Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Does your oximetry program have the ability to report pulse events?
Post Reply Post Reply
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thank you very much for getting back to me Rubicon.  I have a Wellue Sleepu wrist pulse oximeter.  I don't think that it reports (pulse) events.  I think it only records heart rate all night in graphic form.  

I am deferring to you here Rubicon.  I know in SPO2 (ODI) that either a 3% drop or 4% drop constitutes an "event."  I don't even know what constitutes an event in pulse rate recording.  I am all ears if you will explain it to me.  Sorry about that.  Is it a sudden % drop or gain?
Download OSCAR
OSCAR Chart Organization
Attaching Files

Advisory Members serve as an "Advisory Committee" to help 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.  
Post Reply Post Reply
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
A Pulse Event is generally considered to be a change in rate by at least 6 bpm for a minimum duration of 8 seconds but not an AASM required parameter.  Being able to  have the software do the calculation makes the job a heckuva lot easier tho
Post Reply Post Reply
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thank you for explaining that Rubicon.  I will look into getting this software.  

Basically, I saw more heart rate variability using the ventilator.  I saw more variability in SPO2 using the ventilator also.   Does heart rate variability = central apneas?  Or not necessarily?  Is a straight horizontal line SPO2 better than one with more variability?  Or not necessarily?  To me, my heart has to work harder using the vent. to circulate the increased air that is introduces into my system.   I want the healthiest, best balance long term between my respiratory system and my cardiovascular system.  You have seen many more of these charts than me though.  Please correct any errors in my thinking here.
Download OSCAR
OSCAR Chart Organization
Attaching Files

Advisory Members serve as an "Advisory Committee" to help 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.  
Post Reply Post Reply
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Update:  I saw the Pulmonologist today.  It has been a 2 month wait to get in to see him.  My PCP is absolutely excellent with her referrals (it was worth the wait).  The Pulmonologist has about 35 years of experience and specializes in sleep apnea treatment.  He said he has seen thousands of sleep studies.  Definitely worth the trip today for sure.

I had basic bloodwork for electrolytes (metabolic alkalosis) tested in April.  Came back normal.  My arterial blood gas draw actually showed just the opposite of what we were anticipating:  I had lower CO2 in my blood than normal).  This helped get me the Pulmonologist consult.  

I took all 4 sleep studies and the lab report from April to the Pulmonologist this morning.  He looked at the labs and 2 capnometry and home sleep studay for about 5 seconds.  He then looked over my clinical polysomnography I had done last June for 15 minutes.  He went over it with a fine tooth comb and found numerous errors.  He wants me to have another one done at his lab (this will be my 5th).  

He was not concerned at all with my respiratory rate varying from 5 to 48 at times during sleep.  He was not concerned with my tidal volume shallowing during sleep.  After looking over the entire 9 pages, the only thing that concerned him was, "my central sleep apnea."  I asked him if it could be neurological in origen.  He was 99% sure that it was not.  He thinks my central sleep apnea is 2ndary.  He believes it is caused my breathing mechanics (poor shallow inhale and exceptionally strong exhale).  

I did a lot of tests this morning.  He said the results of the tests showed that I have COPD, but he assured me that I do not.  He said he has had many false positive tests like this over his career, and with my athletic history, never smoked or lived with a smoker, and low bmi, I absolutely do not have COPD.  He said I have a poor (shallow) in hale, but an exceptional exhale (I blow off CO2 better than anyone he has ever tested).  This unique combination explains why it has been so exceptionally difficult for me to tolerate either pap or a vent.  He had me do a chest x-ray also (I won't get the results for awhile).  

He is not even worried about me having Cheyne-Stokes respirations 21% of the time on the home sleep study.  He explained Cheyne-Stokes:  the brain realizes it is getting low on oxygen.   It sends a signal to diaphragm for more air.  Signal is not heard.  The brain panics and send out an emergency signal very loudly:  body responds by hyperventilating (panting) bringing in a lot of O2 very quickly.  But the brain always overshoots its target.  I prefers to err on the side of too much oxygen rather than too little.  When the brain realizes it has too much oxygen it sends the signal to the body to "knock it off."  Have a central sleep apnea or 2 or 3 and just stop breathing for awhile.  I have plenty of oxygen for the next minutes or more.  I will let you know when to start breathing again.  O2 finally gets low again and the process repeats itself over and over as necessary.  

He said with most people Cheyne-Stokes points to another serious problem that needs to be looked at (CHF, etc.), but mine is probably just the way my brain and body have adapted to my faulty resting breathing mechanics (too shallow and short inhales, but exceptional exhales - blowing off too much CO2).  

He is familiar with all paps and vents.  He said the ASV could work for me if my volume stays high enough at night. (I am trying my best to sleep with the ASV, but still have not been able to do it.)  I may lower the PS max.  (My asv adapt only has one epap setting and 2 PS (min and max) settings.   The epap at 5 seems to be ok.  I have the PS numbers you gave me Sleeprider programmed into it that you gave me (the standard settings).  

He likes the Evo and is very familiar with it.  He said he can tweak it a thousand ways to get my respiratory rate more stable, volume more stable, etc.  He likes both the newer IVAPS and AVAPS (the flexibility of them and the more things you can do with them).  He was not very concerned with me and said that he has seen much worse.  He really liked my SPO2 numbers (96) average during sleep, so all the rest does not concern him very much.  

Long term he thinks my current set up of the 45 degree angle upper body wedge and very large thick cervical collar (that basically immobilizes my neck at night) should be fine the rest of my life.  But he said it could get better with either the ASV or the Evo (if I could ever learn how to tolerate it).  

