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[Treatment] May be Too Late for Me Too
#1
Below is an oximeter printout for last night. As you can see my basal SpO2% is running fairly low. It has been this low for some time (I first found out in late October 2014 when I purchased my oximeter. My SpO2 readings have not changed much since then, maybe very slightly lower now (not much, thankfully). Although I started with the CPAP forum sometime in June, I have only posted questions (in somebody else's threads -- oops! -- My bad -- I'm still new at this).

I have now completed 32 nights with my auto CPAP system. My auto CPAP data (SleepyHead mostly) usually comes up with an AHI in the range of 1+ to 5, occasionally a bit higher. I've had no AHI readings below 1, however. I think my AHI has decreased since I started auto CPAP and is better than the AHI I had during my initial sleep test which was 13. I can post the SleepyHead graphs, data, etc., but not tonight (I'm not up to it).

I had 2 nights where CSR reared its ugly head (showed up in both SleepyHead & ResScan): June 7 @ 6.23% (AHI of 7.23) and June 8 @ 2.87 (AHI of 4.06). I've had no other instances of OSR indications.

I've been waiting to post data until I had completed some auto CPAP sleep sessions in hopes my SpO2 oximeter readings would improve -- they have not. Also, I was hoping my continued daytime drowsiness would lessen -- it has not. I will try to post some SleepyHead data tomorrow if I have a bit more energy (it's still July 15 here). In the meantime I hope some of you folks can give me an idea what I might be up against. I shall see my sleep doctor June 19 and I hope he has some good (not too extreme) thoughts about where to go from here.

FYI: It's my understanding (I could be wrong) that Medicare frowns on my making some adjustments to my auto CPAP machine. I don't want to be disqualified so I'm reluctant to do any adjustments at this time.

Thank you in advance!
Tubaman
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#2
O2 is low but not off the charts. Your AHI is doing great. If they are concerned they may add O2 to the CPAP and boost it up.
Be interesting to see the plots and see how the snoring looks and the flow limits. Then we have to figure out if you are comfortable with CPAP and letting you get good sleep.
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#3
[attachment=2656][attachment=2657][attachment=2658]Here are my SleepyHead reports (3 pages). I hope these are what you need.
Thank you!
Tubaman
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#4
Tubaman, what is your mean tidal volume and minute vent rate (statistics on the left side of Sleepyhead charts)? It would help if you would include those statistics in your images. https://sleep.tnet.com/reference/tips/imgur . Also, do you have any chronic medical conditions like chronic obstructive pulmonary disease or any coronary conditions that may be affecting you?

The images you posted suggest you may have an abnormally high respiration rate along with a tidal volume under 400. There are machines that can improve your ventilation rate and volume by using bilevel pressures. These are not ASV (you don't have centrals), but are in the bilevel category that provide more pressure support on inhale to improve your volume with a lower respiratory rate (breaths/minute). I notice your pressure is set to 5-12 and you appear to be using EPR of 3. When your machine is near its minimum pressure most of the night, the machine will not go below 4.0 cm pressure on exhale. As a result, you do not get the benefit of the "pressure support" on inhale, since the pressure can only drop by 1.0 cm. A possible solution may be to increase the minimum pressure to 7.0 which would then ensure you get a full 3 cm pressure relief on each breath. The Airsense 10 autoset has limited bilevel capability, but taking advantage of its full range of 3 might get you some additional volume which might slow the resp rate which currently appears to spend a lot of time around 25 bpm.
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#5
There is lots of room for you Doctor to make some adjustments. Everything Sleeprider said. I also noticed that you are still snoring and have lots of flow limits going on also.
If/when they move you to a BiLevel (they did that to me) you again like me are a slow breather, there are settings on Resmed (at least) machines that you will probably need to adjust (Ti min, Ti max, Trigger, and cycle) the default is set to cut off the inhale after 3 seconds and this was like someone putting their had over my nose right before the end of every inhale, I just changed it to 4 seconds and was fine.

When interfacing to your Doctor, YMMV, mine would roll his eyes when I said "someone on the forum said", so I changed to just stating my concerns without telling him why I was concerned.

"My respiration rate seems quite high even though I don't feel like I am getting a deep breathe"= abnormally high respiration rate along with a tidal volume under 400
"When I first start the machine it seems like it's difficult to exhale, but when the pressure increases it actually seems easier to exhale"-I notice your pressure is set to 5-12 and you appear to be using EPR of 3. When your machine is near its minimum pressure most of the night, the machine will not go below 4.0 cm pressure on exhale. As a result, you do not get the benefit of the "pressure support" on inhale, since the pressure can only drop by 1.0 cm. A possible solution may be to increase the minimum pressure to 7.0 which would then ensure you get a full 3 cm pressure relief on each breath.

