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Hyperventilating in General
#1
Hi guys,

I posted a while back and you were all really helpful in helping me out, I ended up figuring out to use a pressure of 18.5 - 20, this was okay, but I would regularly get AHI's of 3-4, so I upped the pressure to 20.  I've been doing this for a while with mixed results, even if the AHI is low I might be sleepy, but besides that, it has been hard to breath in general.

I've always yawned a LOT, but it seems like even when I yawn it's hard to get that satisfying yawn.  As of lately I've been breathing heavy and it feels like I can't get enough air regardless of CPAP or just sitting around the house in general.  Here are some graphs showing me attempting to get my lungs full of air, I've tried my best to breath more shallow, but sometimes I end up waking up breathing really deep.  I don't think this is related to my apnea at all, or maybe its a compounding issue, any help would be appreciated.

I'm 24 / male / ~170lbs and I exercise regularly

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#2
I'm only new, I really would get to a doctor, your rapid breath, low tidal flow and max pressure says your current treatment isn't working for you. perhaps using the EPR function may help with breathing, but it may not help with max pressure and the obstructive apneas still present. Did you have a sleep test, my other thought was if on a nasal mask with nasal obstruction may throw the numbers out. also the breathing may be from another cause, unrelated to apnea. I really would see a doctor.
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#3
With pressures that high, you should be on BiPAP. It would make exhale much easier, improve tidal volume and better treat events. After reaching a pressure of 14 or 15, CPAP becomes less tolerated by many people. Discuss bilevel with your doctor. Take a look at Medicare or CMS Approval criteria for bilevel PAP. https://www.cms.gov/Outreach-and-Educati...905064.pdf
https://www.google.com/search?q=hipaa+pa...8&oe=utf-8
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#4
Yes. I wondered also why you were not using a mode that gave you some exhale relief.  Usually it is 2 cm for this machine in APAP mode.  Could you do APAP with min of 20 and max of 20, and see what that does?

Sorry if that was already something you have been through.

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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#5
(04-22-2017, 06:32 PM)ajack Wrote: I'm only new, I really would get to a doctor, your rapid breath, low tidal flow and max pressure says your current treatment isn't working for you. perhaps using the EPR function may help with breathing, but it may not help with max pressure and the obstructive apneas still present. Did you have a sleep test, my other thought was if on a nasal mask with nasal obstruction may throw the numbers out. also the breathing may be from another cause, unrelated to apnea. I really would see a doctor.

I'm in the process atm, he seemed to be persistent on lowering the pressure, but whenever I do I get significantly more events that I don't sleep very well.  I mentioned tidal volume (because your body does breath automatically when asleep, although CPAP must make a difference), but he told me he only really cares if the machine is treating me and that the AHI is lowered.  I had an at home sleep test that was somewhat inconclusive, my nose randomly closes up at night, I'm almost always breathing out of one nostril, despite using flonase / anti-histamines..

(04-22-2017, 08:00 PM)Sleeprider Wrote: With pressures that high, you should be on BiPAP.  It would make exhale much easier, improve tidal volume and better treat events.  After reaching a pressure of 14 or 15, CPAP becomes less tolerated by many people.  Discuss bilevel with your doctor.  Take a look at Medicare or CMS Approval criteria for bilevel PAP.  https://www.cms.gov/Outreach-and-Educati...905064.pdf
https://www.google.com/search?q=hipaa+pa...8&oe=utf-8

I think this would be the best option to look into for me.  I'm also somewhat concerned on the "why" this is exactly happening, I'm in good shape, why would I need such a high pressure and get such a low tidal volume for my age/weight, any ideas?  The only way to truly know is probably some type of sleep endoscopy?

Also, doesn't EPAP treat hypopneas?  Wouldn't that just force me to raise my inhale pressure a little higher overall for more ventilation?

Also, side note: I'm like almost always excessively yawning, regardless of what I'm doing I have no idea what's going on ..

(04-22-2017, 08:21 PM)quiescence at last Wrote: Yes. I wondered also why you were not using a mode that gave you some exhale relief.  Usually it is 2 cm for this machine in APAP mode.  Could you do APAP with min of 20 and max of 20, and see what that does?

Sorry if that was already something you have been through.

QAL

I think I've tried that with Aflex set to 3, still got AHIs above 3 with mixed results..  I might've gotten a Median Tidal Volume of around 420, which is a little higher.  My tidal volumes have been extremely random, I think sometimes they get really low and maybe that is why I haven't been breathing well?


It seems like even with a "good" AHI my body reallllly needs to sleep regardless..  Don't get me wrong I noticed significant differences on CPAP, but it hasn't been consistent enough to stop me from fighting falling asleep during the day.  I once slept like 2-3 nights in a row with 7hours of sleep and felt refreshed, but I haven't been able to keep that consistency for whatever reason..  I've been taping and using a special chinstrap to stop leaks, but even then I sometimes wake up hearing my throat closed and as I wake up it opens, but right as I fall back asleep it closes again (I think this happens sometimes when I don't tighten the chinstrap hard enough?)

Also, the leak rate on the graph has looked strange ever since I got a new P10 (ripped the other one off in my sleep and broke the tube on the P10)  I bought a new one, but it still shows unintended leaks for whatever reason, the CPAP tubing didn't have any leaks, but I ended up buying a spare so I will see if that fixes it.



The Doctor wanted to do a titration study with a MSLT at the end, although I feel the majority of the problems are from some type of breathing or apnea..  Is this worth it?  I honestly feel like I'm spinning my wheels with the medical system as it's been years since I've brought this issue up and still haven't gotten a real sleep study...  It's honestly so bad I would be willing to take my chances with surgery as so much time has been wasted and I'm running into so many problems stemming from my sleep...  If I go to bed on any given night I can't predict how long I will sleep and I almost never wake up refreshed..


