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Help with settings - Printable Version

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RE: Help with settings - Hamish McTavish - 01-22-2019

Sorry, that one screenshot wasn't great, here's another


RE: Help with settings - Sleeprider - 01-22-2019

The screenshot with the closeup respiration from 1/21 shows perfection and a respiratory rate of 15.0 BPM at 22:42-22:43. The next one shows a respiration rate of 7.5 BPM and some flow limitation at 22:54. The session information is cutoff so I don't know what changed, but the first one is only a 6-minute session. Anyway, your minute vent and tidal volume is up and not particularly alarming. We still don't know the source of flow limitation or slow respiratory rate, but maybe it's not a problem. You should ask you doctor if that is anything to be concerned about.

RE: Help with settings - Hamish McTavish - 01-23-2019

So I decided to buy a pulse oximeter to see how my oxygen levels and heart rate were when I am asleep. Not sure if it's good or bad or average, just wondering what your impressions/analysis might be. I woke up around 4 am and removed it because my finger was a little sore. My heart rate will probably seem low to you, but it's not out of the ordinary for myself, it's usually in the low 60's when I'm relaxing at home, but it seems to change a lot when I'm asleep. 
The leaking seems under control and my AHI is pretty reasonable.


RE: Help with settings - Sleeprider - 01-24-2019

Your median oxygen saturation of 93% at night is not very impressive, and a normal range is 95-100%. My own oxygen saturation rarely falls below 97%. Values below 90% are considered low and the Medicare guidelines would require desaturation to less than 88% for more than 5 minutes. You might want to include a dotted line at 88% to see where you actually reach that threshold or locate the statistic for tme below 88%.

Your doctor is the most qualified individual to look at your results, perhaps use arterial blood samples, and determine if there is a need for treatment. At this point, I'd consider you chronically below average during sleep. An interesting correlation on your chart is that pulse rate rises and SpO2 drops during the periods where your expiration time increases. It would be interesting to see the respiration rate chart as I suspect this also correlates to times where the respiratory rate drops.

RE: Help with settings - Hamish McTavish - 03-12-2019

So I went for my appointment with my respiratory doctor and he had a few tests done. 

Pulmonary function=normal
Did not do blood gases...but all other blood tests were normal.

He advised me to continue with my CPAP for another couple of months to see if anything changes/improves. I asked for a level 1 sleep test he said he would discuss that with me at my next appointment. However, he said if I did go for the level 1 it would take a year to get in for this test...one of the hazards of public health care. 

In the meantime I have been up and down with my nightly results and having mostly central apneas, and still tired most of the time. Just wondering if these centrals are treatment related? If it wasn't for the centrals I would have a pretty good AHI. 

I also got a prescription to buy a 'travel' CPAP and was wondering if I should or could use that prescription to buy an APAP to use at home instead of my CPAP machine? Would it help me more than the machine I have? Some good sales on those at the moment at one the Canadian retailers. Any suggestions/input would be appreciated.

RE: Help with settings - Sleeprider - 03-13-2019

Hamish, you are using EPR at 3 and a fixed pressure of 6.0 which in theory should produce a pressure of 6.0/4.0. Even if you cut EPR to 2 the pressure would not change because the minimum pressure your machine will generate is 4.0. Since your events are mostly central here, I would suggest turning EPR off.

Your respiration rate of 7.4 breaths per minute is extremely low, and your minute vent at 4.2 L/min is also low. This low respiration rate has been a consistent feature of your therapy. You were diagnosed with "mild obstructive apnea" using a home sleep test, however, I suspect that test also shows your hypoventilation which is your root problem. AHI is not significant with or without CPAP, but you don't breath enough to meet basic metabolic requirements. Your doctor is completely missing the important facts here, didn't perform appropriate blood gas tests, and even a sleep test may miss it since the obsession of the sleep doctors and clinicians is to "count" your AHI. Instead of waiting a year for a sleep test, your doctor should be able to provide you with a recording oximeter to document your SpO2% as you sleep.

I think the oximetry will document a need for night-time oxygen supplementation, and supplemental oxygen may resolve the problem. That leaves unanswered whether your low respiration rate is related to a primary central breathing disorder, but at least we can treat the symptom.

RE: Help with settings - Hamish McTavish - 03-13-2019

I believe your are correct Sleeprider, my main issue is the low respiratory rate. I have my own theories about why this is happening but no sense getting into that. All I can say is that is not because I am on any drugs, prescription or otherwise, and don't seem to have any heart or lung issues. 

I have attached the sleep report I got and as you can see I only had one obstructive apnea and the rest of it was hypopneas and desaturation. Not sure if I even qualify as having obstructive sleep apnea? My oxygen level would seem to be the problem because of the slow breathing...even when I'm fully awake I only average about 10 or 11 breaths per minute. I've made another appointment with my respiratory doctor on Friday morning to ask for arterial blood tests and oxygen monitoring. I have my own oximeter and I seem to average about 93 to 96 when awake but not sure how accurate it is. I'm going to try it again tonight and see what it comes up with overnight. All I know is I'm walking around like a zombie most of the day and struggle to stay awake until 10 o'clock when I can finally go to sleep. Not much fun....

RE: Help with settings - Sleeprider - 03-14-2019

Please explain to your doctor that the purpose of your consultation is to identify and treat the hypoventilation you experience, not to diagnose conventional sleep apnea. I think you really need to hit him over the head with the problem to make him sit up and notice that you are not another dissatisfied CPAP customer. If he cannot help you, then you should be consulting a pulmonologist or neurologist. You do indeed have hypopnea, which is a reduced breathing rate of at least 50% of your normal volume that results in desaturation of at least 3-4% SpO2, but remember that you may have a chronically low respiration rate all the time, that would be hypopnea for someone else. Your sleep test result with 90% average and 78% nadir, is prima facie evidence that you should be treated with oxygen, or some kind of ventilator with a backup rate. CPAP cannot resolve this. I think your long-term health depends on you diligently pursuing appropriate and effective treatment. Please do not accept "no" for an answer.

RE: Help with settings - Hamish McTavish - 03-15-2019

So I took your advice and whacked this guy on the head Smile. Going to get the arterial blood tests and an overnight oximetry done and then probably get booked in for a Level 1 sleep test. He's actually a good doctor and a good listener, just had to get a little more proactive. I will keep you up to date and thanks for your input

RE: Help with settings - Sleeprider - 03-15-2019

(03-15-2019, 07:59 PM)Hamish McTavish Wrote: So I took your advice and whacked this guy on the head Smile. Going to get the arterial blood tests and an overnight oximetry done and then probably get booked in for a Level 1 sleep test. He's actually a good doctor and a good listener, just had to get a little more proactive. I will keep you up to date and thanks for your input

like   good luck!