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Getting worse..
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GTOdude Offline

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Posts: 94
Joined: Dec 2015

Machine: RemStar Auto APAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFIT P10
Humidifier: Unsure
CPAP Pressure: 7-14
CPAP Software: SleepyHead EncoreBasic

Other Comments: Other Dx: cabg x3 '94. Hypothyroid '15 and other maladies.

Sex: Male
Location: Central Valley, Left Coast

Post: #21
RE: Getting worse..
Right you are, Mongo. GTO (gas, tires and oil).

I was set last night at 8.5 to 13 APAP. Didnt go straight pressure. I was able to inhale easier and my Aflex is on 3. I was back on my P10 which can give me a sore nose and it did. Im going to leave it like that for a while.

Really am not sure if a PAP is my answer to my issues. I see my brathing is quite shallow at times at night and my recording oximeter shows me a big desaturation to like 88% just as im falling asleep. These desats are why I have to take 1/2 an Ambien to fall asleep. Theyre scary when they hit me and im still awake. My O2 during the night kinda steadys out to around 95-98%. The machine and mask really dont bother me anymore. My anxiety is much lower than 3 weeks ago, just dont like them events. Gonna try and see the cardio tomorrow. Maybe ill find out something..

Mark
12-27-2015 04:12 PM
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Sleeprider Online
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Advisory Members

Posts: 3,335
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #22
RE: Getting worse..
Mark, something I've noted for a long time on your data is your tidal volume on CPAP is low, and would be appropriate for a small person. Also, you have a long inhale and short exhale, nearly 3:1 ratio. This is inverse of the normal breathing pattern in which exhale is equal or longer than inhale time. May not be significant for you, but also might be worth discussing with your doc.

The RERA you are experiencing, would likely be significantly relieved with a bilevel machine, and it would also increase your tidal volume if setup right. You have never posted a closeup of your flow rate waveform data, but it looks like you have a lot of resistance on inhale that would benefit from higher pressure, but your exhale pressure would need to stay low for other reasons.

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12-27-2015 06:03 PM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #23
RE: Getting worse..
(12-27-2015 04:12 PM)GTOdude Wrote:  Really am not sure if a PAP is my answer to my issues. I see my brathing is quite shallow at times at night and my recording oximeter shows me a big desaturation to like 88% just as im falling asleep. These desats are why I have to take 1/2 an Ambien to fall asleep. Theyre scary when they hit me and im still awake. My O2 during the night kinda steadys out to around 95-98%. The machine and mask really dont bother me anymore. My anxiety is much lower than 3 weeks ago, just dont like them events. Gonna try and see the cardio tomorrow. Maybe ill find out something..

With PAP therapy your average SpO2 between 95% to 98% while fully asleep is very good. Without some form of PAP therapy, that might not happen.

There are several types of PAP machine which will not stand by and do nothing while your unobstructed breathing becomes ever more shallow. These are PAP machines which will gently help us to breathe by providing additional pressure support during inhalation if our natural breathing starts to become shallow, or stops.

One type is the bilevel ST (with Spontaneous Timed therapy mode) machines. These follow our spontaneous (natural, self-initiated) breathing pattern, but if our breathing slows too much or stops, ST mode will continue cycling between the fixed EPAP pressure and the fixed IPAP pressure at a preset backup respiration rate. When we recover and start breathing normally again the machine changes back from the backup rate to our natural rate.

I think a better type is the ResMed ASV machine which has a range within which the pressure support can automatically vary as needed to keep our Minute Volume at least about 90% of our recent average Minute Volume. Minute Volume is the total volume of air inhaled or exhaled during one minute. Pressure Support (PS) is defined as the amount the pressure is boosted during IPAP. PS is the difference between EPAP and IPAP, and on my ASV machine PS varies breath-to-breath between 6 and 11 to prevent any sudden reduction in my breathing. EPAP is always 14 and my IPAP varies from 20 to 25. More recent models of ASV allow EPAP to vary also, so it may be only as high as needed.

But since you have few or no central apneas, perhaps a better type for you would be a machine which allows a minimum target for the Tidal Volume or Minute Ventilation, a feature which ASV machines do not have. Tidal Volume is the average volume of air inhaled or exhaled in each breath, and the Minute Volume or Minute Ventilation is the TV times the number of breaths per minute. An ASV machine has no minimum floor for our Tidal Volume or Minute Ventilation so it will stand by and watch without intervening if our MV very slowly drops very low, perhaps leading to our awakening gasping for air. A PAP machine with an adjustable target for Alveolar Minute Volume is the S9 VPAP ST-A with iVAPS. Alveolar Minute Volume is a portion (perhaps 70%) of the total Minute Volume, the portion which actually reaches the alveoli and is available for gas exchange.

