep apnea parameters to deem you "treated". An AHI under 5 still leaves you seriously fatigued, probably due to a lack of ventilation. The diagnostic objective in this case is different, as is the treatment objective. Something to consider would be to perform a study under the influence of moderate alcohol intake so that that risk can be evaluated.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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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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#19
RE: Massive bradypneas, scared
(09-18-2018, 10:42 AM)Sleeprider Wrote: Any physician, sleep specialist and a pulmonologist sounds like the best choice.  I think you need to consider a sleep study focused on your tidal volume, minute vent and SpO2 results, that evaluates CPAP vs VPAP ST/AVAPS.  Your problem is not apnea, it is potentially hypoventilation, and your doctor should not be looking at conventional sleep apnea parameters to deem you "treated".  An AHI under 5 still leaves you seriously fatigued, probably due to a lack of ventilation.  The diagnostic objective in this case is different, as is the treatment objective.  Something to consider would be to perform a study under the influence of moderate alcohol intake so that that risk can be evaluated.

Ok great, I will take care of this ASAP. I guess I need to find another doctor since the one who diagnosed my apneas was ENT.

What I can tell you so far is the following:
- Friday, I have been drinking, but no hypoventilation
- Saturday, drinking as well, probably as much as friday, and I got around 10min of hypoventilation according to the PR
- And sunday was the worst: more alcohol taken, and hypoventilation of 40min+.

There is definitely a link with the alcohol intake and the "resting" time in between.
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#20
RE: Massive bradypneas, scared
We cannot diagnose hypoventilation on the forum. This is just a possibility that is based on a low tidal volume and minute vent indicated in your CPAP data along with surprisingly low ventilation rates in the flow rate chart. These are ideas for discussion with a professional. Consider writing down a list of your symptoms and concerns and discussing them with a doctor. If it turns out you need more ventilation support, that is pretty easy to accomplish with bilevel or bilevel with backup. A simple blood test for HCO3 may be a good screening test as extended periods of inadequate breathing.
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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