COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI?

[Sleeprider]

I think we can also work your problem from the supplemental O2 bleed aspect. What is your current bleed rate? I wrote a wiki on Oxygen Bleed With CPAP that covers a lot of the basics, and reading it might help you to better understand the therapy and how it should work and be titrated. http://www.apneaboard.com/wiki/index.php..._with_CPAP Given your low AHI and good control of events with ASV therapy, the correct oxygen bleed should not be that hard to derive, but it is usually much higher than most doctors realize due to the dilution effects of the positive air pressure therapy.

[Motorheadrulz]

my oxy bleed calc= 29%:

   

My numbers may be off since the mask and oxy conc specs did not exactly specify my flows, but are close enuff.

I'm hoping the scan will finally find something repairable; I shouldn't be getting winded going to the head...

Will hold until I fix my plumbing.

TY, MHR

[Sleeprider]

It's close enough. The default FiO2 is 21%, and your approximate FiO2 in therapy is 29%. That gives you a pretty good point of discussion with your doctors of what a 4.0 L/min flow actually delivers. Well done!

[Motorheadrulz]

Update:
I had a stress echo + saw cardio + pulm in the last week. Stress echo was within (the upper) threshold for my age, but dr. noted the shortness of breath and coughing during the test- so it wasn't great. "Exercise hypertension" and poor exercise tolerance was noted; I only lasted 6.5 min during the test.

In short- nobody knows wtf is going on. Both drs were alarmed when they saw how often my SpO2 is dropping <90%. The protocol is <88% for 5+ min continuous, they noted how often it happens throughout the night- 3 min here, 2 min there, etc... I also recorded it from 1500-2100 to show how low it goes while awake, moving around the house, before bed+ASV+O2.

I have a CT angiogram scheduled in Feb.
MHR

[Motorheadrulz]

It's been a while since my last update, but I have some potential answers:

I spent last week getting prodded/poked/tested that included pulm, cardio, GI, ENT, and sleep. The consensus is I have "silent reflux", aka gastric aspiration. They found my hiatal hernia is back; I had it fixed in 2005, but it must be leaking. I don't have classic GERD symptoms, so go figure.

In short... stomach acid is traveling up and pissing off my esophagus, trachea, larynx, sinuses, and going into my lungs. Especially when lying down. This explains the chronic cough, congestion, SOB, elevated BP, and O2 drops. I'm waiting for all the tests and biopsies to come back for the final answer. It's treatable with steroids, antibiotics, and acid reducing meds; TBD on if I need a hernia revision.

I also had a consult with the sleep Dr. She is ordering an overnight lab titration study since the hypoxia, apneas, and chronic fatigue are uncontrolled; even though my AHI <2 on avg, but I'm having hypoxias while awake. She noted that I don't have a backup rate on the ResMed Aircurve 10, but I think she misspoke since I looked it up and by default= 15 bpm. I have a consult with their insomnia clinic, and they specialize in CBTI and sleep improvement. She was appalled that my previous CBTI experience was only an online class and an app...

She adjusted my ASV settings to EPAP min= 9, EPAP max= 12, Pressure min= 4,  pressure max= 9; I'm trying them out and am tolerating them.

I showed her my OSCAR charts, and I got told I was "too damned smart for my own good". 


MHR

[Dormeo]

It's a darn lucky thing you're "too smart for your own good"! I'm glad you seem to be on a path toward improvement. Just curious: did your workup include an endoscopic look at your esophagus?

[Motorheadrulz]

Dormeo:
yes... upper GI, 24 hr manometry up the shnoz, biposies, + laryngoscopy. I actually saw the inflammation on the esoph/trachea/throat.
I have a follow up with my local GI dr next month to discuss surgery.

[hopeforusall]

Motorheadrulz, I have had some significant success with a very low dose of Baclafen. I can send you links to a summary of about 29 studies that show the results of what I have seen myself. Or do a search on Baclafen and gerd. Ask if you can start with 5-10mg x2/day. It may save you some throatache, chestache, and heartache.

[Motorheadrulz]

Update:
I'm scheduled for an overnight in-lab sleep study, a consult with an insomnia clinic that offers personal CBTI, and a surgical consult to fix the hiatal hernia this month.
Elevating the head of the mattress and double doses of Prilosec have helped.
My ASV +O2 is still working, but I'm still struggling with sleep and fatigue until I get this shat fixed...

[Dormeo]

It's good to hear that so much is now in progress. Keep us posted!