Figure out what you are going to tell your Doctor, I your words, about what is going on. Of course you may have a Doctor that will listen you what someone on a forum says, or not Smile

Things to be done and you will feel better once adjusted.
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#6
Some good advice in this thread. I'll address a couple of the other concerns:
(07-15-2016, 11:36 PM)Tubaman Wrote: ..............
I had 2 nights where CSR reared its ugly head (showed up in both SleepyHead & ResScan): June 7 @ 6.23% (AHI of 7.23) and June 8 @ 2.87 (AHI of 4.06). I've had no other instances of OSR indications.
I don't know Resmed machines, but the comparable algorithm in Phillips Resperonics would call these Periodic Breathing, and, from my reading, they are frequently not true Cheyne-Stokes events. Moreso true when they are not accompanied by CA events and seem to happen randomly. Of course you should discuss with the sleep doc, and perhaps a cardiologist. As you know, nothing here is medical advice.

..........
Quote:FYI: It's my understanding (I could be wrong) that Medicare frowns on my making some adjustments to my auto CPAP machine. I don't want to be disqualified so I'm reluctant to do any adjustments at this time.
I don't think that should be concern. Medicare only looks for time compliance: minimum of 4 hours use for 70% of the days during which compliance is monitored. It's the sleep doc who might be concerned, but I (and many others, from my reading) have found it's a lot easier to get forgiveness than permission, and many docs don't even care. In any event, the combination of two great things - SH and our ability to get to the machines' clinical menu - affords us the opportunity to examine the data in greater detail than probably most docs ever will, and to take action. My feeling is we should take advantage of that opportunity.

Good luck and feel better. -Ron



We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
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#7
The following attachments contain the statistical information from the left side of SleepyHead graph display. I hope this gives everybody the information needed.

SleepRider asked:
"Also, do you have any chronic medical conditions like chronic obstructive pulmonary disease or any coronary conditions that may be affecting you?"

As far as I know I don't have COPD and/or any coronary conditions that may be affecting me. At least, I have not been diagnosed with anything like this (not yet, anyway).

PoolQ mentioned: "YMMV".
I don't know what this means.

It just occurred to me. I had pneumonia 3 times -- one session came close to doing me in when I was about 6 - 7 years old. Penicillin and my cousin (a doctor) saved my life. I also played tuba for several German bands -- I played hard and loud (lots of lung power needed / used). I played this way for about 25 years until the late 1970s. Could these experiences have caused lung problems? Just a thought.

You folks have given me much information that I had no idea even existed. I have learned much and learned there is much more for me to learn. Thank you! Thank you! Thank you!
Tubaman (Carl)



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#8
YMMV = Your Mileage May Very- in other words worked for me, may or may not work for you
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#9
Tubaman, I'm going with my original hunch. Your tidal volume is suitable for a small woman, and I will presume that does not describe you. Although your AHI is satisfactory, I think you'd benefit from a higher minimum pressure. You are using EPR at 2, and a minimum pressure of 5.0. You really need to increase minimum pressure to 6 or 7. Just give it a try and see if you don't feel some significant relief. In simple terms, you're not getting enough air at your current pressure settings, and this results in a rapid respiration rate and low volume. Many people will have flow limitations, snores and obstructive events that increases pressure with an auto machine, but you're not one of them. With EPR at 2.0 your pressure starts at 5/4 and even at your average pressure of 5.7 you don't get to enjoy the benefits of the pressure differential of 2.

Try it. It is nothing more than changing your minimum pressure to match your average needs, and is still a relatively low minimum pressure for your needs.
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#10
I will also suggest that you check the accuracy of that Oximeter against a known good one (or check it on someone who is not symptomatic). Your O2 readings are lower than one would expect, even when awake. If your oximeter proves to be accurate, you should schedule a checkup with a pulmonologist to get your lung function checked. Have you ever been a smoker or worked in an occupation that exposed you to toxic fumes (like welding) or lots of dust?

As an alternate test, and much quicker and cheaper, your primary care doctor can perform a simple spirometry test that can suffice to prove how well your are breathing and possibly point to the need for further testing by a pulmonologist.

Dude
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