CSA and periodic breathing

[Herbert0815]

Herbert, I think ASV is the right therapy in your case, but there is one other technique we can use to stabilize the CO2, and that is by adding enhanced expiratory rebreathing space (EERS).  This is simply blocking the vent at your mask, adding a short section of tubing and relocate the vent farther from the mask. This causes you to breath a small part of the air you exhaled in the last breath, increasing CO2. Increasing the respired CO2 increasing respiratory drive by keeping PCO2 higher, and buffers the effect of periodic breathing.  http://www.apneaboard.com/wiki/index.php...ace_(EERS)

This technique is mostly experimental but has been used successfully by several members.

Hello sleeprider. thanks for the suggestion but how does this fit to the suggestion of my sleep doc. I mean the eers aims to increase the co2 level in order to enhance the respiratory drive. but my sleep doctors suggested additional o2 as a next step in order to improve my periodic breathing. for me those are two completely contrary concepts. while I can understand the underlying theory of your proposal I don't get the o2 approach of my sleep doctor at all. do you know how they think the additional o2 could work? do you see any possibility that this could work as well?

[Herbert0815]

and also another question that is really buggering me: asyoute talking a lot about the catorid receptors - those seems to be somehow damaged by covid. do you think covid might ehave caused my respiratory drive time become unstable? I only faced those problems after having my first covid infection

[Sleeprider]

I have seen the use of oxygen reduce CA, in a member affected by high altitude. The mechanism is likely a direct effect on the carotid and aortic bodies, which are the principal arterial chemoreceptors. I have never actually recommended EERS for someone with central apnea that was not therapy induced. The purpose of my discussion was mainly to hep you deal with having central apnea as a relatively common issue among healthy individuals. It's certainly a problem, but does not reflect a severe underlying illness or health problem.

I'm not aware of a connection between COVID and the carotid bodies or the brain stem pons. A good article to help understand mechanisms of respiratory drive is here and it probably is a much better and more accurate description than I can write from my limited knowledge on the matter. https://www.britannica.com/science/human...oreceptors

[Herbert0815]

Hello Sleeprider,

tonight I did another O2 reading with my oxyring and while saturation looked quite okay, I had regular heart rate spikes. As I also suffer from occasional afib, I'm afraid this might be a trigger. Is it possible that I still have enough "mess" going on in my breathing to cause those spikes without really desaturating my O2 levels?

Thanks for your thoughts.

[Sleeprider]

There is no way for me to make a connection between your breathing and cardiac "spikes", and I'm not qualified to comment on matters outside your CPAP therapy and the information we can see in Oscar. Anything is possible, but your question will need to be answered by your doctor. You may wish to inquire about wearing a Holter monitor to collect appropriate data to address your concerns. This will provide data from both awake and asleep activity that your cardiologist can interpret to give you the answers you are looking for.

[Herbert0815]

Ok, I understand. Just recently I was wearing a 24h Holsten Monitor. my cardiologist said everything was fine. but how shouldni know if he even paid attention to those nights Spikes, as he is not a somnologist. :/

[Sleeprider]

Pulse spikes with a portable device can be caused by many things, including movement of the monitor and factors not related to respiration. There are monitors that work with Oscar and let you view the pulse and SpO2 graphs along with the respiration flow. I don't see how the graph you're using could be useful without the ability to also see the sleep data. http://www.apneaboard.com/wiki/index.php..._oximeters Good news!, I think you can read that wiki in Deutch (German).

[quiescence at last]

The results you posted do not alarm me at all. The pulse "spikes" are not high, do not correlate with desaturations. The worst desaturations did not get close to traditional markers.

QAL