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Yet Another Newbie Question
#1
Thank you for allowing me to be a member of this forum.  Wow - tons of information.  My (brief) story:

50 year old male who has had 2 open heart surgeries (OHS) to replace mitral valve.  The first replacement was a tissue valve that was supposed to last for approx. 10 years at a minimum.  It lasted 1 year before it failed.  Had a mechanical valve put in 1 year ago & am on Warfarin for life.  I actually developed pneumonia post surgery & almost didn't make it out. 

The first surgery was minimally invasive through the ribs.  However, I developed a lung hernia that I lived with until 7 months ago when they repaired it.  But, suffice it to say that the lung slipped through the ribs after my last OHS so that I was simultaneously dealing w. the pain from not only my sternotomy, but the hernia as well.  Nightmare - to put it mildly Oh-jeez .

During post-op. of my first OHS the oxygen kept going off when sleeping.  They set me up w. a sleep clinic who determined that I had moderate apnea, hence the CPAP.  They also determined that I have chronic insomnia & I take 10mg of Ambien each night.  I have seen many times that I have taken 10mg ambien, 10mg melatonin & benadryl...& still stayed awake for hours Dont-know !  My usual sleep time is from 4:00 a.m. - 12:00 p.m.  

My query (sorry for lengthy post):  I have read that a CPAP actually causes the lungs to become dependent on the forced air leading to shortness of breath & weakening of the lungs (?).  This may be completely fallacious, which is why I am presenting it to those w. far more knowledge & experience in this area than myself (which doesn't take much).

I ask this because I am noticing much-much more shortness of breath when I engage in things like running & tussling w. my puppy.  Crazy thing is that I work out on stair master & can jog okay, but when I perform spontaneous physical exercise I am gasping for air in no time! 

When I go to the Dr. my oxygen saturation is usually around 98% (which is not perfect if I understand right?).  But, I do get the sense that my body is not getting the oxygen it needs.  Oddly, really deep breathing seems to help, which, again, infers to me that my body is not getting the oxygen it needs.  Simply, I fear that I will have to be on oxygen soon.  (Note:  I also pastor a church which is highly stressful & I am wondering if could contribute to my shortness of breath?)

This is not due to any heart-related issues since I just had an echocardiogram done a month ago & it looked okay.  My cardiologist said my heart actually seems to be getting a little better.  I am wondering if the CPAP is indeed weakening my lungs & the issue is potentially pulmonological.  Or, if it's possible that I have developed scarring on my lungs from all of the surgeries or pneumonia (?). 

I have a Drs. appointment tomorrow & will inquire about these issues, but I'm thinking I should see a pulmonologist.  I am also going to schedule w. my sleep Dr. to see about getting another sleep test done.

Finally, it may take me a day or 2 to respond & I can almost never respond until late at night for reasons stated above.  This place seems like a wealth of knowledge & I am looking forward to reading & learning all I can from you.  Thank you in advance!
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#2
G'day Homeskillet. Welcome to Apnea Board. It sounds like you've been through the wringer, so hopefully you'll be able to make a fast and complete recovery.

The question of CPAP causing weakness of the lungs has been raised here a few times, but I've never seen any definitive evidence that this is the case. The machine is not breathing for you, just supplying pressure to splint your airway. If you are using EPR or Flex at a high setting there is a small element of the machine assisting you to breathe, but not to the extent that your body would get dependent on it. In fact I would expect the opposite - you're actually exhaling against pressure which is higher than atmospheric, so over time your diaphragm should get stronger, even if only slightly.

Given your medical history my guess (and that's all it is) is that there is likely to be scarring from your operations and the herniation which is causing you the problem. This needs to be discussed with the pulmonologist and it might need further investigation. However a normal awake oxygen saturation of 98% is good, so there's no apparent problem there.
DeepBreathing
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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
Hi Homeskillet and welcome to the forum! Glad you found us. Sure seems like you need some help and there's lots of experienced helpful users on here to do just that! I'm sure you'll get lots of advice in time. Good luck!
APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
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#4
A sincere welcome to Apnea Board.

I agree with DeepBreathing, you should not be concerned about a CPAP dependence. And the herniated issue and scarring is my opinion as well for the issues you mentioned about shortness of breath.

Ask your pulmonary physician their medical opinion above all else. Take care of yourself and let us know how doing, which you'll hopefully say is that you're doing better.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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#5
Perhaps you should get some pulmonary function tests, specifically Spirometry. When I had that done 20 years ago or so, I was found to have COPD (even though I never smoked). At a minimum it will check your lung volume to see if it normal or below normal.
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#6
Thank you for all of the input. Saw my Dr. today. My oxygen was at 96%. He had me walk to see if my oxygen went down - and it went up to 98%?? Crazy.

He also took an x-ray of my lungs. Will get results tomorrow.

