[CPAP] Low oxygen on CPAP/hearth palpitation and cough + Oscar reading

[hegel]

Yep, ultrasound will tell you about artery/valve issues and such--plumbing--but NOTHING about electrical issues. these last are the cause of most heart arrhythmia. 

My EP told me my atrial fibrillation won't kill me but the stroke that it causes might. I'm not saying this is your issue! But the reason undetected afib is concerning is that blood pools in the atria and then clots. when normal functioning begins again--since arrhythms are intermittent or only at night--those clots are thrown. This can cause a stroke.

my heart functioning is excellent in terms of its plumbing. In fact it was my over exercising that was the likely culprit for my afib developing. Marathon runners and nordic skiers all are far more likely to develop fib than regular schlubs. Swimmers too.


Again, perhaps press for a Zio patch/Holter monitor. I hope I'm not sounding alarmist! I just think this is good practice.

[SarcasticDave94]

Due to heart palpitations I've mentioned for a few years to doctors, my new cardiologist had me do a chemical stress test. It revealed a heart condition called PVC or premature ventricular contractions. It is I'm thinking my left ventricle that goes rogue and beats prematurely of the normal beat electrical signal and things go off-kilter, tending to make heart rate go up but oxygen level goes down. I am not sure if any of this applies, nor do I imply it does apply, but here's the 2 cents worth anyway. Get doc to check things out is my best piece of advice.

[merlinakis]

I think your strategy needs to be to slowly increase PS to drive down flow limitation, but not so high as to cause CA. You will find that you will likely adapt as you go up in PS, so don't hesitate to be at the point where CAI is about 1/hour.  

With regard to your question about the machine, there is no official way for you to do that kind of modification, however as a member, you can read the COVID-19 forum, and at the top of the page is a restricted thread called "machine modificaitons". If you want to read that, you might find something interesting.

Hello, I checked the COVID-19 forum but couldn't find any restricted threads.

[merlinakis]

Hi all,
Thank you for your valuable insight. A quick update on my situation:

1. I was checked for possible arrhythmia and it looks normal. Normal rhythm no AF, just tachycardia. 

2. The seller came back in relation to the device and Resmed said that the extra functions (Trigger/cycle) are not available in our region with no possibility of adding the functions. 

3. I've done a full sleep study in the hospital to get a proper diagnosis but I am quite disappointed in the outcome. I was pretty anxious and it was noisy and only managed to sleep after 3am. The results came back and AHI was less than 5 so the doctor said that there is no need for a CPAP but he referred me to a dentist for a MAD.
I didn't go for the MAD because I am tolerating the CPAP pretty well. I mean it doesn't bother me that I have to sleep with a mask on. To be honest the sleep doc was very dismissive and he asked me why do I have a Bipap (paid it myself) because Bipap is not for sleep apnea. 
I managed to ask for the full report and on close inspection I noticed that they used 4% rule for hypopnea desaturation and also RERAs are 0, so I don't think they scored it. I asked if the study can be re-scored but I doubt that the hospital will do that. The other thing I've noticed is that I had quite a lot of arousals but they have marked those as spontaneous.
I'll attach the report here later on today. I am just thinking if I should try to buy a disposable watchpat at least to have a confirmation of UARS.

4. In regards to the treatment it's difficult to balance the numbers. I've noticed that if I up the PS the flow limit graph looks better but have a lot of CA events. If I lower PS and bump up the EPAP I get aerophagia. I assume this is to do with TECSA (CO2 washout) that doesn't clear up. No centrals were noted in the sleep study. 
I started stopping my device when I wake up during the night and noticed that I don't wake up when I have a central, but the flow limit graph has the typical V shape at peak when inhaling. I assume that I don't properly treat my flow limits.
Is there anything else that I can do? I can't buy an ASV at this moment. Any advice is much appreciated.  
    
5. In relation to my symptoms when I have a bad night the next day I have a lot of weird symptoms.
I have a garmin watch that I use for fitness but I've noticed that whenever I wake up in the middle of the night my "stress" is high. I've done a lot of reading and the "stress" in this instance means that my hearth variability rate (HRV) is low which means that the sympathetic nervous system (fight or flight) is very active. I have a feeling that the tachycardia that I am feeling might be a panic attack because if I stay calm my heart rate returns to normal pretty quickly.  
I started reading a lot this forum and I noticed that I have very similar symptoms to hoselife. I also sometimes jolt from sleep and my right hand is numb.
I also have a suspicion that my sleep might also be ruined by gastric issues because after a bad night the next day my back hurts and I only get relief after I had a deep cough. Nothing came up on a recent lung CT or check by a doctor.
Also a long time ago two different dentists already told me that my teeth are very thin and asked me if I usually have acid reflux. One of them suggested me to check for sleep apnea.
I do sometimes wake up with reflux but not always. I am not sure if my breathing problems are causing my gastric issues or the other way around or both. 
I started sleeping with a wedge pillow, changed my diet, not eating before bed, avoid possible trigger foods; I've also put on a few pounds in the pandemic and I am working on losing the extra weight.
I will probably visit a gastroenterologist to check this as well.
Additional if I have a bad night where I violently wake up the next day sometimes I have a range of weird symptoms sort of like I have inflammation in my body which usually resolves before evening. 
- Tiredness and brain fog.
- Back ache
- I am cold or my hands are cold and hurt.
- Bladder issues (had a bladder scope and gave a lot of samples and everything looks fine).

