[Diagnosis] Massive bradypneas, scared

[thibaulthib]

I'm going to go out on a limb to address the uncomfortable topic of drinking. thibaulthib, most people are embarrassed by conspicuous over drinking but you've mentioned it in nearly all your posts.  clearly you are aware that alcohol is seriously and negatively affecting your life and your physical health.  as reported it seems to inhibit your ability to breathe.  I can't think of a more compelling incentive than that to manage your consumption, quit or get help to quit. to my 'ear', your frequent references sound like you know there's a problem and are reaching out for help, in a way, but are thus far unwilling to do what you know you need to do, at least until you sort out your breathing issues.  help is good but ultimately it comes down to each of us and no one else.  no judgement.  I have personal experience.

Sheepless,

I think you resumed quite well the situation and I will take measures about this, because as you said, I know where the hypoventilation problem comes from: alcohol. So I will take actions because it is too dangerous.

The second problem still remain my very low tidal volume, which needs to be increase with BiPAP, so I need to test the Resmed AirCurve.

The third problem is that my pulmonologist strongly suspects I have either OHS or CHS, because of the alveoles when I sleep (every other night).

Quick question though, what is the difference between ASV and S/T ?

[jaswilliams]

Sleeprider, what is the difference between the following Resmed:
- Aircurve 10 ASV
- Aircurve 10 vAuto
- Aircurve 10 ST

Aircurve 10 vAuto BiLevel version of the Autoset 10 suitable for people who need more than 3 cm of pressure support of pressure over 20CM but will do nothing for Clear airway apnoea 

Aircurve 10 ST Fixed pressure BiLevel but in ST mode it can force a breath by switching from EPAP to IPAP (low to high pressure) if it does not detect a breath after a fixed time. often used to treat breathing conditions and low tidal volume not designed to treat Sleep Apnoea but it can treat central apnea but the ASV is better.

Aircurve 10 ASV fully automatic machine that can force a breath based on the previous 3 minutes breathing rate, it is the best machine for treating mixed apnoea where there are elements of Obstructive and Clear Airway Apnoea.



Jason

[thibaulthib]

So does it mean ASV will always be better than BiPAP S/T, or it really depends on the patient?

[robermax]

Have you checked overnight oximetry on CPAP yet?

[Gideon]

Per ResMed

The AirCurve™ 10 ST-A provides effective non-invasive ventilation for patients with respiratory insufficiency such as neuromuscular disease, restrictive lung disorders, severe COPD and hypoventilation syndromes. It features iVAPS (intelligent Volume-Assured Pressure Support), ResMed’s proprietary mode that automatically adapts to each user’s changing needs, and an intelligent Backup Rate (iBR)* that maximizes their opportunity to breathe spontaneously. The AirCurve™ 10 ST-A includes both fixed and adjustable alarms for added safety.

The AirCurve 10 ST is a bilevel device with backup rate that provides exceptional patient–ventilator synchrony, reducing the work of breathing so patients remain comfortable and well-ventilated. It’s an ideal choice for reliable, cost-effective noninvasive ventilation when alarms are not required.

The AirCurve 10 S is ideal for sleep apnea patients who find it difficult to adjust to sleep apnea therapy on a continuous fixed  pressure device, as well as patients who need extra pressure support. This bilevel machine has two different, adjustable set pressures which can make therapy feel more comfortable. An integrated humidifier simplifies setting up the device and makes therapy easier.   (Get the ST)

The AirCurve 10 ASV bilevel machine offers truly personalized therapy for central breathing disorders, such as Cheyne-Stokes respiration (CSR), central sleep apnea (CSA) and associated obstructive events. Featuring the most clinically-studied and proven ASV algorithm, AirCurve 10 ASV is the only adaptive servo-ventilator that targets the patient’s own recent minute ventilation.  This machine does not offer the S, T, or ST Modes

IMHO IF the ASV works for you (this is a guess) go for it, BUT this is a guess.

What we THINK (we do NOT KNOW) your conditions is one of the ST machines may be better.

This is why we are encouraging you to see an appropriate doctor.


Fred


How to buy Support for AirCurve 10 ST

[jaswilliams]

So does it mean ASV will always be better than BiPAP S/T, or it really depends on the patient?

It depends on the patient and their needs for instance ASV won’t help increase tidal volume as it uses the patients existing tidal volume in its calculations


I think

[Sleeprider]

The information above is good information, and your doctor should advise on the correct machine. I think the recommendation is for S/T or ST-A which has the Average Volume Assured Pressure Support AVAPS capability.

Your blood test raises an interesting dilemma because all of the flagged parameters suggest hyperventilation and metabolic alkalosis rather than hypoventilation and metabolic acidosis. I simply will not comment on this....ask your doctor.

[thibaulthib]

The information above is good information, and  your doctor should advise on the correct machine.  I think the recommendation is for S/T or ST-A which has the Average Volume Assured Pressure Support  AVAPS capability.

Your blood test raises an interesting dilemma because all of the flagged parameters suggest hyperventilation and metabolic alkalosis rather than hypoventilation and metabolic acidosis.  I simply will not comment on this....ask your doctor.

Sleeprider, I get your point and thanks for it. I have told my pneumologist and neurologist again, seems they are more preoccupied by something else...

They are suspecting I may be developing narcolespy, even though I have never fallen asleep during day before. But I've got all the other symptoms such as EDS, extremely vivid dreams, hallucinations while falling asleep leading to "panic attack" (let's call it this way), loss of muscle tone before these "panic attacks" and whole body stif during my last panic attack on wednesday.

1) Tonight, they are asking me to repeat another PSG (as per 6 months ago), so no BiPAP titration. We are putting this on-hold for now since the priority is not there anymore. They want to check again all the results especially with regards to REM latency, etc. while I am wearing my PR Dreamstation.
2) Tomorrow, I will get the MSLT test too, probably followed by EEG.
3) I may get a spinal puncture if needed.

Yesterday night, I have been admitted to the hospital again because I did 4 more small panic attacks, hence my results are really crap (AHI 7).
My breathing is still really shallow and my mind still very confused as in I was high.

Thibault

[thibaulthib]

Ok, 

Some news: 

1) I did not perform the new PSG because I strongly believe I am not narcoleptic.
2) However, I have performed an EEG, which showed everything is alright in my brain! 
3) I will be going for a nerve conduction study the 11th october, with regards to the fact I have difficulty swallowing solids

The hospital is discharging me now. 

Conclusion is I need a BiPAP S/T to increase my tidal volume and reduce alcohol consumption a lot because I definitely have some predisposition of massive hypoventilation as soon as I start drinking, even just a little.

This afternoon, I will be renting the only Resmed VPAP S/T available in Singapore right now, for 1 month, the Lumis 150. If everything is alright, I will buy the Resmed AirCurve 10 ST-A.
In about 3 weeks, I will go back to see my pulmonologist and assess if the VPAP is doing well on me, with Sleepyhead.

If I am comfortable with the Lumis 150, I guess I will also be comfortable with the AirCurve, but I would like your confirmation?

I would not want to throw US $5K away... Thank you !

Thibault

[silentsnore]

If I were you, I would not only "reduce alcohol consumption a lot", but I will permanently stop consuming alcohol.