He did send a referall to a pulmonologist to run some further tests.

I am still significantly short of breath. He seems to contribute much of it to anxiety due to the numerous major recent surgeries. While I’m sure there is some of that, I don’t at all believe that is what is causing such marked shortness of breath.

On another note (don’t want to start numerous threads from a newbie), I have really been wondering what the best, most up-to-date CPAP is? And, is it possible to order one w.out a prescription? If so, I wouldn’t even know where to begin to get it functioning correctly (e.g., settings, etc.).

Again, thank you for the responses - I also suspect scarring from the surgeries or, possibly COPD is my issue. Will tag back in soon. I can see that I will reading a ton on here!
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#7
Quote:I have really been wondering what the best, most up-to-date CPAP is? And, is it possible to order one w.out a prescription? If so, I wouldn’t even know where to begin to get it functioning correctly (e.g., settings, etc.).

If you had ordinary obstructive apnea with no complications I would recommend the Resmed Airsense Autset for Her. (The "for Her" gives access to an additional algorithm which is designed for women but has proven successful for some of our male members as well). However your case is more complicated and I think this is a situation where you need to have detailed input from your medical team. It's possible you might end up with one of the AirCurve bilevel machines.

As you are working with doctors already, one or more of them will be able to give you a prescription. The normal procedure from there is to obtain a machine from a DME associated with your insurance company. Alternatively you could try an online vendor from our suppliers list (see the link at the top of this page) or even alternative channels like Amazon. It's also likely you'll have a titration study, where you sleep with the machine in a lab and the technicians fiddle with the pressures to get something close to optimum. In my not-so-humble opinion this is a waste of time, but it's often one of the hoops you need to jump through. Most of this process is controlled by your insurance company, so get nice and cosy with them to ensure you get the best deal.

Once you have your machine, you can use software called SleepyHead to get graphic reports of your breathing all night long, on a breath-by-breath basis. Post your daily charts here and there are many well experienced members who will then help you optimise your results and maximise your comfort with the machine.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#8
Referral to a pulmonologist for a PFT: excellent idea.

Dependence on CPAP: it doesn't sound likely.  This bit is unscientific, but the main inventor/developer of CPAP in the 1980s, Dr. Colin Sullivan, used to say in interviews (there are one or two transcripts on this board, posted years ago) that it's useful to compare a CPAP machine to eyeglasses.  There are some similarities.  No one who does not need eyeglasses would choose to wear them, but for those who do need them, they're indispensable.  The only dependence is a slight psychological one: deprived of my glasses or my CPAP machine, I would be very unhappy, but there would be no physiological difference in my underlying condition. I would just be back to where I started without the device.  Someone with sleep apnea needs to use CPAP in the same way that someone who is very myopic needs glasses.

Beginners' questions answered: please read New to Apnea?  Helpful tips to ensure success ... and yes, it does take a long time to read and absorb all of this stuff, in the wiki and in the discussion threads.  So it's good at first to devote some amount of time per day to it, whatever you can spare, or longer reading sessions on weekends.
"I wanted to be a Boy Scout, but I had all the wrong qualities.  They were looking for kids who were trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent.  Whereas I tended to be devious, fickle, obstructive, hostile, rude, mean, defiant, glum, extravagant, cowardly, dirty, and sacrilegious."  (George Carlin)
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#9
Hi Homeskillet,
Welcome to the ApneaBoard forum.

I have been on CPAP for 20 odd years and I have not noticed shortness of breath or weakening of the lungs due to the CPAP.
They used to check lung capacity etc at the hospital, but they do not do it now as they found CPAP made little difference to lung opperation.
Might be different  if you have lung problems cpod or asthma before you started CPAP, or heart problems etc.
>^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^<
I am NOT a doctor.  I try to help, but do not take what I say as medical advice.

I am just a long term user of c.p.a.p. and therefore I have some experience in using these machines and equipment.

However, I am NOT an expert, so advice given should be taken as given in good faith only and NOT medical advice.

Every journey, however large or small starts with the first step.   Coffee
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#10
If the machine were capable of producing, and the lungs could withstand, 1000 psi, would we breath any easier or become dependent?  My point is that the machine merely increases the flow, but doesn't generate flow into the lungs in a static sense. It doesn't raise pressure...it increases flow to back-fill as we intake our air.

If we consciously withhold diaphragm movement until we go unconscious, assuming such a thing were possible, would the PAP machine take over our breathing?  Nope.  We have to initiate the breath.  The machine only 'charges' the air by helping flow.

Then we ask, well how to PAP machines treat CA's. They don't breathe for us in those instances either....they flutter air against our throats (if I understand correctly) in an attempt to encourage a breath.  They induce a pressure wave pulse.  But they can't cause air to enter our lungs.  Our brains must do that.
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