Sorry to start new thread but need nap

[Morgannon]

Need a zoomed image of the event progression to see if it is obstructive. Please include mask pressure so we see the breath by breath machine response and pressure support.

I will do this first thing tomorrow Sleeprider, thank you!

[Morgannon]

Update:  at sleep doctor's suggestion went off AVAPS in order to troubleshoot it down the road.  Back on BIPAP and about ready to give up therapy because I feel like it's absolutely screwing with my breathing badly.  So far a neuroweakness diagnosis is off the table but I am having asthma exacerbations now.

Here is last night's data.  Again, at the sleep doc's suggestion she wanted me to bump up pressure support a little, so I did.  With disastrous results.  Eight events per hour, all central.  Pressure hardly budged.  I don't understand any of this.  Some nights I seem to have "traditional" obstructive sleep apnea.  Some nights I have central apnea.

Is there any way to find and pay for the time of an expert on these things?  I really need one of you guys and your deep knowledge of these events, but I also know my problems might need a lot of troubleshooting and don't want to monopolize someone's time.  Any suggestions are appreciated.

Last night's data.  Very brief sleep.  However I feel better overall.  I'm very close to ditching my therapy if my problem is not neuromuscular and is instead related to asthma.

[Sleeprider]

Normally I would say PS 7 is clearly too high and is flushing the CO2 from your system. The thing is you previously used PS 7.2 with minimum pressure 7.0 on your Vauto and had very low AHI. The only difference I see here is a lower minimum pressure. With ST-A you were using minimum PS of 6.0. The increase in centrals does not make much sense in the context of your previous results. In a previous post I noted a similar wide swing in results:

No change in settings, big changes in results. The settings are not necessarily the problem.

Once again, I think your results tend to vary, even with similar settings, and I suspect things will swing back to good results again. When you have high events, it has always been central. Remind me why you were put on AVAPS and not ASV?

[Morgannon]

Hello Sleeprider, thank you for responding.  I'm sorry about the extreme lag time between responses.  Along with my respiratory issues I seem to be dealing with brain fog from an unknown condition, so I often forget what conversations and threads I am following.

My original diagnosis was obstructive sleep apnea.  Centrals were minimal - less than one an hour.  The majority of my events were hypopneas.  In the beginning I was being very successfully treated with BIPAP.  Now, as you've pointed out, my results are all over the place.

This is the reason I am banging on so much about having some sort of neurological condition.  My results are way too inconsistent with the same or near same settings.  And if I exert myself at a normal level, which I have done over the last several days, I pay for it with increased weakness.

So in a nutshell I'm not on an ASV because my original diagnosis was not central apneas.  It was majority hypopneas and some few obstructive apneas.

Before October of last year I had zero symptoms of sleep apnea.  No morning headaches, sleep was good, and refreshing.  My prior sleep study two years ago showed approximately nine events per hour, mostly obstructive, and o2 would never drop below 93%.  Two years later, and I'm having forty events per hour, and drops to 80%.  With no appreciable weight gain.  

Yet, my doctors all say I have no symptoms of breathing weakness.  Period.  I'm so fed up with their BS I'm going to go insane.

My mental health is declining because none of these people will listen to me.

I am so very appreciative of all of the support you and the others give me.  It's the only way I've been able to survive.

Here's a close up of some of the centrals if this will help.  Any suggestions are most welcome.  I'm about ready to switch back to AVAPS because that device annihilated my apneas.  I had almost zero.

[Morgannon]

Well the AVAPS didn't do its job last night.  Almost 7 events per hour and I feel like crap.  I even turned down the tidal volume setting on this son of a bitch so that it wouldn't keep hitting me with pressure all night.  But it did.  

Any suggestions anyone?

[Jay51]

This was the major battle for me with Ivaps and Avaps.  To be effective, I needed a certain tidal volume (but I still could use the auto rate setting) to get effective therapy.  

One strategy my RT and me used that finally worked was this:  she moved my tidal volume down to a very low 300.  I finally was able to sleep all night with it.  I was doing cartwheels!  Then every 2 weeks or so she moved it up 50ml (to 350, then 400, then 450, then 500).  It was kind of psychological.  Once I finally had some success with it, moving up a little at a time was manageable.  (With your ivaps here, you can lower your rate a little bit also to make is easier when you increase the tidal volume.  

This was my experience.  Sleeprider may have some suggestions also.

[Morgannon]

Jay, thank you so much, I will try this!

[Morgannon]

Got some improvement - some better sleep last night and lower AHIs.  Almost below 1!  

Also can someone tell me what kind of hypopnea this is?  Thanks!

[Sleeprider]

What hypopnea? 15 breaths per minute and mostly normal volume and profile. Don't over-analyze success. If there is hypopnea here, it will show up in the minute vent.