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In anticipation of my BIPAP Re: New Thread
RE: In anticipation of my BIPAP Re: New Thread
In the meantime, here is what I THINK you additionally wanted, wasn't sure.  This is from 2/6.  It looks to me like the "car compactor" waves made an appearance again?



4 Minute Zoom from February 6th charts.  It goes on longer, but couldn't get it all in a zoom.

   

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
Here is the Zoom for February 6th @ 1:50AM I think you requested.

   

I am preparing views of last night's charts, will post them shortly.  Thank you for helping me.

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
And just like that here are charts from last night: 2/7




      Entire chart for last night.

    A zoom I chose to show you because there were no events happening at the moment in this view, just a tiny blip of FLOW LIMIT.

Let me know if you would like anything else or what you might propose at this point.  I have been getting more time asleep with mask and machine, I have been on my medications for about a week, my leak rate is a bit improved, at least for many time areas.  I don't know if I am sitting up as much as I was or not, because I can't view the past few days.




Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
The first graph from 2/5 at 3:50 shows alternating extreme flow limited breaths with two or three strong recovery breaths. Pressure support fully lets you down here and barely supports the limited breaths if at all.

[Image: attachment.php?aid=19799]

Next we have car-compactor FL and again PS fails when it is needed most.

[Image: attachment.php?aid=19800]

Finally, a segment of mostly normal breathing with full inspiration/expiration volume.

[Image: attachment.php?aid=19803]

We have to consider the flow limitations as obstructive. They show some kind of intermittent airway restriction that is, as you describe, like a switch. It's on or off.  For some reason, you don't generally have  a lot of OA events during these flow restrictions, but your fight hard for each breath.  As I mentioned above, your current bilevel works great when the switch is off, but is proportional to respiratory flow, and so PS becomes nearly zero when severe FL occurs.  We have discussed ASV as a solution, but I'm starting to think a change in tactic might help convince doctors to prescribe an appropriate device for this severe obstructive flow limitation, the Resmed Aircurve 10 ST-A. 

The ST-A has multiple modes including all the modes of the ST (CPAP, VPAP-S, T, PCM, ST). It also have a iVAPS which is specifically designed to ensure your respiratory volume (alveolar vent rate) and breath rate are consistently met.  Unlike ASV, it has a maximum pressure capability of 30 cm. It uses fixed EPAP to resolve OA events, and applies dynamic pressure support to fight obstructive pulmonary resistance as needed when needed.  In other words, it can act like a CPAP or mild bilevel when your FL switch is off, and it can raise pressure support as much as necessary to maintain volume, even when you have car-compactor flow limits. Unlike your bilevel, pressure support is inverse to your respiratory flow rate.  It has target breath rates, but uses iBR (intelligent breath rate) to trigger breaths if spontaneous effort is absent.  iVAPS is intended to treat conditions like COPD, neuromuscualar disease and restrictive conditions, and chronic hypoventilation.  You have respiratory issues the resemble COPD restrictive conditions, but the problem is intermittent.  Maybe your medical advisors would be more open to getting you on ST, but you want to get the ST-A iVAPS mode.  At least this approach might make them more comfortable, since you don't have central or complex apnea, but have severe obstructive airway resistance.  We know full time high pressure support is not a good solution from using VPAP-S, but the iVAPS could turn that PS on and off and ramp it up to as high as necessary to maintain volume without hyperventilation. It would resolve both of the first two examples in this post by stabilizing and evening out respiration, and would back off and let you breath as in the third example.
Sleeprider
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RE: In anticipation of my BIPAP Re: New Thread
Thanks 5 For your detailed response to my situation.

I have just printed out this last reply and will physically go to the sleep doctor's office on Monday with this in hand, if you think that is ok that is.

I am growing weary of not getting actual medical support and having to rely on the members of this board to get any help.  I have been searching for a specialist that might be willing to work with me, but in my immediate area that seems impossible.  I have contacted 3 doctors outside of my state that appear to be well versed in helping those like me.  One, Dr. Krakow is in AZ and is no longer seeing patients, he is passing them on to new doctors taking over his clinic.  Two have not responded to my inquiries.  I was hoping that the sleep department at Mayo Clinic in Jacksonville might have someone and wanted to talk about options with them, but it is a complicated process with them.  They were of great help to me in the past for a different issue, so they might be worth pursuing.  (IF I can't get results with my current doctor).

So, it seems we have reached the end of the line for tweaks to my current machine that would give me consistent results of decent sleep.  I'll continue to participate on this board, just not be so prolific with my chart analyzation requests. 

