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I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
#91
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
A significant cause of central apnea is hyperventilation, and the Astral probably ends up assuming more control of your respiration as your respiratory drive fails. It is going to maintain the set respiratory volume and pace, so you will be breathing, but relatively little of that will be spontaneous. The ASV will use a 3-minute window to establish your normal minute vent and rate. The main difference is it steps out of the way when your spontaneous effort is good, and it won't promote hyperventilation. I applaud your efforts to make therapy work, however am still baffled that you ended up with a full non-invasive ventilator. Anyway, Merry Christmas. Enjoy the holidays and it looks like you will be picking up with the cardiologist in the new year.
Sleeprider
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#92
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thank you for that detailed explanation Dave.  You have been through this several times.  This is my first time through this process (2nd counting ST-A).  I will give your exact explanation here to my 1.  RT at DME:  I will text her (and hopefully meet soon, too) 2.  Definitely to the manufacturers of the Astral.  I have their number.  3.  my PCP in January. 

I do have Central Apnea and not respiratory disease.  I am unfamiliar with the different ways these different machines treat these 2 categories, but thanks again for explaining this to me, Dave.  Now I know the difference and this knowledge should get me from the Astral to the ASV faster.
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#93
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
OK best wishes for a happy holiday. Keep us updated on progress.
Dave

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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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#94
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thank you for that post and explanation also Sleeprider.  Hyperventilation is exactly what I feel like is happening to me with the Astral.  I remember having to stop the polysomnogram because I felt like I was hyperventilating (you said that regular bipap without back up can significantly increase central apneas I remember).  
I definitely get the feeling that the Astral will never back off even when I am breathing normally.  I have 2 more very significant terms to use now in my attempt to get the ASV:  hyperventilation (what I don't want) and spontaneous breathing (what I need and the ASV will produce more of it).  
Multiple times I have contacted my RT with questions like this and the response I got was either no more returned phone calls or no more returned texts.  I have bought into the ASV because both you and Dave have explained everything to me and have answered all of my questions.  Much appreciation again.  

Merry Christmas and Happy Holidays to both of you as well.  The Astral (both a machine that I don't need but am having a little difficulty returning) (and the machine Dave really needs, but he can't seem to get his hands on one yet).
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#95
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
I'll add a third term; hypocapnia. The real effect of hyperventilation is a reduction of CO2 (hypocapnia). CO2 is an important cog in your respiratory drive, and while the process is complex, involving bloodstream CO2 and pH and interaction with the Carpal Bodies, it is a major cause of idiopathic central apnea. The American Academy of Sleep Medicine. International classification of sleep disorders, second edition: diagnostic and coding manual concludes there are two basic mechanisms that trigger central respiratory events: (1) post-hyperventilation central apnea, which may be triggered by a variety of clinical conditions, and (2) central apnea secondary to hypoventilation, which has been described with opioid use. I don't want to lose you here, but if you hyperventilate due to the use of a ventilator, you will become hypercapnic and many individuals experience a loss of respiratory drive and consequential central apnea or periodic breathing (Cheye-Stokes Respiration).

AASM identifies 6 causes for central sleep apnea syndrome (CSAS). (1) Primary Central Sleep Apnea, (2) Central Sleep Apnea Due to Cheyne Stokes Breathing Pattern, (3) Central Sleep Apnea Due to Medical Condition Not Cheyne Stokes, (4) Central Sleep Apnea Due to High-Altitude Periodic Breathing, (5) Central Sleep Apnea Due to Drug or Substance, and (6) Primary Sleep Apnea of Infancy.

You probably fall under (3) which is an undefined (idiopathic or unknown) medical condition. We have had members that experience CA as a result of all these above conditions. High altitude CSAS and idiopathic or unknown cause CSAS are the most common and most difficult for most physicians to diagnose and treat. Both of those categories are highly affected by hyperventilation, and may only display CSAS after being placed on CPAP to treat obstructive sleep apnea syndrome (OSAS).

Okay, it's almost Christmas Eve, but if you want to pick up this technical discussion further let me know. Much of it can be found here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3242685/
Sleeprider
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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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#96
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Hi Jay,
       WOW - long post, but will jump in here.  I have mixed sleep apnea AND INSOMNIA.  Mostly see CSA events now.  I wanted aircurve ASV but doc would not go along.  I have been using airsense auto and getting low events.  I ALSO TAKE LUNESTA TO HELP WITH THE INSOMNIA.  That is powerful stuff and one 1 or 2 mg is enough.  I can go to sleep fairly easily but wake up hour or 2 later.  Taking 1 mg twice in nite gets me thru.  Tried benedryl first, but that failed after a while.
Under 4 events/hr - mostly under 2.
          Good luch,   Steve   Sleep-well
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#97
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thank you for that Reply Steve.  I think the vast majority of my problem is mechanical (physiological) and caused by sleep apnea.  I believe the ASV will be my permanent solution.   I can fall asleep rather quickly most nights and can easily doze off for a nap during the day.  But my problem has been waking up several times during the night.  With each successive time I wake up during the night, it is a little harder to fall back asleep, too, I have noticed.  

Maybe 15 years ago (before I had any sleep apnea symptoms) I took Benedryl for allergies.  I had to stop taking it because it made me too sleepy/drowsy.  I now see though that I can purchase some of it over the counter and used it when needed as a boost to help me fall asleep (and maybe even stay asleep) when necessary.  I don't think I have an "insomnia" component to my situation, but I could be wrong.  If I incur problems that the ASV (and even Benedryl) can't solve for me, I will go to my PCP about possible Lunesta, etc.  But thank you again for the suggestion. 

