Every dang sleep apnea problem under the sun

[Morgannon]

Sleeprider thank you - you guys are very good people.  I'm going to try to fall asleep on the BIPAP tonight so Incan give you guys some more good data.  

The only concern I have is that I have sinus pain so I'm worried that I'm developing a sinus infection.  I read somewhere that might be dangerous to have and use PAP.  But I feel it's more dangerous not to use it.  Would anyone mind opining on this?

Morgannon

[Sleeprider]

Sinus infection = antibiotics. It never kept me from using the PAP. Sometimes turn up the heat or humidity a bit during a cold.

[Morgannon]

Thank you Sleeprider!  Going to be gearing up shortly!

[quiescence at last]

having the volume you have (tidal volume) and (minute volume) both are way north of mine and I would not have guessed you were having any problem with getting rid of CO2.  However, your CO2 blood gas can go up when the lungs are not able to effectively exchange oxygen and CO2 gases. That has to do with having the right partial pressure of CO2 near the alveoli to enable even more CO2 to perfuse increasing the exhausted CO2 and of course reducing the arterial CO2 level.

https://www.clinicalcorrelations.org/2016/09/28/oxygen-induced-hypercapnia-in-copd-what-is-the-mechanism/
"The authors noted that despite this near-complete restoration of minute ventilation, arterial carbon dioxide tensions still remained significantly elevated compared to control, an observation that could not be explained by decreased minute ventilation alone.4 They hypothesized that the primary explanation for hypercarbia in the setting of oxygen supplementation was not alteration in minute ventilation, as had previously been thought, but rather, ventilation-perfusion (V/Q) mismatch.

Respiration: Ventilation, Diffusion and Perfusion | Ausmed
"Diffusion is the process whereby gases move from an area of high pressure to low pressure. This includes during - Internal respiration - this is the movement in the internal tissues between cells and capillaries, and - External respiration - when gas is exchanged between the alveoli and lung capillaries. Perfusion refers to the blood flow to tissues and organs. Alveoli are perfused by capillaries so the diffusion of oxygen and carbon dioxide can take place."

basically the high volume of ventilation is creating an imbalance (perhaps thoroughly flushing out CO2) enough to temporarily block the diffusion so no more CO2 can convert to gas and be exhaled.  It just gets worse and worse.
So, ultra-high ventilation volume detracts from effective CO2 off-gasing.

I do believe it is all tied in to the drive to take a breath.  Lungs will signal the brain in normal sleep when a breath is needed. and the central apnea is usually that the lungs are (rightly) choosing not to trigger a breath. if that seems weird to some mechanical helper and it takes over a forces a breath, this will fight the correction the lungs are trying to accomplish.  how much interference can be allowed before the out of balance causes additional harm? I don't know that, but I imagine our resilient body can recovery from alot of it.

The pulse-ox machines out there measure the blood oxygen, not CO2, so good spO2 may not mean your CO2 is aok.

Read, learn, ask professional doctors if you can get them to work the problem.

We are rooting for you.

QAL

[Gideon]

On sinus infection yes antibiotics, but the congestion associated with it. I force myself to use my mask, honestly very unsuccessful for the firstv10-20 minutes, but always physics wins, the pressure pushes through and when it does, and I often swear it will nor, when it pushes thru the rest of my night is normal.
Use your pap

[Morgannon]

Thanks for all of your input guys - I think I've found out what the problem is.  I have borderline COPD and evidence of moderate to severe airway obstruction.  Have had asthma for years and now it seems my bronchi spasm a lot whenever I inhale my medicine or when my BIPAP hits my throat with the pressurized air.  And to add to this that nerve disorder that hits my lung muscles and makes them weak.  

So the net effect is I need to take slow deep breaths to not trigger my bronchii now. I'm going to be looking into surgical methods to fix my upper airway laxity.  Or maybe just sack up and do a traech and double lung transplant since my asthma medicines aren't doing anything for my breath now and COPD is progressive.  I don't really have any other option at this point.

Thanks for all of your help guys.  If anyone has an idea on how I could possibly be treated I would really like that.  The best short term solution I've come up with is getting an iron lung type breathing machine set to slow deep breaths to make me breathe and supplemental o2 to counteract nocturnal hypoxia via low flow nasal cannula.  And maybe an airway stent for my throat.  And it will probably be months before I can get this setup going.

Thanks again guys,

Morgannon

[Jay51]

You are navigating through your own personal maze much quicker by coming here to apneaboard.  If all of your neurological testing turns out negative, obesity hypoventilation syndrome occurs because adipose tissue places a compression or constricting force on the lungs (preventing them from fully expanding).  Trauma to the lungs or phrenic nerve could also figure into the equation.  

Also, do you feel you have maxed out all of the possible medications for COPD and asthma?  You have some good ideas that might work and pretty much know the correct machine for you at this point.

[Morgannon]

Hey there Jay;

My standard bronchodilators are no
Longer working.  I'm going to try some medicines at the pulmonologists office on Friday.  Hopefully I will get my sputum cultured and find out what kind of COPD inflammation it is.  That should give me a basic idea of where to go.

Thanks for talking man.  I feel like every day my damn airways are getting a little smaller.  Hopefully I can find some sort of medication that will stop this decline or slow it down.  And hopefully I will be a candidate for a dual lung transplant sooner rather than later.  Or maybe we will finally get artificial lungs so I can take these fing things out of me and put in robotic ones.  

Supposedly there are settings that I can use for my conildition but when I use those settings they blow the mask off of my face and it feels like the air doesn't go into my lungs at all.  

I wish I could hire Sleeprider or one of you guys to come over to my home and help me troubleshoot this thing.  I'd like so much to be able to use it and get it working for me.  The only time I ever get any sleep on these machines is when I use Auto mode, and that is apparently useless to blow off the CO2 I need to.

I also know I don't want to use O2 as a COPD patient because it will make me retain too much CO2.  But I just don't feel that I can get enough air into my lungs with the machine.  I don't understand how COPD patients with much worse lung function then me can use these higher settings and i cant.  Makes me soo angry and frustrated.

[Jay51]

There is a basic rescue inhaler for most asthma and copd patients.  Some medications treat asthma better and others treat copd better.  And some meds overlap (can treat both).   There are several of them, so maybe trying a new copd med or 2 could help some.  

The Vauto will most likely not ever treat you sufficiently.  Possibly making a push for a vaps machine (Ivaps or avaps) could improve your situation.  In the medical system, showing documented failure at one level of machine can usually get you moved to a more sophisticated machine that might help more.  In vaps, you can set your own personal rate and own personal tidal volume, ti min, ti max, rise time, etc. for a very customized application.   

I "freaked out" when I 1st tried ivaps.  The pressure did similar things to me that it has done to you.  After many, many, many months of trying, I have become accustomed to it.  

If your spo2 levels are relatively normal when not using the vauto, I am not sure supplemental o2 would help you much, but it could be worth attempting.  

Leaks can be a huge problem.  Reducing mask leaks by trying different masks reduced the high pressure I had in the beginning and made it more tolerable.  Also, cold air kind of hurt, so a heated hose or higher humidity and hose covering (or putting the hose under a heated blanket can help some.  One night in a recliner was a life changer for me (sleeping at an increased angle helped me a lot).  


Lastly, an Allergist could possibly find an allergy that could be contributing to the problem.  Small chance, but a chance.  Hang in there.

[cmpman1974]

Have you ever seen anyone beat obesity hypoventilation syndrome by losing enough weight?