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Cheyne Stokes Respiration ?
#11
RE: Cheyne Stokes Respiration ?
Ive decided to reduce EPR to 2 to start with. Also I notice with my pressure at 10-15 I was hitting the maximum a couple of times. What pressure setting do you suggest now? Maybe 10-17 or 18? Do I need to adjust minimum if I reduce EPR?
I also have turned ramp off

Finally I have a pacemaker and have had some abnormal ECG readings (left bundle branch block) so will discuss all this with my electrophysiologist when I see him this Thursday
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#12
RE: Cheyne Stokes Respiration ?
You have a persistent flow limitation which suggests some upper airway restriction. Your CPAP pressure tends to follow increasing flow limitation and you can easily see the correlation on your charts.  You also have an inverse inspiration/expiration time that appears to be confirmed by the closeup posted on the 12/11 graph.  This gives rise to the strong spikes on the bottom half of the flow rate chart.  I wonder if a review of your sleep study might offer any insight into this odd patter of slow inspiration and rapid exhale? Are you aware of this breathing pattern?

In all of your charts, the periodic breathing episodes occur near the time when you awaken or immediately following an arousal and start of therapy, so this anomaly is either sleep transition or while awake.  In the chart you posted yesterday, we can see the same pattern at each arousal. While these are not flagged, we can see the pattern is there nearly every time you start sleep or awaken.

Considering your pacemaker and cardiac issues, your consultation with the cardiologist seems well advised.  You might be a good candidate for an Apple Watch (4 or newer) which monitors your cardiac condition and can alarm.  You are using an Airtouch F20 mask with magnetic clips which are contra indicated for individuals with pacemakers.

I'd like to get into some closer examination of your flow rate outside of the periods of periodic breathing and see what is going on elsewhere. These will be 2-minute segments that clearly show the flow wave.


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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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#13
RE: Cheyne Stokes Respiration ?
Thanks so much Sleeprider.
Yes, I have noticed breathing issues. Almost like I "forget to breath" sometimes, or depressed breathing. Gets worse when my cpap pressure gets up toward 15 

I have attached 3 screenshots from 14/12/19

I have tried almost every mask and the F20 is the only one I could sleep with. I am a mouth breather. I will try to modify it by taking out magnets and taking mask on and off via other straps. Have you heard of anyone doing this successfully? 

Will discuss all this with my Cardiologist on Thursday, and look into the Apple watch (I use a Kardia at the moment to check for Afib) Also will request another sleep study as you suggested

I tried tonight to sleep without Stilnox as I thought that may be contributing to the periodic breathing. . Got 2 hours now wide awake since 1.30 am (its 4.30am here now).  What is your opinion on Stilnox and cpap. I am desperate for sleep.

Finally, I have read the Resmed Aircurve ASV would help periodic breathing. Also may help with exhaling when the pressure on my Airsense gets to 12-15. I feel suffocated often.  I qualify for Aircurveas I dont have heart failure (Ejection fraction is 63%)  Do you think the Aircurve may assist with these 2 issues?

kind regards
Mal
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#14
RE: Cheyne Stokes Respiration ?
Thanks so much Sleeprider. (I'm not sure if my last post was successful so will send again)

I have attached 3 screenshots from 14/12/19 of 2 minute flow minute (away from the periodic breathing), as you requested




Yes, I have noticed breathing issues. Almost like I "forget to breath" sometimes, or depressed breathing. Gets worse when my cpap pressure gets up toward 15 


I have tried almost every mask and the F20 is the only one I could sleep with. I am a mouth breather. I will try to modify it by taking out magnets and taking mask on and off via other straps. Have you heard of anyone doing this successfully? 

Will discuss all this with my Cardiologist on Thursday, and look into the Apple watch (I use a Kardia at the moment to check for Afib) Also will request another sleep study as you suggested

I tried tonight to sleep without Stilnox as I thought that may be contributing to the periodic breathing. . Got 2 hours now wide awake since 1.30 am (its 4.30am here now).  What is your opinion on Stilnox and cpap. I am desperate for sleep.