But if like most of us you're limited to what our insurance will pay for, insurance is unlikely to cover an ST or ST-A or ASV, and a standard bilevel Auto would likely be the best for you, as SleepRider has pointed out. By setting the Min PS higher, our Tidal Volume will tend to increase. That, alone, may be enough that you will not feel like you are suffocating as you fall asleep.

By the way, setting A-Flex to 3 makes exhalation easiet, but I think an A-Flex of 1 (not zero) will make inhalation easiest and may be better for you.

Take care,
--- Vaughn

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 12-27-2015 09:13 PM by vsheline.)
12-27-2015 08:31 PM
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GTOdude Offline

Preferred Members

Posts: 94
Joined: Dec 2015

Machine: RemStar Auto APAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFIT P10
Humidifier: Unsure
CPAP Pressure: 7-14
CPAP Software: SleepyHead EncoreBasic

Other Comments: Other Dx: cabg x3 '94. Hypothyroid '15 and other maladies.

Sex: Male
Location: Central Valley, Left Coast

Post: #24
RE: Getting worse..
(12-27-2015 08:31 PM)vsheline Wrote:  
(12-27-2015 04:12 PM)GTOdude Wrote:  Really am not sure if a PAP is my answer to my issues. I see my brathing is quite shallow at times at night and my recording oximeter shows me a big desaturation to like 88% just as im falling asleep. These desats are why I have to take 1/2 an Ambien to fall asleep. Theyre scary when they hit me and im still awake. My O2 during the night kinda steadys out to around 95-98%. The machine and mask really dont bother me anymore. My anxiety is much lower than 3 weeks ago, just dont like them events. Gonna try and see the cardio tomorrow. Maybe ill find out something..

With PAP therapy your average SpO2 between 95% to 98% while fully asleep is very good. Without some form of PAP therapy, that might not happen.

There are several types of PAP machine which will not stand by and do nothing while your unobstructed breathing becomes ever more shallow. These are PAP machines which will gently help us to breathe by providing additional pressure support during inhalation if our natural breathing starts to become shallow, or stops.

One type is the bilevel ST (with Spontaneous Timed therapy mode) machines. These follow our spontaneous (natural, self-initiated) breathing pattern, but if our breathing slows too much or stops, ST mode will continue cycling between the fixed EPAP pressure and the fixed IPAP pressure at a preset backup respiration rate. When we recover and start breathing normally again the machine changes back from the backup rate to our natural rate.

I think a better type is the ASV machine which has a range within which the pressure support can automatically vary as needed to keep our Minute Volume at least about 90% of our recent average Minute Volume. Minute Volume is the total volume of air inhaled or exhaled during one minute. Pressure Support (PS) is defined as the amount the pressure is boosted during IPAP. PS is the difference between EPAP and IPAP, and on my ASV machine PS varies breath-to-breath between 6 and 11 to prevent any sudden reduction in my breathing. EPAP is always 14 and my IPAP varies from 20 to 25. More recent models of ASV allow EPAP to vary also, so it may be only as high as needed.

But since you have few or no central apneas, perhaps a better type for you would be a machine which allows a minimum target for the Tidal Volume or Minute Ventilation, a feature which ASV machines do not have. Tidal Volume is the average volume of air inhaled or exhaled in each breath, and the Minute Volume or Minute Ventilation is the TV times the number of breaths per minute. An ASV machine has no minimum floor for our Tidal Volume or Minute Ventilation so it will stand by and watch without intervening if our MV very slowly drops very low, perhaps leading to our awakening gasping for air. A PAP machine with an adjustable target for Alveolar Minute Volume is the S9 VPAP ST-A with iVAPS. Alveolar Minute Volume is a portion (perhaps 70%) of the total Minute Volume, the portion which actually reaches the alveoli and is available for gas exchange.

But if like most of us you're limited to what your insurance will pay for, insurance is unlikely to cover an ST or ST-A or ASV, and a standard bilevel Auto would likely be the best for you, as SleepRider has pointed out. By setting the Min PS higher, our Tidal Volume will tend to increase.

By the way, setting A-Flex to 3 makes exhalation easiet, but I think an A-Flex of 1 (not zero) will make inhalation easiest and may be better for you.
Well im now getting confused lol not sure what to do. Ok ill set my Aflex to 1 for tonite. Still gonna go to the cardio cuz my chest is very achy and i have a dry cough and it hurts to cough. I wouldnt be surprised if this infernal machine is causing all this. I can try to get back into my ENT but what should i bring/tell him.

