Grant's CA Diagnosis Thread

[Sleeprider]

There is definitely a heavy cluster of CA with periodic breathing here, but it may not be CSR. We need to look at this problem in the context of your overall health and therapy results, and I think this remains a relatively isolated 10-minute anomaly for you. The cyclical minute vent is characteristic of CSR and many other central apnea patterns that alternate between hyperventilation and hypoventilation. No doubt that ASV would level this out and treat it. As you know we are working with very-high trigger level and possibly EERS, so I'd rather not address this question in isolation from your other CA thread.

I merged this with your CA thread because it's obviously related or the same topic and should be considered along with previously submitted questions and data.

[GrantT]

Thanks Sleeprider...appreciate the thread merge/discussion.

Just to keep it in mind...the CA pattern completely disappeared recently for the entire 20 days when we traveled to sea level....so does that additional oxygen at 0 altitude mean anything in this case?

[Sleeprider]

It makes for an interesting hypothesis, the answer to which is to duplicate the test. I strongly recommend you take a 2-week vacation in Jamaica, the Bahamas, Keys or similar setting. Send me a coconut and keep me posted.

[GrantT]

Haha...yeah, I wish. I was thinking more along the line of supplemental oxygen, but we'll see where this goes! Coconut...haha.

[GrantT]

It may be just me, but I seem to be seeing a lot more CA threads here lately?  Perhaps because I started getting them, I am just paying more attention...life works that way.

Anyways, one thing I picked up from my of your (@Sleeprider) comments to many is that BIPAP, EPR settings etc can impact/cause CA's. Aside from being at sea level seemingly resolving things, it is one factor out of my control.

So, over some nights, I've been trying a couple minor and sequential adjustments and noticed what I see as a distinct pattern:

Examples... just note the Min setting in each case as well as the EPR setting and the resultant sleep data:

February 27th - Mode: APAP   Min 6.0 Max 10.0 (cmH2O) with EPR 1

   

February 28th - Mode: APAP   Min 6.0 Max 10.0 (cmH2O) with EPR Off

   

March 1st -Mode: APAP Min 5.4 Max 10.0 (cmH2O) with EPR Off

   

[GrantT]

....continued.

March 2nd - Mode: APAP   Min 4.8 Max 10.0 (cmH2O) with EPR Off

   

March 3rd -  Mode: APAP   Min 6.0 Max 10.0 (cmH2O) with EPR Off (back to "Good" setting for me?!?)

   


So, from my view, it seems that I cannot go below a 6.0 Min, and EPR off seems to all but eliminate the CA's.  I would appreciate any comments, suggestions, and directions to experiment even more perhaps.  Any consideration to looking at a higher Min?

Grant

[Sleeprider]

Your AHI increases with the range of pressures, and drops with limited pressure range. All sessions have a maximum range of 10, but best results were 6.0 to 10.0. To be honest I don't think it actually makes much difference and the AHI is random. You did best with EPR 2 and pressure 6.0 to 10.0. So EPR is not hurting therapy.

[GrantT]

Where were you seeing the EPR 2? I think all those posts are from when I was at sea level (and not home) where I was having CA issues both before the trip and afterwards...but not at all the during the 20 days I was there.