Sorry for the amount of text, but I really appreciate any input from you guys.  Thanks a ton.
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#6
I'm only going to address this aspect of your quetions:


Quote:I think this would be the best option to look into for me.  I'm also somewhat concerned on the "why" this is exactly happening, I'm in good shape, why would I need such a high pressure and get such a low tidal volume for my age/weight, any ideas?  The only way to truly know is probably some type of sleep endoscopy?

A bilevel machine uses EPAP to support good oxygenation and to prevent central apnea.  It uses pressure support to address hypopnea and flow limitations, as well as to increase ventilation rate and volume.  You have many more tools to work with from bilevel machines.  Your CPAP can only use one pressure to try to treat all.  A bilevel can treat your obstructive apnea at a lower pressure, and use pressure support to treat your low volume and other aspects of sleep apnea. 

At the high pressure you are now using, exhalation is difficult.  Think of a shock absorber that is in a repeating series of bumps that becomes packed down to where it no longer extends; it can only operate in a short range and so the ride gets progressively bumpier.  With pressure, if you fail to fully exhale, you can't inhale your full Tv.  This most often happens with COPD patients including asthma sufferers.  They have a medical need for bilevel because they otherwise will not fully breathe.   If you have any conditions like this, it simply point to another reason you should be using bilevel. 

The main point to make is the current pressure is "intolerable".  "I can't sleep comfortably".  You can point to symptoms like lowered Tv and continuing events to justify a change to a machine that can probably treat you with a much lower pressure.  I think your obstructive apnea at a pressure of 20 is due to pressure being too high and it is mimicking obstructive apnea because, like that shock absorber, you're all stacked up.  You need a biPAP titration, or an auto bilevel machine and an order to self-titrate.
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#7
Thread Revival:


I am fed up so, I ended up buying a Resmed Aircurve 10 VAuto to help resolve this..  Now the thing is, my Dreamstation rarely ever showed Clear Airway events, now this one is exclusively reporting Clear Airways, though it was my first time using it and I left it on the default settings..  I also definitely felt like complete crap after waking up yesterday.

My tidal volume still looks low on this, I'm not really sure what settings I should try tonight to see if it gets any better.  I'm not as familiar with configuring a BiLevel machine, I might just try putting the EPAP setting to 16 minimum tonight and see what happens..  (It also seems to always have the IPAP being 4CM higher than the EPAP, there must be a way to configure this?)  The machines don't seem to respond fast enough for my events so I'll need to find a pressure eventually without using auto most likely.

I appreciate any help you guys can give me, thanks.

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#8
The same as 3 months ago, I think you need to see a doctor. The vauto won't treat the CA, hopefully they are pressure induced and will settle.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#9
Sleepyguy, I would cut back on pressure support to 3 and increase EPAP minimum to 6.0 and see if that reduces the events. I can see an eventual need to increase EPAP min, but let's start here. The higher EPAP will likely help resolve OA events and the increase in positive end expiratory pressure (PEEP) will improve oxygenation. Reduction in PS will help prevent CA by not washing out quite as much CO2.

As far as Tidal Volume, that is something that theoretically would respond to increases in pressure support, but I don't think this forum should be advising on that aspect of ventilatory support or manipulation. Your TV seems fairly low, but it would take a pulmonary workup to assess the reasons and best course of action (if any). Lets use CPAP and BiPAP as apnea and sleep disordered breathing devices, and if you have more complex issues with restrictive lung conditions or inspiratory volume, it may be best to discuss that with a specialist.
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#10
(07-28-2017, 07:41 AM)ajack Wrote: The same as 3 months ago, I think you need to see a doctor. The vauto won't treat the CA, hopefully they are pressure induced and will settle.
Thanks ajack, I've seen a doctor about this and am currently waiting on seeing another one about this for another opinion, it's just taking way too long to get treatment..  Yeah this was my first night using it, looks like my 2nd night got a lot better.  

(07-28-2017, 08:05 AM)Sleeprider Wrote: Sleepyguy, I would cut back on pressure support to 3 and increase EPAP minimum to 6.0 and see if that reduces the events.  I can see an eventual need to increase EPAP min, but let's start here.   The higher EPAP will likely help resolve OA events and the increase in positive end expiratory pressure (PEEP) will improve oxygenation.  Reduction in PS will help prevent CA by not washing out quite as much CO2.

As far as Tidal Volume, that is something that theoretically would respond to increases in pressure support, but I don't think this forum should be advising on that aspect of ventilatory support  or manipulation.   Your TV seems fairly low, but it would take a pulmonary workup to assess the reasons and best course of action (if any).   Lets use CPAP and BiPAP as apnea and sleep disordered breathing devices, and if you have more complex issues with restrictive lung conditions or inspiratory volume, it may be best to discuss that with a specialist.
Thanks so much Sleeprider, I've really appreciated the help you've been giving me.  I will try your advice, but last night I ended up going to sleep using a PS of 5.0 with an EPAP of 16 and I woke up after 6 hours of sleep feeling pretty refreshed and remembering 2 dreams (rarely ever happens)..  When I checked my machine it said my AHI was 26, but Sleepyhead is reporting an AHI of 1.24!  I heard Resmed's report lower AHI's, but it seems like the biggest change here was Tidal Volume?  I will definitely bring this up with a specialist, I've just gotten sick of waiting around..

EDIT: Actually, I think it looks like SleepyHead just did not mark any Apnea's for that session for whatever reason..  Though, the higher tidal volume seemed to help.  This might take some messing around with.

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