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"SHALLOW BREATHER"
#1
Question 
"SHALLOW BREATHER"
Good Morning,  I am obviously new to this forum.  I suffer from an auto immune disease that is currently stable due to spleen removal.  I always have an elevated retic count.  Recently 6.8.  I suffer from fatigue and anxiety because of it.  I was sent for intial sleep study with summary as follows. Total recorded time 485.8.  Sleep time 269.5.  Sleep efficiency 56.0%. Latency 80.5 min. REM 257.0 min. 4.5% Stage N1 82.2%, N2 0.0% N3 13.4 % Arousals 11. 2.4.  Respiratory Data 9 apneas and 4a hypopneas (4% oxygen desaturation or greater) Apnea/Hypopnea AHI 2.0 per hour. length 24.1 to 42.1 seconds. RERAS in addition to above. making RDI 6.7 per hour.  Oxygen 77.4 % equal or above 88%.  Lowest was 85%. They sent me for follow up even though mild for mask test.  I am picking up copy of the test tomorrow and prescription.  They said my machine should be set at 4 to keep oxygen level above 90.  I used pillow nasal mask.  I still had insomnia the second time but when I woke up in the am I did feel better.  Doctors order says Nocturnal Hypoxia and Hypersomnia.  I am desperate to have a little more energy and would like to know what questions and what machine might give the best relief as I do not qualify as having "Sleep Apnea" . Any feedback would be very appreciated.
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#2
RE: "SHALLOW BREATHER"
MKinchie, your AHI is very low and it's not clear why you experience seriously low SpO2 based on the sleep disordered breathing alone. Additional information to find from your study include your range of tidal volume, respiratory rate and minute vent. All should be recorded. Your prescription for CPAP pressure is minimal and at a fixed minimum pressure where most of us feel air-starved. 4.0 cm is not a therapeutic pressure for the problems you are experiencing, which should focus on increased Positive End Expiratory Pressure (PEEP) to assist in aveolar recruitment (keeping the air sacks in the lung inflated) to improve oxygen exchange.

First, you need to ensure you will get the best possible CPAP for your purposes. That is going to be a Resmed Airsense 10 Autoset. The reason is that it is the only commonly distributed CPAP that can offer bilevel therapy (separate inhale and exhale pressure) for when they finally learn that 4-cm is not therapeutic for you. In addition, in the absense of higher pressures and potentially bilevel therapy, you may need supplemental oxygen. Read about adding an Oxygen Bleed to CPAP in our wiki here http://www.apneaboard.com/wiki/index.php..._with_CPAP Finally, your doctor should be prescribing a recording oximeter to monitor your SpO2 and pulse. Such monitors can be inexpensive (see Supplier #19) from less than $100 readable on OSCAR data, to over $800 for the Resmed Oximeter which actually plugs into the CPAP machine and records data readable by the Resmed Resscan software.

In summary, It would help to know why you experience low respiratory volume or oxygen exchange efficiency. If the problem is related to upper airway restriction, the solution would be different from other physiologic causes. I hope you will be dispensed the most capable CPAP possible, at least with a minimal 3-cm bilevel capability such as the exhale pressure relief of the Resmed machines, and that your doctors will continue to monitor the efficacy of that treatment in terms of SpO2. Without data tools and effective equipment, you will continue to rely on how you feel and relatively expensive sleep studies to evaluate the effectiveness of what is being done. You need both the CPAP and the recording oximeter to do this.
Sleeprider
Apnea Board Moderator
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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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#3
RE: "SHALLOW BREATHER"
I am ever so grateful for the informative feedback.  I am picking up a copy of my study and the script tomorrow.  I am anxious to get started and want to feel better soon.  I will follow up with copies of my studies for the powers greater than mine to have a look.  I have suffered with this fatigue for far too long.  The doctors have been puzzled for quite sometime.  I am lucky to have come across people such as yourself willing to spend the time and energy helping others.  I look forward to donating to this cause.  It is a maze out there for most of us Smile
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#4
RE: "SHALLOW BREATHER"
It would help if you said what auto immune disease you have. an ahi of 2 and O2 sat% of >85% is not exactly known to cause sleep apnea related fatigue.

Also from total 269.5 sleep time you had 257.0 min of REM sleep, is that correct? That is very much not normal. Once you confirm your actual values with a sleep report, a different machine may be of more benefit.
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#5
RE: "SHALLOW BREATHER"
Sorry went back and looked.  The wording is latency to REM 257.   I have auto immune hemolytic anemia that is under control with spleen removal but continue to have an elevated puzzling retic count.  I will  upload test today when I pick up titration study results.
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#6
RE: "SHALLOW BREATHER"
Please be sure to redact any personal information you do not want to publish on a public forum. Names, locations, contact information are not needed or wanted.
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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#7
RE: "SHALLOW BREATHER"
Here are my Summaries for reviewSmile


Attached Files
.pdf   SLEEP-STUDY #1 SHARE.pdf (Size: 966.62 KB / Downloads: 30)
.pdf    #2 SUMMARY SHARE.pdf (Size: 646.61 KB / Downloads: 28)
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#8
RE: "SHALLOW BREATHER"
I think you would benefit from CPAP therapy, but more-so from bilevel therapy as provided by the Resmed CPAP machines. Your AHI / RDI is apparently resolved with low pressures, so I would recommend either the Airsense 10 Autoset or Elite (fixed CPAP), both set to a minimum pressure of 7.0 with EPR at 3. This will provide a bilevel pressure of 7.0/4.0 (IPAP/EPAP) which will resolve the obstructive issues and help with UARS. Your sleep study did not specifically get into flow limitations, but they can be significant actors in lower SpO2 even with low AHI. It is the pressure support (difference between inhale and exhale pressures) that can resolve the upper airway resistance. You might want to use a recording oximeter along with CPAP therapy to verify that your oxygen levels remain in a satisfactory range.

Here is a link to a wiki on UARS and using bilevel pressure to minimize it. Please read. http://www.apneaboard.com/wiki/index.php...ome_(UARS)
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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#9
RE: "SHALLOW BREATHER"
Thanks again for your valued input.  I have attached my actual graph's for someone to take a look because as anticipated the insurance company denied my prescription for the cpap machine and I will be purchasing one out of pocket it looks like and I would like to minimize my risk of purchasing the wrong one.  I think I want the Resmed Airsense 10 Autoset with the plug in oximeter.  Thanks for taking a look.  The summaries are attached to my previous post. :Smilelease note 5/08/19 Original.  07/03/19 Titration test.


Attached Files
.pdf   APNEA:SHARE.pdf (Size: 454.01 KB / Downloads: 16)
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#10
RE: "SHALLOW BREATHER"
I agree with the Resmed Airsense 10, but suggest you consider a much less expensive recording oximeter alternative like the CMS 50F from Supplier #19. Best prices on the Resmed Airsense 10 seem to be from Supplier #2 or Supplier #33.
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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