Finally, I have read the Resmed Aircurve ASV would help periodic breathing. Also may help with exhaling when the pressure on my Airsense gets to 12-15. I feel suffocated often.  I qualify for Aircurve it seems as I dont have heart failure (Ejection fraction is 63%)  Do you think the Aircurve may assist with these 2 issues?

kind regards
Mal
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#15
RE: Cheyne Stokes Respiration ?
Each of the three graphs shows flow limits that are significant. If you have the ability to get to an Aircurve 10 Vauto, we could make a pretty good dent on that and normalize your respiration. You are expending so much effort and time on inspiration that when you finally fill your lungs, you are blowing air out for expiration. Your AHI is not going to get you much attention, but I can assure you that bilevel would make a huge difference in how you feel. The small waves in the flow rate have a frequency of about 78/minute and are most likely your heart rate translating into the respiration wave. This suggests some stress and it's worth talking about. Your doctor will tell you I'm full of it, but I have seen this in others, and bilevel or ASV resolves it. The lack of central apnea does not suggest ASV to me, so a more simple bilevel should help you to even this out. In simpler terms, we want to off-load some of the physical effort of respiration during sleep to the machine by using pressure support.
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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#16
RE: Cheyne Stokes Respiration ?
Thanks Sleeprider . Valuable information 
The machine here in Australia is the ResMed Aircurve CS Pacewave . I presume that is the same as the Aircurve Vauto? 
Also does the Aircurve help with the exhaling/suffocating feeling I get with my airsense Apap 10. 
The CPAP shop wants a sleep physicians script before I can buy it and there is a 4 month waiting list!!
I will talk to my cardiologist tomorrow and hopefully a letter from him will suffice. I have Left bundle branch block but luckily no HF (EF 63%)

Mal
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#17
RE: Cheyne Stokes Respiration ?
Hi Mal

Just a correction - the CS Pacewave is equivalent to the Aircurve ASV. You're probably looking for a Lumis 100 which is equivalent to the VAuto Sleeprider referred to.

Lumis brochure: https://www.resmed.com/au/dam/documents/...nz_eng.pdf

Resmed Australia devices: https://www.resmed.com/au/en/healthcare-...vices.html
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#18
RE: Cheyne Stokes Respiration ?
Mal777 Wrote:I tried tonight to sleep without Stilnox as I thought that may be contributing to the periodic breathing. . Got 2 hours now wide awake since 1.30 am (its 4.30am here now). What is your opinion on Stilnox and cpap. I am desperate for sleep.

Stilnox (Zolpidem, Ambien) is contraindicated for patients with sleep apnea. I've had two doctors refuse to prescribe it for me when my regular GP was away. However, as he says - once you're on the machine and it's working well then the reason for contraindication has been eliminated. I have been taking it for years as I have severe insomnia associated with fibromyalgia. Occasionally I might forget to take the pill then I'm lying awake at 2:00am wondering why I can't sleep.

I am quite sure it's addictive or dependency-causing, but it's the only way I can get some sleep. It sounds like we're in the same boat.
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#19
RE: Cheyne Stokes Respiration ?
Thanks but I Sleeprider suggested aircurve10 v auto which I’m pretty sure as the Aircurve 10 ASV in Aus. 
I really should see a sleep physician but 4 month wait!!
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#20
RE: Cheyne Stokes Respiration ?
(12-18-2019, 05:33 AM)DeepBreathing Wrote:
Mal777 Wrote:I tried tonight to sleep without Stilnox as I thought that may be contributing to the periodic breathing. . Got 2 hours now wide awake since 1.30 am (its 4.30am here now).  What is your opinion on Stilnox and cpap. I am desperate for sleep.

Stilnox (Zolpidem, Ambien) is contraindicated for patients with sleep apnea. I've had two doctors refuse to prescribe it for me when my regular GP was away. However, as he says - once you're on the machine and it's working well then the reason for contraindication has been eliminated. I have been taking it for years as I have severe insomnia associated with fibromyalgia. Occasionally I might forget to take the pill then I'm lying awake at 2:00am wondering why I can't sleep.

I am quite sure it's addictive or dependency-causing, but it's the only way I can get some sleep. It sounds like we're in the same boat.

Yep I’m the same with stilnox. Can’t sleep at all without it   Good to know it may be ok if using CPAP ?
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