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Please help, frightened Bipap user with chest pain
#11
RE: Please help, frightened Bipap user with chest pain
Thanks for posting the sleep study. It looks like you have mixed apnea, with both central and obstructive apneas represented, along with some periodic breathing. The derived CA index is 26, with a total AHI of 95. It'll be useful to see your chart.

For what it's worth, I had costochondritis for 4 months while the doctor first tried treating for GERD, then after a clean upper endoscopy had me do several kinds of heart tests, including the nuclear option, plus a lung xray. Once he ruled out those other kinds of problems, he said he was pretty sure it was costochondritis, especially because the pain worsened with deep breathing or bending over. Three weeks of cold packs and ibuprofin, and I was all better.

If you're convinced you have a heart problem, you should talk some more with your doctor to understand his/her perspective on that. Above all, I hope the pain resolves soon.
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#12
RE: Please help, frightened Bipap user with chest pain
Okay, hopefully I did this correctly.  I did leave out a little bit of the graph time, since I used it some while I was awake, to get used to it, so those times are missing from the graph.  

To answer some questions/comments...as far as heart issues, I have had 4 ER visits, countless tests, all ruling out heart issues.  Which basically means, I have no blockages, damage, valve, or flow problems.  I've had endoscopy, liver/gall bladder scans, all clear.  The pain is coming from my heart and it seems there's no "test" for that?  My pain is always worse when sleeping, and I'm about 99 percent sure it's from the apnea and the severe anemia is likely contributing.  I know the cause of my anemia and I need a surgery (UFE), but I can't have it until I get my heart/sleeping problems under control.  

As far as having both central and obstructive apnea, I'm wondering how accurate that is? I did an at-home sleep study and they only had a finger pulse-ox and something taped to my upper chest.  That was it.  Nothing monitoring my brain, feet movements, anything like that.  Are they able to tell central vs obstructive from that?  

Thanks so much for the help!


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#13
RE: Please help, frightened Bipap user with chest pain
Everyone here at AB wants you to succeed.  Since I have a similar machine as you do, I was wondering if you could share the following settings.  What are the values for Trig, Ti_Min, Ti_Max, and Cycle?  These settings can only be found when the machine is in "Clinician Mode".  You can enter the clinician mode by simultaneously pressing both the dial and the home button simultaneously for about 4 seconds.  I have found that some of the default values do not work well for me.  

If you do not have the Clinician Manual for your VAuto bilevel, you can get a copy by going to the top of the webpage and clicking on icon CPAP Setup Manuals.  A copy will be emailed to you.  I found the manual very helpful.

Another thing that works surprisingly well to control clusters of apnea is to use a soft cervical collar.  Please use this link to read about it. Soft Collar wiki  I found about it here on AB.  It actually worked for me and a lot of other people.  19 nights ago I had 56 Central apneas.  Today and yesterday I had 0.  That is what a bilevel could do for you with the proper settings and a soft collar.
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#14
RE: Please help, frightened Bipap user with chest pain
(11-11-2020, 08:31 PM)happydreams Wrote: Everyone here at AB wants you to succeed.  Since I have a similar machine as you do, I was wondering if you could share the following settings.  What are the values for Trig, Ti_Min, Ti_Max, and Cycle?  These settings can only be found when the machine is in "Clinician Mode".  You can enter the clinician mode by simultaneously pressing both the dial and the home button simultaneously for about 4 seconds.  I have found that some of the default values do not work well for me.  

If you do not have the Clinician Manual for your VAuto bilevel, you can get a copy by going to the top of the webpage and clicking on icon CPAP Setup Manuals.  A copy will be emailed to you.  I found the manual very helpful.

Another thing that works surprisingly well to control clusters of apnea is to use a soft cervical collar.  Please use this link to read about it. xxx found about it here on AB.  It actually worked for me and a lot of other people.  19 nights ago I had 56 Central apneas.  Today and yesterday I had 0.  That is what a bilevel could do for you with the proper settings and a soft collar.

Thank you!  I will check into that collar!  Does it help keep my mouth shut?  LOL I'm guessing that could be the issue?  I did get a new chin strap today to try....

Trig: Med
Ti Min:  .3 s
Ti Max:  2.0 s
Cycle:  Med
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#15
RE: Please help, frightened Bipap user with chest pain
Just commenting on the CA's on your graph...
You could try moving the Trigger setting to High.  This has shown to lower CA's for many, including myself.  
If that doesn't work, then we can discuss lowering the Pressure Support a bit.  But only change one thing at a time.

I don't know what to say about the pain you experience, and don't doubt what you are feeling.  
You seem to have had all the necessary tests to detect heart problems, but if it continues, see a Cardiologist.
There could be something they missed, as pain in that area is not normal.
OpalRose
Apnea Board Administrator
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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#16
RE: Please help, frightened Bipap user with chest pain
Before we get into fine-tuning, your current settings have done a good job of eliminating all obstructive apnea. Your leak rate looks excellent and while you have a break in therapy at 04:40, it looks like an excellent night. Your apnea is all central, and that is usually related to ventilation (pressure support) being just a bit high. If you want to deal with that, a simple adjustment is to reduce the pressure support from 5.0 to 4.6. That is only a 0.4 cm reduction, but should help. I'd like you to do this change first, and if that does not clear up the CA events, we can look at increasing trigger sensitivity to high. Your therapy looks great! We don't want to disrupt that and the reduction of pressure support (PS) should get you most of the way there. I use a trigger sensitivity at high and that should help your therapy as well.
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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#17
RE: Please help, frightened Bipap user with chest pain
Not sure if the collar will help you keep your mouth shut.  Your large leaks need to go to zero eventually, but don't seem to be the major problem.   Since your median respiration rate seems to be slightly lower than mine (17.5) I will suggest the following changes.

Trig = High, Cycle = Medium, Ti_Min=0.7, Ti_Max=2.4

For the most part, you seem to have mostly centrals.  Most people have lower CA if Trig is increased.  I ended up at Very High.  First try Trig=High.

The reason I recommend setting Ti_Min to 0.7 is that it appears to be appropriate for respiration rates of 25 and lower.  A value of 0.3 sec is not even shown on the suggested settings in the Clinician Manual on page 6.  Also, since your respiration rate is lower than mine, I would suggest increasing Ti_Max from the default of 2.0 to 2.4 sec or even 2.8 seconds.  This will give you longer time to inhale, should you need it.

Let us know how that works.

I defer to Sleeprider.  He will get you there.
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#18
RE: Please help, frightened Bipap user with chest pain
I see no reason to change TiMin with these results. Please don't.
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.
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#19
RE: Please help, frightened Bipap user with chest pain
I myself have a heart condition called PVC and a few other things that cause a bit of pain. It seems like you've had a stress test and it came back OK. Have you been checked for GERD/acid reflux? I have it a few times a week, and the worst attacks were where I had a burning in the esophagus and a tight pain near the heart. If it continued, I may get a tightness and pain in the jaw and it could accompany acid taste in my mouth or throat. My GERD is most always after eating several peppermint or mint candies, sometimes with coffee or other caffeine containing drinks, some spicy foods or chocolate may trigger it as well.

I'd suggest asking the doc to consider if maybe GERD is the cause. And of course the cardiac doc needs to be made aware of the continued pain.
Dave

OSCAR
Standard OSCAR Chart Order
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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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#20
RE: Please help, frightened Bipap user with chest pain
Fourkidlett, Sleeprider has deep expertise, and I highly recommend that you follow his advice. You couldn’t have a better advisor.

By the way, great job on Oscar and the chart. Plus you got it all done in record time.

I hope you have a restful night.
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