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Please help, frightened Bipap user with chest pain
#41
RE: Please help, frightened Bipap user with chest pain
Hi Cyndi, a three minute zoom with the CA toward the right will provide a little bit more of the context.  

In general, CAs can occur after a bit of arousal breathing, which is often deeper than usual.  That washes out some CO2, which depressed the urge to breathe.  I'm attaching a view of this kind of pattern; it's what my CAs typically look like.  Actually, you can see that my breathing dwindled after the first arousal, then deepened to catch up, then dwindled again to a CA.  That's a mini-version of what is called periodic breathing.

The arousal may be a little wake-up, though it may also just shift you from one sleep stage to a lighter one.  The problem in these cases isn't so much the CA as the arousal.

Have a great camping trip!


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#42
RE: Please help, frightened Bipap user with chest pain
Let's talk about CA events.  Quite a while back in this thread, I made a suggestion that will lower your central apnea incidence.  Your  CA at the level we have seen is not a serious health problem, and may not even be the disruptive to your sleep. In the example above, it appears that an arousal has occurred before the CA event, and the apnea are all of a minimal duration.  Before you expend a lot of effort or emotional energy worrying about CA events, just try what I suggested before.  A little less pressure support and moving your trigger sensitivity from medium to high may eliminate most of them.  Give it a try, or accept that the problem is not really very serious.

(11-11-2020, 09:05 PM)Sleeprider Wrote: 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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#43
RE: Please help, frightened Bipap user with chest pain
Thanks to you both, SR I do remember the change you mentioned and will try that. I'm just trying to wrap my mind around it all and understand it, as central apnea is a little scarier to me than the OSA, especially reading I wouldn't have the right machine to treat CA. I have very little faith in Kaiser right now is the REAL issue. I still haven't actually talked to a doctor or even had my sleep class yet. Everything I've learned has been on my own. Thank you for chiming in again and helping put my mind at ease.

Okay NOW I'm packing!!!!
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#44
RE: Please help, frightened Bipap user with chest pain
I believe Sleeprider has the right approach. Edit these things and it will improve. I gave info on CA just as information, not that it specifically applied. Call it an info exchange on defining CA and general descriptions. Keep in mind a large percentage of apnea patients have obstructive apnea only. Some to most do get a bit of CA showing especially when first starting PAP therapy. Then there's the small group like me that has pre-existing or predominant CA. Take your pick on which name you like, I'm referring to the same CA that only ASV treats.

Now specifics, I see your CA as similar to treatment emergent but very likely positional/movement breath holds mixed in with arousals that just happen to be 10 or more seconds which causes the PAP to throw the CA flag. That is what I see on that last set of 3 OSCAR charts. I honestly think you can rest assured these are not the CA to be concerned over. Think with me on this question; if you didn't look at OSCAR and have seen these CA, would you be inclined to be concerned with CA that you probably don't recall even existed or probably haven't felt the effects of them?

It is a very different story if you had pre-existing CA purple flags all over your chart. I think doing the edit suggested will address these CA blips and it's over and done with. Focus on enjoying the camping trip.
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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#45
RE: Please help, frightened Bipap user with chest pain
I also suggested the same, lowering the Pressure Support and/or raising the trigger to high.  (Post #37)

But don't worry over it too much and enjoy your trip, as I really believe that changing settings right before a trip doesn't make too much sense.  

If you are only going for the weekend, check back with us Monday.  We can lower the PS a bit and see if that helps.  Then we can try the Trigger setting.  The reason for just making one change at a time is to see what works.  If both are changed at once, you won't know which helped the CA's.  

Enjoy your trip!
OpalRose
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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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#46
RE: Please help, frightened Bipap user with chest pain
Thank you all!  I’ll check back in on Monday. I get my iron infusion that day!  I’ve been anemic for 12 years so this is way overdue.  

Have a great weekend!

Cyndi
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#47
RE: Please help, frightened Bipap user with chest pain
Good luck with the iron infusion.
OpalRose
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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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