I do want to remind everyone that quite a while ago I mentioned I noticed in my videos periods of time when it was obvious my breathing was labored.  I don't know if any of what you have talked about in your last reply is pertinent, but the heaving up and down, in and out of my chest while I am asleep always concerned/interested me, but I was told this was just normal, the way people breathe.  I just wasn't able to accept that and ultimately let the issue drop.  It wasn't a constant thing but periodic.  When my breathing appeared "normal" my chest, stomach, etc. rose and fell at a gentle, even pace/rate.  When not doing this, it was like one of those elevator drop rides.  COULD THESE BREATHS BE TIED TO THE RESULTS OF THESE CHARTS?  Or maybe I am over analyzing things again?

Most Appreciatively,
Phoebe
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
Absolutely! The flow limitations we see in these charts reflect a person working hard to get a breath of air. Your description of a chest heaving with labored effort is exactly what I would expect. That is where the kind of pressure support from iVAPS could really assist, and unload this effort of breathing onto the machine when you need it. At other times the iVAPS will simply follow your normal spontaneous breathing. That's the whole idea. Let you breathe and standby to assist. I think many people would be unable to breathe with the kinds of flow restriction we see in your charts, and there would be extraordinary hypopnea and OA. You have a very strong respiratory drive that does not quit when it encounters restriction. I just wish we could better understand the physiology of these episodes. To my unpracticed eye these look like asthma attacks that come and go, but your lack of daytime symptoms is perplexing.
Sleeprider
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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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RE: In anticipation of my BIPAP Re: New Thread
Finally!

If my current sleep doctor can't provide me the help I need, off I go to hunt one down who will.  Between your reply and maybe, just maybe, finding such a breathing episode on the one and only video I downloaded to my computer there will be SLEEP!!!   Cool

(If this isn't possible I guess I could look for the machine you recommend from a private source)?

Best Wishes,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
Re-read my last reply because I edited.
There are two current threads where an individual has been dispensed ST-A and is not the ideal machine for the person using it. ST-A seems to be getting dispensed on place of ST in some cases, and the two cases we are looking at should be on ASV for complex apnea. The way the machines work and what we are doing with iVAPS might be of interest to you.
First night BiPAP High Pressure - Terrible http://www.apneaboard.com/forums/Thread-...s-terrible
ST Help http://www.apneaboard.com/forums/Thread-VPAP-ST-Help
Sleeprider
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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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RE: In anticipation of my BIPAP Re: New Thread
Hmmm.  I definitely do not have daytime asthma.  Unless, one were to examine me while running.  If I were to run with the health I am in I'd be in big trouble.  Also, at the sleep doctor's office, all of them actually, they have me breathe into some sort of tube/machine, even in a booth of some kind, and they have never said there were any issues.

Lung imaging has never showed them any concern, except for a tiny spot at the bottom of one lung, (this was brought up in around 2003), the doc said the spot may be from an episode of walking pneumonia back when I was younger.  But I have had 0 reports of any other issues with my lungs.

The ONLY other thing I can think of would be how far down my oxygenation level goes when not on pap therapy.  But I'm not sure if this is connected to issues while ON therapy.  I am trying to find a decent quality 02 meter that I can afford.  Maybe that would help figure things out?  Back in 2003 at my very first appointment with sleep doctor they took arterial blood gas measurements, but I don't recall the results.  No dr. since has done this test.

I will definitely read the citations of the other threads you mentioned, but before I do are you saying that a different machine will NOT help me, or are you saying it needs to be the ST-A, or are you saying we need to concentrate agin on the ASV, or are you saying I probably need the iVaps machine, or are you saying one of these machines does it all?   Huhsign . It is possible the latest prescription from the sleep doctor was an iVAPS.  For some reason the last conversation I had with their office this MIGHT have been mentioned by them.  Is it easier to get an IVaps than a ASV?  Maybe this was their solution to not being able to get the sleep lab manager to test me on ASV.

Sorry, as my signature line states I tend to get befuddled at times.

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
The tube you breathe into is a spirometry or pulmonary function test. I would expect it to be normal, and it seems likely whatever the restriction is, comes from the upper airway. Like I said, we don't know.

I am focusing on the ST-A as appropriate for you. I actually brought it up very early on in these threads, but jumped on the ASV bandwagon as we were seeing other users treating flow limitation with it. For your episodes of flow limitation, it seems like the best choice. You don't need the fast response of ASV, and iVAPS seems to be a good fit for the kinds of restrictive flow limit that seems to happen from time to time. If there is any problem, it is that you can go several nights and not have a single episode, then the switch flips and it is pretty awful. This makes diagnosis and sleep testing very difficult, but points to the value of a device that can provide the pressure support of your Vauto, but increase PS as needed, rather than dropping support when you need it most. Most importantly, the ASV is becoming a contentious issue with doctors due to the warnings from SERVE-HF, and of course, you don't have CSA. I think there will be much less resistance to ST-A.
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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