APAP and central apnea

[Ghandi]

Sometime it's a flat line with a micro inhalation and exhalation here and there It hard to tell how big it is cause it's on a 19 -19 scale. Maybe one or 2 seconds . so i dont techincally breath. Sometimes Long enough for the machine to sent 4 or 5 pressure pulse.

I can easyly hold my breath for over a minute when i took a full inspiration. After a small inspiration ,40 seconds is not so bad. But according to my flow it happens after i exhale. I did the test after an exhalatioon. After 40 second i did't gaps but i was happy to breath. Maybe that when my body just reclaims air. After those event there is a small inhalation a big exhalation. i dont get it. How can i exhale longer then the breath i took after beeing deprived from air?

But i just noticed those event are usually proceeded by very long serie of inhalation followed by smaller exhalations.

well this is an example. ACa Of about 30 seconds followed by a little bit smaller OA
https://drive.google.com/file/d/0B-P3aJu...sp=sharing

Or that one. A 41 seconds OA
https://drive.google.com/file/d/0B-P3aJu...sp=sharing

On that one you can see the big breath peak before and the bigger exhalation afterward.
https://drive.google.com/file/d/0B-P3aJu...sp=sharing

so my question is, do i look lime i'm breathing a little or not at all? And whats how come there is a big exhalation afterward. Could i just be really full of air when that happens ? Does it look like a desaturation situation? Or am i misreading the flow chart.

They dont happen everynight. they most likely occur when i'm on my back. Well it there is nothing to worry about i'm going to let it go. but if it's abnormal i'm going to make a strong case about raising my pressure to the doctor presenting those events.

[retired_guy]

What I do not see in your charts is any compelling reason why on earth you are being treated at a pressure of 7. You did score 6 CA's in the first of three samples, and maybe they really are Clear Airway events.

But it just doesn't look to me like your machine is doing very much for you.

So why aren't you slowly and gently titrating that pressure up a little?

[justMongo]

Ask you physician about Cheyne-Stokes Respiration.
http://en.wikipedia.org/wiki/Cheyne%E2%8...espiration

I no expert; but the pattern reminds me of that seen in Cheyne-Stokes.

[vsheline]

Hi Ghandi,

First plot looks like obstruction (pressure too low) perhaps combined with CA and a looks perhaps a little like CSR (but I think it is not CSR). The second plot looks like obstruction (pressure too low) and does not look like CSR at all.

First plot shows about 100 seconds with no significant breathing (starting 1 minute 33 seconds and ending around 3 minutes 20 seconds) but clear signs of obstruction (raggedly exhalation starting around 1 minute 50 seconds, earlier than the scored CA, and additional raggedly exhalations with the resumption of breathing starting around 3 minutes 20 seconds).

The second plot shows what looks like a nearly 100 sec obstructive apnea starting around 2minutes 40 seconds and ending around 4 minutes 20 seconds (in addition to a second scored OA).

Alarming. Email the second plot to your doctor and then call to get pressure raised.

Either MAKE SURE you are never sleeping on your back any more or get the pressure raised pronto.

Normally would not suggest raising pressure more than 1 cm H2O per week or so in order to watch for side effects. But I suggest either wearing a teeshirt with a tennis ball in a pocket sewn on the back, right between shoulder blades or a little higher, to make VERY SURE you don't stay on your back when you roll onto it while asleep, or (if that doesn't work for you) I suggest raising pressure 2 cm H2O, and monitor data to see if more pressure needed.

Raising pressure may increase CAI but I think more important to stay off your back (preferred) or if that won't work for you then raise pressure in order to avoid these 100 second apneas (which to me look like they are primarily obstructive).

Take care,
--- Vaughn

[CynthiaMueller]

I've had a prescription for a BiPAP ASV since the beginning of May but I haven't been able to get a DME to actually get a hold of one in order to sell one to me. (I have been through a few. I think that they have to get someone to invent it or refine the plastic used in it or something. ) Insurance has said "no problem" to coverage - they have the documentation.

Hi Cindy,

That's amazing. Maybe you can call your insurance company and ask them to identify a DME who can dispense the unit to you. Or ask if you can buy on line and be reimbursed at same rate as if using an in-network DME because you have been unable to locate a DME in your area which will supply the machine.

Hurry, or you may need to start all over again because pre-authorizations are only good for a few months, and then another ASV titration may be required or something like that.

Make sure you get either the newer S9 VPAP Adapt REF# 36037 (NOT older S9 VPAP Adapt REF# 36007 or 36017 if including Humidifier or 36027 if including Humidifier and heated hose, which had ASV mode but did not have the new ASVauto mode), or the PRS1 DS960 with heated humidifier AND HEATED HOSE).

Best of luck,
--- Vaughn

Thanks, Vaughn,
all 3 companies were recommended by insurance. They don't require predetermination, so that won't expire. The doctor would issue a new prescription if it becomes outdated. I've tried a third company but the doctor told them that she'd already sent the paperwork to the second company and I would have to contact her to explain the change.in the meantime, I have one more month on my 10 months rental to own insurance program for the plain BiPAP. I'm going to keep that then get the new one
I want to stay with ResMed but the doctor uses Respironics, so that's what is on my Rx. I really hope that I get lucky and can get what I want.
if tomorrow the current DME has no idea when delivery will occur, I will cannot the doctor and head to a third company (Located - hate their billing, but I always get product on time and all that is needed.)
Even being a squeaky wheel, it's not forcing the issue through the channels
You just have to be patient and be your own advocate. Also, ask the insurance company questions about how the DME should do it so you understand the process.
Is everyone bald before getting the right equipment from pulling out their hair?
Have a great night!

Cindy

[Ghandi]

Oh well thats not really reassuring but it's what i've been thinking all along. Pressure is not high enough and does't fix what it should.

I'll show the graphs to my doctor and see if he identifies CSR

So you are suggesting i avoid sleeping on my back forever or when i'll have pressure raised the machine should take care of it events on my back?

[Ghandi]

BTW i have a really good hr and aerobic condition. At rest my h4 is 47 and my v02max is 47 with 172bpm max hr. Heart has been scanned from a to z with an echo. And it's in perfect condition.

[retired_guy]

Oh well thats not really reassuring but it's what i've been thinking all along. Pressure is not high enough and does't fix what it should.

I'll show the graphs to my doctor and see if he identifies CSR

So you are suggesting i avoid sleeping on my back forever or when i'll have pressure raised the machine should take care of it events on my back?

Can't speak for Vaughn, but I'm not suggesting you will never be able to sleep on your back. You should avoid it for now until you get your apnea controlled though.

What seems clear is your pressure needs to increase. You need to do whatever you need to do to get that done. In the meantime, avoid sleeping on your back. Also sleep with the head of your bed propped up.

BTW i have a really good hr and aerobic condition. At rest my h4 is 47 and my v02max is 47 with 172bpm max hr. Heart has been scanned from a to z with an echo. And it's in perfect condition.

That's great Ghandi, now get your apnea under control and you'll be good to go!

[Ghandi]

What seems clear is your pressure needs to increase. You need to do whatever you need to do to get that done. In the meantime, avoid sleeping on your back. Also sleep with the head of your bed propped up.

I'm working on it I'll find a way. Thx for your support. i called the hospital archives to get my polysonography results to, support my case. I had almost no apnea while not on my back.