Feeling like I cannot breathe

[vgrando]

Yes, hopefully, the V-Com will decrease mouth leaks. Last night AHI. was 4.4 (0.9 OA), Leak 8.4, 02 >90 for 45 minutes.

[vgrando]

In an attempt to decrease desaturations, last night I set my settings to: CPAP, nasal cap mask (the only type I feel like I can breathe with), increased my pressure 11cmH02, EPR 3, 2, EPAP 8. 

Things looked good except my 02. AHI was 0.6 and that was all CA. The leak rate was 13. 


I desaturated >90 for one hour and 40 minutes to a low of 86%, which is better than 83%.

I can see that the desaturation occurred when my breathing was shallow. with a low tidal volume

[Jay51]

Victoria, you have done a great job IMO experimenting to try to get the best therapy out of your Airsense 11.  If you continue you might find and even better combination of (EPAP, EPR, and mask) to get your SPO2 levels as high as possible during sleep.  

Your therapy with this Airsense would be acceptable if you can keep your SPO2 high enough at night.  Supplementing with supplemental oxygen + your current Airsense with a low AHI = good enough therapy (IMO). 

The only other option might be a VAPS machine that assures you a certain tidal volume with each breath.  The Resmed ST (A) has IVAPS in which you can assure a certain tidal volume.  The Philips Dreamstation bipap AVAPS can do this too (although I have never seen any data on this machine, it could work also for assuring a certain tidal volume.)  The other 2 options are the Resmed Astral ventilator and the Philips Evo ventilator.  The ST (A) and Dreamstation are much cheaper than the ventilators, but fairly espensive in their own right.  *And even if you achieve a normal tidal volume, you still might desaturate a lot like you are doing now (the problem may be in your lungs and increasing your tidal volume may not increase your SPO2 levels during sleep).  

A third option to increase your tidal volume could even possibly be doing a lot of work on your nose and nasal breathing (work with ENT, etc.) to increase tidal volume (and even then, improving your nasal breathing might not improve your SPO2 levels at night).

These are my best observations and suggestions based on my experience with hypoventilation and personal use of:  ST (A), Resmed Astral venitlator, and Philips Evo ventilator.  Anyone else with suggestions please feel free to post also.  

Also, with a consistent AHI below 5 like you are achieving now, insurance would be reluctant to pay for an advanced machine like the 4 machines described above.  A significant failure on a major breathing test might get them to support a machine change though (from my experience).

[vgrando]

Thank you! Your suggestions are so appreciated!!!

I just got the nasal dilator that you suggested. I could feel a big difference in my nasal breathing with it in my nose. I will use it tonight and also during the day. When sitting at rest, my 02 goes down to 85% frequently. Maybe it will help with that also.

Since I have no lung or heart disease, I firmly believe that structural changes to my chest wall have caused my lower lung athletics and shallow breathing. We cannot consciously breathe less deeply! The new sleep MD told me to do breathing exercises, and maybe this is the only thing that will help. I have started doing Qi Gong exercises focusing on deep breathing and chest expansion. I also have an apparatus that improves lung compacity.  

I also agree with you that my small nares, allergies to dust, and deviated septum add to all of this. I have appointments with both an allergist and ENT.  For many years, one nostril is closed when I sleep on one side, and if I turn to the other side, it reverses. So I only breathe through one nostril at a time. I hope the nasal dilator will help with this.

And I know you are so correct, my MD was so happy my AHIs were so low. He will not see the bigger picture. My problem is not AHIs but my documented desaturations and hypoventilation that did not occur with respiratory events. In the titration study, one desaturation occurred with apnea, which did not account for the other 90 minutes of 02 under 89% and as low as 76%. It reminds me of when the principal of my daughter's school would not provide her with needed services for documented learning disabilities because she was a "B" student.

He is only focused on AHIs. He even said to me that AHIs is what he thinks is important. if I cannot get him to address the other issues. I will find a new MD. He did diminish my concerns by telling me I was too anxious.  But the article I quoted clearly states that testing gas exchange while sleeping is the only way to diagnose hypoventilation. And as I told you, I can pay for the better machine out of pocket.

I have not been able to post any more charts. I guess I will have to start a new thread.

[vgrando]

Getting ready for my in-home oxygen study next week. Therefore, I set my machine to the settings my MD ordered (APAP with pressure 11 to 14, and EPR full time at 3), wore my F&P Evora FFM, had no nasal dilator (it kept falling out), and had no oxygen supplementation. I had zero leaks and my AHI of 4 with CA at 3.64. Without 02 supplementations, my 02 was >90% for 1 hour and 25 minutes, with a low of 85%.

[Jay51]

I hope your home oxygen study goes well.  I had to take all 4 of the capnometry/capnography tests on room air (no pap machine or ventilator).  Not sure how they want to you to take it.

[vgrando]

I do not know how I will do the study, but I assume while on Pap because I complained that my 02 went down for over an hour+ on Pap.

Here are my findings from my titration study while on Pap

Reason For Study: The patient had a sleep study 4/2/23. AHI was 18.14/hr and
the lowest SPO2 was 83%. 1L oxygen was added during the study, and concern for
hypoventilation

PAP TITRATION:
CPAP was started at 5 cmH2O and was incrementally titrated to 10 cmH2O.
Patient respiratory events were not corrected in supine REM on final pressure.
OXIMETRY DATA:
The lowest oxygen saturation was 76.0 %. The patient had an O2 saturation <89 % for 91.20 min.
Oxygen Desaturation Index was 9.9.
The lowest oxygen saturation was associated with a respiratory event.
Hypovrentalation
Baseline TcCO2 was 39 mmHg, and the maximum TcC02 was 49 mmHg during the study.

I believe that this study documents desaturation while on Pap. Am I wrong?

[Jay51]

You are correct Victoria.  It documents desaturations on pap and hypoventilation.

[vgrando]

Thank you!

[vgrando]

I have been supplementing with 1 liter of 02 but my 02 still drops.

This night, I had supplemented with 1 liter of Oxygen and still dropped 02 for 46 minutes to a low of 86%.