Seeing more UA and CA - due to being sick or AFIB med?

[MyronH]

Well last night, was even better. AHI 1.16. Although my oximeter showed several sp02 dips to 80-82% for unknown reason. I can't get the sleephead chart to align properly. It is shifted to the right for some reason.

Only problem with the few OA/CA events I see, are they are rather long, 22-31 seconds each. Not sure if anything can be done about that.

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[Sleeprider]

The CA clusters, night before last look obstructive to me in the close-up wave forms. Lots of flow limitation leading into the apnea and it just lacks central characteristics. The most recent night looks a lot better except for leaks. I think using the ergonomic pillow is a great idea, and I used to suggest it as an alternative to a soft cervical collar. It's all about airway alignment, so how you get there most comfortably is your choice. Your breathing is looking a lot better than when we first took a look, and your results are very good. Maybe the doctor will leave your tongue in one piece.

[MyronH]

So my sleep doctor wants me to try an auto BIPAP, and he is going to load me one to pick up tomorrow. They said they would put the range from 4-16. I am hesitant at trying one. Can't BIPAP make CA's worse? My APAP range is 7-14, so not sure why they would start BIPAP so low. Is the range calculated differently with BIPAP?

I don't understand why they would set it so low starting at 4-16 on BIPAP. My APAP starts at 7 and even then i get apneas, until it reaches 10 sometimes.

I think I may hold off trying BIPAP, since last two nights have been okay, since I'm using my ergonomic pillow. My last AHI <2.

[ajack]

As you know, you also need to work on your leaks with the f20 mask. as well as the link in my signature, there are lots of mask fit videos on youtube. If you still have trouble, mask a post about it.

[MyronH]

Last night, my Contec O2 sensor alarm went off a couple times. SpO2 dropping to 80% during an apnea. And my HR increased too. But one time my HR went to 120 with no apneas.

A couple nights previously, I've seen my HR rise to 140bpm and 178bpm, but this was on my watch, and not my O2 sensor, so not sure how accurate it was. But those events did wake me up. I think the only reason my HR didn't rise higher, was the O2 Alarm was on, and woke me up this time.

I had that weird breathing pattern again in the first screenshot, during "CA" events.
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SpO2 desats and high HR..... Is high HR normal during desats?
Second photo, my HR went up for no reason at all.
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[Sleeprider]

The SpO2 desaturations at 02:13 and 06:48 line up with OA and UA events respectively. Can't explain the heart rate spikes, but they seem to occur during periods of large leak, and might be an arousal.

As far as using BiPAP, you have used EPR at 3 and looking back at your results, you generally had less CA at higher EPR settings. After looking at what you have posted, I think your EPAP min is too low. We have never really seen a lot of central apnena from you, and no diagnostic or titration study has identified that as a problem; so that may not be an issue. I recall you used EPR of 3 back on post #27 and had a few, but they were mixed into a cluster of OA. That is hardly definitive of a CA problem. I think whatever therapy you use, you should target a minimum EPAP pressure of 8.0. So if you want to try EPR of 3 you would need a minimum pressure around 11.0. With EPR at 1, you still need a minimum pressure of 9.0 I understand what the doctor is trying to do, but you will choke on BiPAP at 8/4, and can't really see you at less than 12/8, and letting the auto BiPAP move up from there. I think you have obstructive apnea, and you have not really given the positional therapy a shot yet, so give it pressure.

[MyronH]

Well I just got back from picking up a BIPAP machine to try out. The therapist said the pressures were set at IPAP 8-16max and EPAP 4-12max. I told her I was concerned that it was starting so low, but she said the doctor reviewed my last sleep study, and set the pressure accordingly. She said the machine would auto-adjust. It sounds like I'm a guinea pig, or they just like to let the machine make all the adjustments.

Here is what my sleep study shows:
"CPAP failed to eliminate events. BiPAP was initiated at starting pressure 14/10 and titrated to final pressure of 16/12. The most appropriate setting is 14/10."

What else in positional therapy do you recommend? I already tried a collar, and now an ergonomic neck pillow while laying on my back. I can't sleep on my side anymore, as that made symptoms worse. I would wake up with massive heart palpitations and racing heart, while on my side. So my only choice is to lay on my back, and just use the neck pillow.

[Sleeprider]

I think that is what I said...12/8 is the absolute minimum that will work, and I would have no trouble with your titrated BiPAP result of 14/10.

[ajack]

You still need your leaks sorted, or it will make setting up the machine harder for you.
I'm guessing there were other factors in the settings other than ahi. Just on an AHI basis, a min of epap 8, min ps4 giving min 12/8 would be right, going by sleepyhead. The 14/10 would possibly be for o2 or more tidal volume?

I'd be tempted to use the sleep study and set min epap 10, min ps4 and have the max epap and ps higher. Your o2 meter and sleepyhead will help you see the stats.

[MyronH]

First night with the BIPAP. Had some major leaks that I still need to work on. Not sure where the leaks are, since I didn't feel mask leaking. At least my O2 monitor didn't beep and wake me up tonight. 

I just hope my insurance doesn't see that I'm not using my original APAP, and stop paying for it, while I have this loaner. I got this BIPAP loaner through another sleep doctor/provider. My new sleep doctor said my insurance "Aetna" probably won't check to see if im using my original machine. But I'm still worried this may cause confusion with insurance.

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