Feeling like I cannot breathe

[vgrando]

Thank you both!

It is unlikely that Medicare will reimburse me because I am now in my fifth month of Pap use. They have this rule about making changes after your first three months without a new sleep study.

This is not an issue because I want to buy my Machine. 

The order on my patient portal has no code that I can see. I will call on Tuesday to get the correct order.

I hoped to get one on a Labor Day sale, but the model I want does not seem to go on sale. So the delay is not an issue.

[vgrando]

I have another question. Since I do not have enough CAs to cause all of my low oxygen levels, my shallow breathing must be causing the low 02 levels.  If this is the case, would an AirCurve VAuto help with shallow breathing?

[Jay51]

Great question.  If Sleeprider wants to post on this one, please do also.  He has a Vauto.  

I remember from your Medical History that you have a lung condition also (was it atelactasis?)  That could be the reason for your low oxygen levels at night regardless of how well you are breathing (ventilating).  Your shallow breathing could be either completely causing or contributing to the low oxygen levels along with the atelactasis.  

The Aircurve Vauto is about the best bipap (without a back up rate) on the market (IMO).  You can set the difference between EPAP and IPAP.  It also has a cycle setting I think (how long your breath is) and a trigger setting (to help induce more breaths spontaneously).  You have a good, natural spontaneous breathing rate at night.  I rechecked your charts.  It averages around 16 or so at night (median) - even with your CA's.   That is a good rate IMO.  Your tidal volume averages in the 200's though.  250 to 280 or so If I remember correctly.  

IMO the Vauto would be a better machine that the one you currently have because you could:  1.  increase the difference between the EPAP and IPAP much greater than the 3 EPR function you currently have.   2.  It has a cycle setting I think.  That can make the breath longer or shorter I think.  We would want to make each breath of yours as long as possible to increase your tidal volume as much as possible.  3.  With a very high trigger setting, it might cause you to take a few more breaths each night (and even lower your CA's).  IMO the Vauto + supplemental oxygen would be pretty good combination.  The only thing missing would be the tidal volume boost the ST (A) could give.   

If you get this machine free from Medicare, you may be able to give it a try for awhile before you even tried to purchase the ST (A).   You may like the Vauto enough that you keep it and don't even get the ST(A).   I have only given positives for the ST (A) so far.  It can be harder to get to sleep with and sleep all night with it.  It might cause some aerophagia due to the tidal volume "boost" it gives with each breath, too.  

Your decision here Victoria.  Any other questions, please feel free to ask.  It is your $ that you are spending (or if you choose to go with Vauto).

[Sleeprider]

I have a lot of respect for what Jay has suggested above, but if I understand the objective is increase tidal volume or minute vene rates, then the machine that does that is the Aircurve 10 ST-A. It can target a vent rate, while the Vauto only provides a fixed pressure support that aids spontaneous breathing to overcome an obstructed airway, but only follows spontaneous effort. It will improve volume, but is not going to trigger IPAP or hold higher pressure support to cause higher vent rates.

[vgrando]

Thank you both for your insights. I will keep you informed.

[hejohoo]

Yes. I have small nostrils and allergies to dust. So I am stuffy at night and often can breathe only with one nostril.

Have you tried something that dilates your nostrils? I also have problems with stuffy nose and getting enough air (often only through one nostril) and it helps a lot for me. There are different brands and I have tried some of them but my favorite is called Megavent as I feel the least. I buy them from an internet store in sweden but they should be possible to buy outside also or order on their site:

https://dormitek.com/pages/megavent

I also use a sort of "tape" on my nose to dilate it even further called Breathe Right. I think the MegaVent does most of the work but they might also add a little more dilation so I use them also.

[vgrando]

Thank you. Yes, I use nasal dilators. But they irritate my nostrils. I will try to get the one that you suggest!

[vgrando]

I was looking at my recent MIR and I discovered something new that can be adding to my issues.


I have atrophy of paravertebral muscles, which according to "UpToDate", it can be associated with a restrictive, progressive respiratory insufficiency. I am not sure if this is true for Adult onset, but it is worth looking into.

I also have thoracolumbar levoscoliosis, which is also associated with breathing difficulties.


At least, I now have a better understanding of my issues!

 

[vgrando]

Update. Well, the Respiratory Center is giving me trouble. The intake person tells me I have no documentation from my MD that I have difficulty sleeping with my APAP and need a BiPap. This was depressing, given that I had texted the MD and told him my problems. Also, she wants a Bipap titration study. I told her I did not want to hassle with Medicare.

For the past five nights, my OAs have increased to match my CAs. In fact, for the past four nights, my OAs have been a bit higher than my CAs. That being said, my AHis are low, from 5 to 2. My 02 is good on 2 liters of oxygen. I wonder if the added oxygen is responsible for my decrease in CAs. While asleep, my medium Tidal volume is around 250 to 300. My Minute Vent is from 4.25 to 5.25

[Sleeprider]

You know, it might be time to post a chart. We are taking your description of issues at face value, but believe it or not, we can actually help you to interpret therapy and make better recommendations than just agreeing with you.