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

[Sleeprider]

Just a guess, but let's see what happens with PS min 2. That would potentially allow PS mas 7, but we can hold onto that based on what you see. I would change to ASV auto and keep max IPAP the same.

[Motorheadrulz]

will try it and check back in a couple weeks. TY!

[Motorheadrulz]

I had a new sleep study last month, and would like your feedback. I'm not happy where the doctors want to go...

To recap my saga, I'm still dealing with the severe gastric aspiration and recurring hiatal hernia issues. I'm still dumping stomach acid into my lungs and having the cough, shortness of breath, and sever fatigue everyday. I have a new battery of GI testing coming soon and hopefully another hernia revision asap.

I'm still on an ASV + oxygen at night; my AHIs are consistently < 2. My pressures are what Sleeprider suggested above.

I've been doing CBTI since Nov '23 and it's not working. I'm still only getting 2-3 hrs of unrestful sleep, then maybe a couple catnaps until the alarm rings each day.

The new sleep dr thinks I should go to a Bipap and not the ASV. I don't think that will help, nor understand their rationale- they think I have a ventilation problem. I have predominant central apneas and very few if any obstructives, and have been on the ASV for 4 yrs. During the study, I had a short nap, then awoke, rolled over and got back to sleep- so basically the same sh*t that happens at home. They tried me on a backup rate and I couldn't adjust to it- the inhalation would cut off mid breath and suffocate me, then during exhalation it would switch back to inhalation. That kept me awake more than anything.

I also did not see clearly how many awakenings or arousals were reported on this study, compared to the 60+ from June.

The one thing I've been bitching about for years is although the machines are doing their jobs correctly, I'm not getting much benefit from the therapy. My AHIs are low, the ASV is providing the breathing and stopping the apneas, but I'm not sleeping properly nor getting much rest. If you look at my N3 scores from the studies, I'm not getting much, if any, N3 sleep or recuperation. So staying in bed for 5-6 hrs still results in very fragmented and unrestful sleep. I'm beginning to think I may need some neuro help and analyze the brain waves as to what's causing the fragmented sleep. But I have to convince the sleep dr to quit playing whack-a-mole with machines and pressures.

My recent study is attached and any help is greatly appreciated. The one from last June is available in a previous post (note: 0, I mean ZERO, N3 sleep reported on this one).

MHR

[Sleeprider]

I disagree your ventilation would be improved with spontaneous bilevel therapy. Your ASV therapy is highly modified to accommodate your aerophagia and gastric issues.  Your recent titration test was performed using BPAP S (spontaneous fixed pressures) at 10/6 with a breath rate of 10/minute.  That delivered a continuous PS of 4.0, and was probably mostly triggered breaths.  Notably, the efficacy was poor with a residual AHI of 4.75.  They followed with ST (spontaneous/timed) with breath rate of 10, but didn't go that way for some reason. The table in that titration report is incredibly hard to read without the columns lining up, and I'd love to see it as a CSV file or table.

Anyway, just for the heck of it, let's compare the titration with your use of ASV with EPAP 7.0-8.0 and PS 4-9.  We are getting much or more "ventilation" because the PS 4 to 9 rather than a static 4-cm. Your PEEP on ASV is higher at 7.0-8.0 cm-H2O which is higher than their test, which means in theory, your oxygen profusion should be better, especially since your AHI residual is a fraction of the titration results (.26 to .55). I don't see any prospect for static BiPAP to be more comfortable or efficacious than what you are getting on ASV, so explain to me in plain language why that is even an attractive option?  You seem to have more than your share of problems with your gut and maintaining good SaO2/PaCO3 balance, but why would you try to fix what is already optimized.  Any pulmonologist should be able to look at the parameters for your ASV therapy and the proposed BiPAP and understand the the ASV meets all the expectations of BiPAP-S and more with a much lower AHI and better comfort.  Sheesh!

[SarcasticDave94]

Just say no, hold your ASV tightly. Instead of them trying to fix what's broken, they're wanting to break what's fixed.

At this time, regardless of numbers, what is wrong with the ASV, in therapy and in feel? There's only a few settings to edit, however we can try to slide things around to help.

[Motorheadrulz]

Will try these new settings and check back after in a week or two with an oscar print.
I agree switching to a Bipap is a waste.

Sarcastic- I'm only getting 2-3 hrs of sleep + maybe a couple catnaps each night. I don't take any naps during the day, and even when I try to snooze I can't. I feel like sh*t all the time and have no energy for anything. My wife says I have the opposite of narcolepsy.

Mucho grassy ass, amigos!

[Motorheadrulz]

Game over, man!

After years of struggling with this BS- I've given up. Nothing has worked.
Even though statistically the ASV has "controlled" the apnea, the whole person is still hurting and barely able to function. I refused: switching to a BiPap and heavy duty para-psychotic drugs; CBTI failed after 2 yrs of trial, and so forth.

I want to thank everyone on this forum who tried to help- you're much appreciated.
As I said early on- I have too many misbehaving body parts to cope with all this.  No naps, difficulty falling and staying asleep, and functioning on 2-3 hrs total sleep per night for the past 10 yrs, minimal caffeine, no drugs or alcohol, etc.

I believe there is failing neuro component that no one wants to explore. Getting zero to almost no N3 recuperative or REM sleep on the past 5 PSGs tells me something is wrong. I've offered to do multiple EKGs in the lab to capture the brain waves during sleep, but the sleep drs are only focused on titration. And of course, the  neurologists just send me back to the sleep drs...

I want to thank everyone on this forum who tried to help- you are much appreciated. I'm considering moving to a new area with better healthcare (Mayo in Phoenix?) and restart this BS. I need a break.

MHR

[Dormeo]

I really, really hope you get the medical care you need and deserve.