Does anyone have similar symptoms? I don't know if other issues also affect my sleep or if the sleep fragmentation is causing my symptoms.
I exercise daily and have a balanced diet. 
Everyday is a struggle and it's very difficult to get a proper diagnosis when everything comes back negative and doctors are treating the symptoms but not the cause. That said I still have faith in modern medicine and I will also book appointments with doctors to have a proper evaluation. 
It's good to talk to other people who are struggling at least I can make a case for myself when going to the doctor.

Thank you

[Sleeprider]

It sounds like you have optimized the Vauto to obtain the best comfort and effectiveness possible without triggering other symptoms. It is likely the symptoms you are experiencing do not arise from your PAP therapy or necessarily sleep disordered breathing that we can suggest changes to make an improvement. Your doctor was pretty clearly not helpful, and unfortunately, this is pretty typical for sleep tests. Do you know what your SpO2 range was during the test? I think you have some anxiety issues that affect your sleep and sense of well-being during the day.

We have not seen a chart update since November, so perhaps post something more recent and there may be something that will come to mind.

[merlinakis]

It sounds like you have optimized the Vauto to obtain the best comfort and effectiveness possible without triggering other symptoms.  It is likely the symptoms you are experiencing do not arise from your PAP therapy or necessarily sleep disordered breathing that we can suggest changes to make an improvement. Your doctor was pretty clearly not helpful, and unfortunately, this is pretty typical for sleep tests.  Do you know what your SpO2 range was  during the test?  I think you have some anxiety issues that affect your sleep and sense of well-being during the day.

We have not seen a chart update since November, so perhaps post something more recent and there may be something that will come to mind.

Hi Sleeprider,
Thanks for your reply. I will post my more recent full sleep study showing O2 levels. Minim level is 92% and sum of all desaturation was 4:30 minute.

I actually had talked to the sleep technologist and he said that  they scored with a 3% desaturation rule and asked him to score RERAs which he did. I don't have the newer report but he said that I only had 7 RERAs so the RDI is ~4 events/hour. To be honest I couldn't really fall asleep with all of the cables attached so I don't know how accurate is the measurement. I only slept from 3 am even though they recorded a few "sleep stages" while I was awake so the RDI might be a bit higher.

What I noticed is that most of the time I wake up suddenly from a dream but I don't have any nightmares.

I will also upload a few recent Oscar graphs in the following days.

Thank you.

   

[SarcasticDave94]

To me a rather significant nugget of info is sleep efficiency is 58%. Something not playing well with trying to sleep. That's about the same % I get as well and I've got high Centrals and COPD.

NOT stating you've got either, but there's something that hinders rest.

[merlinakis]

To me a rather significant nugget of info is sleep efficiency is 58%. Something not playing well with trying to sleep. That's about the same % I get as well and I've got high Centrals and COPD.

NOT stating you've got either, but there's something that hinders rest.

Hi SarcasticDave94,

I might be wrong but I think that the sleep latency/efficiency might also be related to the fact that I did not sleep for half of the study.
At home it's a different story. I usually fall sleep without any issues, unless for the hypnic jerk that I rarely experience. 

To be honest even though the study results show only small respiratory issues I still feel that I breath easier with the VAuto. My nose doesn't get blocked.
But I still wake up with or without the mask.

I am sure that I have some breathing issues due to my narrow passage and recessed jaw and I can actually see some flow limitations on the VAuto.
I was always mouth-breathing but after surgery for my deviated septum, training to only breath through my nose during the day, mouth taping and using a Neti Pot regularly I can say that I am nose breather.

Probably there is something else as well. I will say that I am a bit on the anxious type of people but I am not overly anxious. I mean I have these symptoms on holiday as well. I sometimes take magnesium before sleep or different vitamins that should promote a good night sleep and I would say I have a good sleep hygiene but I don't see any difference.

I had these symptoms for the last 3-5 years and I still didn't manage to get a proper diagnosis.

My previous bloods that I have done always show that everything is in parameters for my age, except the cholesterol which is usually borderline high.

[merlinakis]

It sounds like you have optimized the Vauto to obtain the best comfort and effectiveness possible without triggering other symptoms.  It is likely the symptoms you are experiencing do not arise from your PAP therapy or necessarily sleep disordered breathing that we can suggest changes to make an improvement. Your doctor was pretty clearly not helpful, and unfortunately, this is pretty typical for sleep tests.  Do you know what your SpO2 range was  during the test?  I think you have some anxiety issues that affect your sleep and sense of well-being during the day.

We have not seen a chart update since November, so perhaps post something more recent and there may be something that will come to mind.

Hi,

I've attached my OSCAR from the last 2 nights. 

I know that the EPAP is low in this instance. I have tried different different EPAPs during the course of the last 6 months: from 7 to 12 just to see how it affects my sleep and numbers but I might get aerophagia on higher pressures. I tried changing the PS a few times to 3 or 4 but then the CAs are between 2.5-5/hours. It also depends on the night because the same setting might yield different results on different nights. Sometimes I wake up on my pillow, near my pillow, on my back, on my side so who really knows. 
I find it kind of odd that people go to their doc for a titration and you get a prescription that is relevant to the night of the study but there are so many factors to take into account, even if you gain or lose some weight you will probably need a new prescription.
   
   

Thanks.

[merlinakis]

I've also noticed that if I have a higher PS and I take a long breath when awake, the machine might change quicker from IPAP to EPAP pressure while I am still inhaling and for 1 second I get startled.