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Since it seems my tidal volume is so low (280ml), and that I know I suffer from sleep apnea (mainly hypopnea though), and that I may be victim of OHS or CHS, shall I directly go for a BiPAP titration study ?
In Singapore, I need to chose between either CPAP or BiPAP. Each of them are $2K SGD and never reimbursed by any insurance (anything related to sleep is excluded), so I would like to make sure that BiPAP is the way to go.
Link to the website: https://www.sgh.com.sg/clinical-departments-centers/respiratory-critical-care-medicine/pages/sleep-disorder-unit.aspx
09-21-2018, 08:45 AM (This post was last modified: 09-21-2018, 08:50 AM by Sleeprider.)
RE: Massive bradypneas, scared
I would go straight to BiPAP study. The purpose is to see if pressure support can improve tidal volume and SpO2, as well as treat hypopnea. CPAP cannot treat respiratory insufficiency, and is a not an effective therapy for the kind of hypopnea you have; it requires pressure support to boost your inspiratory volume. The real question is whether you need a backup-rate on bilevel for the periods you seem to not spontaneously initiate a breath.
With costs like that for testing, if the tests cannot answer the above questions, I would just source an Aircurve 10 vAuto and buy it. It will tell us everything we need to know, and at least you'd own it.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(09-21-2018, 08:45 AM)Sleeprider Wrote: I would go straight to BiPAP study. The purpose is to see if pressure support can improve tidal volume and SpO2, as well as treat hypopnea. CPAP cannot treat respiratory insufficiency, and is a not an effective therapy for the kind of hypopnea you have; it requires pressure support to boost your inspiratory volume. The real question is whether you need a backup-rate on bilevel for the periods you seem to not spontaneously initiate a breath.
With costs like that for testing, if the tests cannot answer the above questions, I would just source an Aircurve 10 vAuto and buy it. It will tell us everything we need to know, and at least you'd own it.
Awesome! Well, if I can save $2K thanks to the help of the forum, I would be more than grateful haha !
In that case I also need to find someone willing to buy over my PR Dreamstation which is only 6 months old, but that is another story :-)
More seriously, tomorrow morning I am going to see the pulmonologist and will ask hil the questions. But personaly, do you think it wouldn't just be worth buying the aircurve and DIY? Or BiPAP settings are way more tricky than CPAP/APAP ? (which I believe, but is there a real need for a relevant expert from sleep center to do so?)
The unanswered, important question is whether you have central apnea, or just need some pressure support to get good volume. Any bilevel can provide the pressure support, but if you don't spontaneously initiate a breath, only ASV and ST will work. Unfortunately, we don't know the cause of the nearly flat-line breathing, but if there was any breathing effort at all, we can set the trigger on the Vauto to very sensitive, and it will provide IPAP.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(09-21-2018, 10:59 AM)Sleeprider Wrote: The unanswered, important question is whether you have central apnea, or just need some pressure support to get good volume. Any bilevel can provide the pressure support, but if you don't spontaneously initiate a breath, only ASV and ST will work. Unfortunately, we don't know the cause of the nearly flat-line breathing, but if there was any breathing effort at all, we can set the trigger on the Vauto to very sensitive, and it will provide IPAP.
Have you ever had any kind of sleep test?
Yes I had one, but not a titration. just a PSG when I have been admitted at the hospital or panic attack 6 months ago, that I shared with you over email early this week.
So I have never been into a sleep center (yet).
The flat line breathing we saw is I am sure real, and caused by way too much alcohol.
Before last weekend, I was not doing any central apneas (as per the PSG I have done 6 months back, because no drinking 10 days prior to it).
Since then, I am doing a lot of centrals and am very concerned... As in either I am still hungover, or if my brain really got headwired for a very long period...
So i don't know what to do, and when to do the titration ?
09-21-2018, 03:08 PM (This post was last modified: 09-21-2018, 03:09 PM by sheepless.)
RE: Massive bradypneas, scared
I'm going to go out on a limb to address the uncomfortable topic of drinking. thibaulthib, most people are embarrassed by conspicuous over drinking but you've mentioned it in nearly all your posts. clearly you are aware that alcohol is seriously and negatively affecting your life and your physical health. as reported it seems to inhibit your ability to breathe. I can't think of a more compelling incentive than that to manage your consumption, quit or get help to quit. to my 'ear', your frequent references sound like you know there's a problem and are reaching out for help, in a way, but are thus far unwilling to do what you know you need to do, at least until you sort out your breathing issues. help is good but ultimately it comes down to each of us and no one else. no judgement. I have personal experience.
Attached my blood gas results. It looks quite good though, maybe it is due because done over wakefulness?
Since I have issues swallowing solids for the past 3 years, and because of all the alveoles shape of my breathing over night while sober, and massive hypoventilation when drunk, my pulmonologist is sending me to a neurologist on tuesday.