In hindsight, I wrote on my medical history:  2 concussions (high school), 2 motor vehicle accidents, mother has Myesthenia Gravis (an autoimmune disorder that is not hereditary), and father's mother died of Parkinson's disease (he has not been diagnosed with it).  I wrote these things simply to help insure that I would get the consultation from my PCP to get an overnight polysomnography.  The only reason I paid out of pocket for the 1st home sleep study I had done was also to help increase the odds that I would qualify for the polysomnography.  

My Doc recommended I get a routine colonoscopy procedure this past February.  I am very curious what the Anesthesiologist (gives the gas that puts a patient to sleep before surgery) saw during this procedure.  Did I start snoring and stop breathing?  What was my heart rate and blood pressure?  I am going to ask about it in a few weeks at my appointment.  In doing some research I saw where anesthesia could pose some potential problems for patients with sleep apnea during surgeries.  I definitely plan on writing on every medical history from now on that I have sleep apnea (2:1 ratio of central to obstructive) mixed type to be safe.  

Lastly I want to explain something else.  The research I have read states that a very large percentage of people with sleep apnea are never even diagnosed with it or receive any treatment for it.  And that many people have died from secondary problems caused by sleep apnea:  heart attack, stroke, etc.  "So why didn't you seek treatment earlier for your situation?"  My answer is that I did.  

At least 2 years ago when I saw my PCP I stated that I felt tired during the day and work up several times during the night (and also the "buzzing sensation").  My PCP's response:  you have BPH (benign prostatic hypertrophy - enlarged prostate making you urinate more frequently) and nocturia (have to go to the bathroom more at night also).  So I was prescribed Flomax for it.   After a year of taking it, no change at all.  

One year ago I go to PCP and say the same thing: "I feel tired during the day (I have to take naps) and I wake up usually 5 times or so during the night.  I feel a buzzing sensation in my chest, neck, head, and left arm when I wake up during the night that goes away in a few minutes."  This time the response I got was:  it could be a pinched nerve in you neck.  So I had X-rays and and MRI and both came back negative (no pinched nerve).  


This year at the chiropractor I am seeing for some back tightness diagnosed 15 years ago, she says, "You could have sleep apnea."  This was the 1st time I heard the words from any medical practitioner.  This is how I got started on the correct path.  About 10 years ago or so I noticed in talking to family, friends, neighbors, coworkers, etc.  that whenever they said hi and how are you doing, my standard response was, "I am doing ok, but I feel a little tired."  Their response was almost always the same:  "I feel tired, too."  So how was I supposed to know that my tiredness was abnormal and caused by sleep apnea when everyone else is tired, too?"  

"Why didn't you get the "buzzing" - A-fib checked out earlier.  My response:  In my personal experience with A-fib at night, it is not painful at all and disappears quickly.  It does not hurt and was very tolerable to me.  What I realize now though is that even though it was relatively painless and very brief when experiencing it, the pain comes later:  it robs me of sleep at night and causes daytime sleepiness.  I just didn't see it until now.  I have been ignorant to what sleep apnea is doing to me at night because I am unconscious (asleep).  But educating myself has helped motivate me to take more and more positive actions in treatment.  #'s like 32.4 AHI,  02 saturation as low as 79 at night; pulse rate 155 and 40 at times during the night, have motivated me in a positive way.  Blood pressure was not recorded on my polysomnogram, but how high is it getting during my apnea events?  Is it getting abnormally low, too, at times?  It seems like blood pressure could be recorded on a polysomnogram by putting a blood pressure cuff on the person during the procedure.  Maybe it would disrupt sleep too much and that is why they don't do it.  BP could easily be taken before the person begins the polysomnography and each time they wake up at least.  Seeing my BP #'s would have definitely motivated me to get checked out by a Cardiologist sooner.  Oh well, I feel grateful to be exactly where I am right now.  I have the feeling that others have gone through even stranger situations to get diagnosed and have had even stranger treatment plans (I had an error on my polysomnography because they didn't try ASV that has led to being given not one, but two pap machine (one a home ventilator) erroneously.  Thanks for listening.  Hopefully something in this post will help someone else, too.
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#98
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Hi Jay,
     Many thanks for the detailed responses.  I have many of the same problems.  I am former athlete and marathon runner.  I found out much later that the marathon running was a very bad idea.  Many cardiologists agree that this damages heart and leads to arhythmias much later.   Sure enough 2 in group of five (maybe more) have pacemakers and arrhythmia.  Did the arhytmias lead to the sleep apnea or vice versa?  Did not get clear answer from Sleep Doc... \I am also waking up to pee, way too many times and PCP recently said probably enlarged prostate.  Currently tweaking settings on the airsense 11 and hoping the AHI numbers stay low.  I noticed that one of the responses to you posts referenced a ncbi article suggesting ambien as possible treatment.  I have tried that and much prefer the lunesta - although I would like to get off that habit... Happy New Year,   Steve
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#99
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
By my own experience, be sure to tell the anesthesiologist of your Central Apnea and that you're currently on the Astral. May be best to mention on phone during appointment setup too. Likely you should bring the Astral kit in the case with you, even if it's not the correct therapy. It's a just in case thing. I actually used my ASV during a kyphoplasty back surgery 12/28/18. I did need intubated once in '16 during a different surgery with active OSA diagnosis but before CA.
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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RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thank you Dave.  I can take my pap machine with me anytime in the future that I am under anesthesia.  Thank you Sleeprider.  I can now explain my hyperventilation and hypocapnia.
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