When Rubicon went over my sleep study here, he said basically the exact same things the Pulmonologist told me today.  Sleeprider, you have told me many of the same things also (and DaveSarcastic - I hope Dave frequents this board also in the future).  I sincerely hope Rubicon decides to visit apneaboard again in the future.  He is an incredibly valuable resourse in my opinion.  Everyone here is with there varied experiences.  I come here and read the posts just about every day.  

Comments and suggestions welcome by everyone.  Especially anyone who have had or known someone with my unique breathing pattern:  (very poor inhale, but exceptionally good {too good} exhale).  How was this solved?  Any theories on what could help me here I would appreciate also.  I am all ears.
Download OSCAR
OSCAR Chart Organization
Attaching Files

Advisory Members serve as an "Advisory Committee" to help 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.  
Post Reply Post Reply
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thanks for the update and synopsis of your pulmonology consult. I didn't expect to hear you have COPD based on the results, but that your doctor says the test is a false positive. I never saw an indication of COPD in the history of this thread. It's all interesting, but I can't really tell what direction he wants to take you. It seems he is taking your positional therapy and wanting to add a more sophisticated ventilator on top of it.
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.
Post Reply Post Reply
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thank you very much Sleeprider for the comments.  Thank you to the founders of Apneaboard and the Administrators, Moderators, Monitors, Advisory Members, all posters, and even people who casually visit just to read and learn.  It is hard work, but you all do a great job of keeping this forum running so smoothly. 

I very much would like to be able to sleep with a night's worth of data with OSCAR on my Adapt ASV.  In my opinion, OSCAR is a fantastic resource, and I believe that if I could post my OSCAR charts here, someone would see something significant that the Pulmonologist, RT, PCP, and ENT have missed.  There are many intelligent and helpful people here I have found.  

I have another question.  I read a post, I believe it was earlier this year, where you stated your former occupation Sleeprider.  I will try to provide some context for my question.  I did a lot of research last night on COPD.  The vast majority of cases are caused my tobacco smoke or 2nd hand smoke.  But a few cases could be caused by exposure to chemicals, airborne pollutants, etc.  I grew up on a cotton farm.  I don't remember any chemicals used during that time, but lots of blowing sand and dirt and dust.  Also, where I live now is right in the middle of an oil patch.  Oil everywhere.  In town here about every 10 blocks or so is zoned specifically for oil production (the entire block is fenced with a large pumpjack on it).  Just outside the city limits is a "sea of oilfield pumpjacks."  Too many to count.  When I come back into town after being out of town, I can smell the oil smell in the air.  

Smoke and 2ndhand smoke have been ruled out in my particular case here.  In your opinion, Sleeprider, could either blowing dust and dirt and sand, or simply living in the middle of this oilfield community contribute to COPD?  I have never directly worked in the oilfield though.  I don't recall ever being significantly exposed to any chemicals during my life either.  An older sister of mine was diagnosed with Asthma about the exact same age that I am now (she has lived around here most of her life, too.).  Thank you very much.
Download OSCAR
OSCAR Chart Organization
Attaching Files

Advisory Members serve as an "Advisory Committee" to help 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.  
Post Reply Post Reply
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Cotton is well known for occupational exposure resulting in "brown lung disease". Agricultural workers and people living in dusty agricultural areas are affected by many contaminates, including an abundance of mold spores. Research "Valley Fever" which is common in California. The spectrum of pulmonary diseases associated with agricultural operations are numerous and this article discusses some of them https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764055/ . Ambient exposure to fumes from the oil production fields can be significant, with the diesel motors that run the pumpjacks being one of the leading causes of toxic emissions and fine particulate. Any or all of these can have a cumulative effect on lung function and other health concerns.

You certainly have an abundance of potential exposures that can be damaging, and individual response and risks will vary according to types, intensity and frequency of exposures. Certainly second-hand smoke is a well documented risk, but there are so many more particulates, pathogens, chemicals and irritants that can affect an individual over a lifetime, that it's really hard to quantify.
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.
Post Reply Post Reply
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thank you very much again for your expertise Sleeprider.  I have a follow up appointment in about a month.  I will mention these things and see if further testing and possible treatment are needed for either of these.
Download OSCAR
OSCAR Chart Organization
Attaching Files

Advisory Members serve as an "Advisory Committee" to help 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.  
Post Reply Post Reply
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thanks to everyone for this fascinating thread....what a wealth of information and intelligent analysis !
Re: the Inspire Device (even though this may not be of ultimate importance to Jay 51's condition)  it's my understanding that this stimulates the hypoglossal nerve at each inspiration so as to keep the tongue from falling back and closing off the airway.  I think about 20,000 people so far worldwide have had the device implanted.  The criteria as I remember them for being a candidate include BMI under 29, no concentric palatal collapse, moderate to severe apnea, and central apnea less than 25% of the total.

My doctor has approved me for the device and I should be getting it 'installed' in the next few months.  I'd be interested in any reports from those who have it.
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  What's the best home sleep test currently on the market? Lucky7 4 118 2 hours ago
Last Post: OpalRose
  [CPAP] First Post - Can't stay asleep with CPAP DKane 9 157 8 hours ago
Last Post: SarcasticDave94
Question [Diagnosis] Home Sleep Study Results & Feedback togapilot 6 532 03-26-2024, 02:36 PM
Last Post: togapilot
  Central events while falling asleep michaelyu15 7 270 03-20-2024, 06:22 PM
Last Post: michaelyu15
  Home Sleep Study - Low AHI but significant desat ArcherNeedsSleep 65 5,930 03-19-2024, 07:08 PM
Last Post: SarcasticDave94
  CPAP making me feel very tense while I'm asleep jlpool 15 836 03-16-2024, 05:34 PM
Last Post: jlpool
  Which biPAP? HalfAsleep 9 254 03-14-2024, 09:04 AM
Last Post: HalfAsleep


New Posts   Today's Posts


About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.