Im so tired of feeling like crap. Wish i could get all this figured out.

Mark
12-27-2015 09:00 PM
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GTOdude Offline

Preferred Members

Posts: 94
Joined: Dec 2015

Machine: RemStar Auto APAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFIT P10
Humidifier: Unsure
CPAP Pressure: 7-14
CPAP Software: SleepyHead EncoreBasic

Other Comments: Other Dx: cabg x3 '94. Hypothyroid '15 and other maladies.

Sex: Male
Location: Central Valley, Left Coast

Post: #25
RE: Getting worse..
(12-27-2015 09:00 PM)GTOdude Wrote:  
(12-27-2015 08:31 PM)vsheline Wrote:  
(12-27-2015 04:12 PM)GTOdude Wrote:  Really am not sure if a PAP is my answer to my issues. I see my brathing is quite shallow at times at night and my recording oximeter shows me a big desaturation to like 88% just as im falling asleep. These desats are why I have to take 1/2 an Ambien to fall asleep. Theyre scary when they hit me and im still awake. My O2 during the night kinda steadys out to around 95-98%. The machine and mask really dont bother me anymore. My anxiety is much lower than 3 weeks ago, just dont like them events. Gonna try and see the cardio tomorrow. Maybe ill find out something..

With PAP therapy your average SpO2 between 95% to 98% while fully asleep is very good. Without some form of PAP therapy, that might not happen.

There are several types of PAP machine which will not stand by and do nothing while your unobstructed breathing becomes ever more shallow. These are PAP machines which will gently help us to breathe by providing additional pressure support during inhalation if our natural breathing starts to become shallow, or stops.

One type is the bilevel ST (with Spontaneous Timed therapy mode) machines. These follow our spontaneous (natural, self-initiated) breathing pattern, but if our breathing slows too much or stops, ST mode will continue cycling between the fixed EPAP pressure and the fixed IPAP pressure at a preset backup respiration rate. When we recover and start breathing normally again the machine changes back from the backup rate to our natural rate.

I think a better type is the ASV machine which has a range within which the pressure support can automatically vary as needed to keep our Minute Volume at least about 90% of our recent average Minute Volume. Minute Volume is the total volume of air inhaled or exhaled during one minute. Pressure Support (PS) is defined as the amount the pressure is boosted during IPAP. PS is the difference between EPAP and IPAP, and on my ASV machine PS varies breath-to-breath between 6 and 11 to prevent any sudden reduction in my breathing. EPAP is always 14 and my IPAP varies from 20 to 25. More recent models of ASV allow EPAP to vary also, so it may be only as high as needed.

But since you have few or no central apneas, perhaps a better type for you would be a machine which allows a minimum target for the Tidal Volume or Minute Ventilation, a feature which ASV machines do not have. Tidal Volume is the average volume of air inhaled or exhaled in each breath, and the Minute Volume or Minute Ventilation is the TV times the number of breaths per minute. An ASV machine has no minimum floor for our Tidal Volume or Minute Ventilation so it will stand by and watch without intervening if our MV very slowly drops very low, perhaps leading to our awakening gasping for air. A PAP machine with an adjustable target for Alveolar Minute Volume is the S9 VPAP ST-A with iVAPS. Alveolar Minute Volume is a portion (perhaps 70%) of the total Minute Volume, the portion which actually reaches the alveoli and is available for gas exchange.

But if like most of us you're limited to what your insurance will pay for, insurance is unlikely to cover an ST or ST-A or ASV, and a standard bilevel Auto would likely be the best for you, as SleepRider has pointed out. By setting the Min PS higher, our Tidal Volume will tend to increase.

By the way, setting A-Flex to 3 makes exhalation easiet, but I think an A-Flex of 1 (not zero) will make inhalation easiest and may be better for you.
Well im now getting confused lol not sure what to do. Ok ill set my Aflex to 1 for tonite. Still gonna go to the cardio cuz my chest is very achy and i have a dry cough and it hurts to cough. I wouldnt be surprised if this infernal machine is causing all this. I can try to get back into my ENT but what should i bring/tell him.

Im so tired of feeling like crap. Wish i could get all this figured out.

Mark
Good morning. I tied using Aflex 1 last night and had to go back to 3, difficult to exhale. Used the machine for 4 hours before cutting it off. Wake up with a sore right nostril. here's my data from last nite, ignore the first 1/2 hour till where I fall asleep. I cough some and do other things which probably score as events on the machine. a AHI of 2.71 doesnt strike me as too bad? I think I still have to deal with a little leakage..

