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COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
#11
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
Atrial fibrillation is apparently one of the problems, according to your OP title.

AF is anxiety-inducing for most sufferers, and if you have paroxysmal AF, you are likely to know when you have it going on. This can, and often does, interfere with sleep.  

Have you consulted an electrophysiologist? 

If you are not on an anti-coagulant, you should be. 

Doing what it takes to make yourself whole again will take a great deal of strength, determination, and education.  It is often the case that you can deal with two things at once, especially if one often follows the other (AF often follows sleep apnea, for example).
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#12
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
Quick update:
Completely off of sleep, thyroid meds- but still only sleeping 2-3 hrs/nt + very fragmented. I basically get the 2 hrs, then wake up and catnap for 1 hr, then lie awake for 1.5-2 hrs before the alarm rings. Still doing the CBTI stuff and sleep restriction for past mo; but not much improvement.
Still using ASV + O2 pump nightly unless I'm on the couch.
Going to a new sleep dr next week and will show recent OSCAR prints; will post asap.
My data shows great compliance and AHI+COSA are under control. I know the ASV is working, but I still feel like dookie.
But blood pressure is still climbing (~145/100+ range); sending weekly logs to cardio for help. I have some tests scheduled after the holidays.
Donating blood every 2 mo to keep HCT down.

More to follow...
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#13
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
Thanks so much for keeping us posted. I hope the new sleep doctor will be excellent, and I hope your cardiologist is being helpful.
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#14
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
OSCAR prints from Fri/Sat attached. (BTW- F12 doesn't work on my pc)
From what I see, the ASV is working and I have minimal mask leakage + hypopneas. Do you folks see anything I don't?
Thx!

   
   
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#15
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
The ASV is working well based on these charts. The pressure support is quite active keeping a steady vent rate and the relatively low PS range of 3-8 seems to be working well. You have a ramp period where respiration seems well maintained, and that might be worth a closer look. It's a little surprising not to see sleep onset apnea when ASV is used with ramp. Ramp is not recommended by Resmed but seems to work well with you and allows respiration to settle before the ASV kicks in. You do have the highest PS of the night as ramp ends, and the night without ramp seems less active for PS.

With regard to polycythemia, I had the same problem, and ended up cutting injection dose to 0.3 cc/week subcutaneous with a 5/8" .25 ga hypo, which is a lot more comfortable than the IM gear. The lower dose resolved the chronically high hematocrit and still seems to maintain levels appropriate to my age. I was never able to absorb the topical cream, didn't like the potential for it to contact my wife, and cost was too high.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#16
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
(11-06-2022, 08:34 AM)Motorheadrulz Wrote: (BTW- F12 doesn't work on my pc)

For future reference:
(on a Mac, Fn+F12)
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
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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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#17
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
Sleeprider,
I had an appt with a new sleep specialist this week and I overwhelmed her with my OSCAR data. She didn't know what to do with it.
She reviewed my ASV settings and suggested changing my EPAP= 8, but I'm already set @ 7-9. She did not make any changes on the machine.
I am also going to look back thru old logs and see when my hypopneas are occurring- there may be a trend. Since I only sleep ~ 3-4 hrs and still feel like dookie everyday, I can't rule out anything except a misbehaving body part.
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#18
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
Update: changed the EPAP=8.
After bumping up my bp meds (bp =~135/90 avg), I showed my cardio my SpO2 scores...this got him to pause and think.

It is clear as day that my oxy is 88-90% without supplemental O2; with= 92-95%. I'm dropping <90% ~ 30-40 times/night. I said there has to be a clogged artery causing all this bs. Bumping bp meds isn't going to find and unblock the clog...

He moved up my stress echo from mid-Jan to this week; also stated we need to get the OSA under control.

I haven't found a way to correlate any O2 drops in conjunction with a CA, hypopnea, or waking up, besides seeing it on a graph in OSCAR or the O2Insight app? Is there a way to tag data, output it, and frequency/reoccurrence? I'll try to find a couple examples and post.

I've stopped the CBTI sleep restriction for the above reasons, and getting 3-4 hrs/nt no matter what time I go to bed is the best it's going to get for now. I have a sleep dr f/u appt in Jan; I'm hoping to fix the plumbing issue to eliminate a variable.

MHR
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#19
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
Here is an example of when a hypopnea and Oxy drop are occurring at nearly the same time, and I'm waking up. 
Ref: 03:12-03:15

From sampling several nights, I'm seeing this repeating in the 01:00 - 04:00 timeframe. Maybe this explains why I can't sleep?

   
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#20
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?
Your AHI remains low, controlled well by the ASV. The hypopnea event drops O2 to levels, not generally considered serious, gut the reduction is in spite of apparent recovery breathing, and normal tidal volume following the event. I would expect to see faster recovery. We would have to zoom in on the respiratory flow to better interpret rate and volume. The triggering event for variable breathing is actually at 03:05:30 where there is a brief pause followed by a recovery breath and then more chaotic breathing. Whatever "misbehaving body part" is being blamed, I hope you manage to identify and tame it. The EPAP at 8.0 seems to have settled things slightly, but the views are so different that I'm not going to make any conclusions without seeing more.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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