I cant get into my cardio, he's booked solid. My ENT is till Feb but im on the cancellation list.

Funny thing, the desat events only seem to occur when Im initially trying to fall asleep with the machine. Last night I woke up and went to the window to check out something outside. I laid back down and fell back asleep no prob. Slept another couple hours and woke up after dreaming like an IMAX. Feel a little better this morning too.

Mark
   
12-28-2015 11:47 AM
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PoolQ Offline

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Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Sillicon Valley

Post: #26
RE: Getting worse..
Just a quick thought. You talked about events happening while you are awake. Same thing happened to me any time I laid down. Took a while to figure out mild COPD on top of sleep apnea.

Any dusty environments, smoking... in your background? Just a thought.
12-28-2015 12:49 PM
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justMongo Offline

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Posts: 3,845
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #27
RE: Getting worse..
By the numbers, last night looks rather good.

There is still the issues pointed out by Sleeprider --
"Mark, something I've noted for a long time on your data is your tidal volume on CPAP is low, and would be appropriate for a small person. Also, you have a long inhale and short exhale, nearly 3:1 ratio. This is inverse of the normal breathing pattern in which exhale is equal or longer than inhale time. May not be significant for you, but also might be worth discussing with your doc."

It's possible that the machine is mis-interpreting your TV and I:E ratio. These machines are amazingly smart; but can be tricked by an unusual patterns.
That's why Sleeprider wanted you to to zoom in on your flow graph so one could see your individual breath waveforms; To see if you are truly taking a long but shallow inhale followed by a short exhale.

Sorry about the cardio doc... Dang VA.

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.
12-28-2015 01:15 PM
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GTOdude Offline

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Posts: 94
Joined: Dec 2015

Machine: RemStar Auto APAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFIT P10
Humidifier: Unsure
CPAP Pressure: 7-14
CPAP Software: SleepyHead EncoreBasic

Other Comments: Other Dx: cabg x3 '94. Hypothyroid '15 and other maladies.

Sex: Male
Location: Central Valley, Left Coast

Post: #28
RE: Getting worse..
(12-28-2015 01:15 PM)justMongo Wrote:  By the numbers, last night looks rather good.

There is still the issues pointed out by Sleeprider --
"Mark, something I've noted for a long time on your data is your tidal volume on CPAP is low, and would be appropriate for a small person. Also, you have a long inhale and short exhale, nearly 3:1 ratio. This is inverse of the normal breathing pattern in which exhale is equal or longer than inhale time. May not be significant for you, but also might be worth discussing with your doc."

It's possible that the machine is mis-interpreting your TV and I:E ratio. These machines are amazingly smart; but can be tricked by an unusual patterns.
That's why Sleeprider wanted you to to zoom in on your flow graph so one could see your individual breath waveforms; To see if you are truly taking a long but shallow inhale followed by a short exhale.

Sorry about the cardio doc... Dang VA.
Here's a little snapshot of my flow rate including one hypopnea marker. If I read it right, short inhale (under pressure) and a longer exhale?

Also smoked since age 13, quit at 35 in '85. Got one dog and three kitties.

I dont mess with the VA much. Their sleep clinic only gives old straight CPAP machines. Went there a few years ago. I use the civilian system cuz im pretty well covered.

Mark
   
12-28-2015 02:12 PM
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PaytonA Online
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Posts: 3,006
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #29
RE: Getting worse..
Long inhale, short exhale. Do you have COPD?
12-28-2015 02:26 PM
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GTOdude Offline

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Posts: 94
Joined: Dec 2015

Machine: RemStar Auto APAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFIT P10
Humidifier: Unsure
CPAP Pressure: 7-14
CPAP Software: SleepyHead EncoreBasic

Other Comments: Other Dx: cabg x3 '94. Hypothyroid '15 and other maladies.

Sex: Male
Location: Central Valley, Left Coast

Post: #30
RE: Getting worse..
(12-28-2015 02:26 PM)PaytonA Wrote:  Long inhale, short exhale. Do you have COPD?
Not to my knowledge..

Mark


(12-28-2015 12:49 PM)PoolQ Wrote:  Just a quick thought. You talked about events happening while you are awake. Same thing happened to me any time I laid down. Took a while to figure out mild COPD on top of sleep apnea.

Any dusty environments, smoking... in your background? Just a thought.
Worth checking out.. Maybe ill make an appt with a Pulmonologist.

Mark
(This post was last modified: 12-28-2015 02:34 PM by GTOdude.)
12-28-2015 02:32 PM
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