Help with adjustments post open heart valve replacement

[SistineKid]

greeting board, 

I had an aorta and aorta valve replacement in December.  I've read that valve replacement can change CPAP needs.  And also read somewhere about increasing IPAP if O2 is dropping even with no events.  

I am a long time (18 yrs) CPAP/BIPAP user.  Even with clean events (low AHI, no CAs, etc.), I have experienced fatigue and non-restorative sleep.  It got to the point where I assumed it was as good as it gets.  My current machine is a ResMed Aircurve 10 VAuto.  Settings are EPAP 13, IPAP 16, PS 3 ... I don't really know where those came from. I wear a full face mask and use a chin strap.  

Part of my home recovery included nocturnal O2 (piped into my tubing). This was based on a nocturnal oxygen study while in the hospital--my O2 was going too low. The surgeon had me use O2 only for six weeks with no special evaluation required for discontinuation.  That rationale was that I only needed O2 for impeded lung function immediately after the surgery, but maybe it's been a long time issue? 

During those six weeks, I felt pretty good and well rested.  I also wasn't doing anything other than sleeping and sitting around the house.  

Since then, I'm back to feeling fatigued and worn out with non-restorative sleep.  I have worn a wellue O2 sensor to check my O2.  It typically shows drops below 90% for several minutes per night.  

So, any advice on adjustments? Anything else that seems problematic?  Obviously the large leaks are not good (this night was well controlled).  Next steps for me after tweaking the machine are to go back to surgeon ...

Thank you!
SistineKid

[Jay51]

Hello SistineKid.  Thank you for the post and congratulations on the surgery.  I was diagnosed with mitral valve prolapse, but my Cardiologist thinks it is very benign and I most likely won't need to either repair or replace it in the future.  

Your 1st chart looks clean and enviable IMO.  Good statistics.  Quick breaths, but good tidal volume to each breathe.  0.00 95% flow limitations is excellent.  

The close up chart is hard for me interpret.  I see 2 large breath spikes (I am not sure what triggers this).  Maybe an attempt to bring in more oxygen to your system as system is sensing spo2 lowering.  Not completely smooth and symmetrical, appears ok IMO.  It almost seems to me that you are kind of wanting to fall into some Central Apneas (CA's), but your pressure support (PS) of 3 is preventing this.  A flat line with no effort is a CA.  Mask pressure stays the same.  Maybe your breathing has a small cyclical component to it based on your spo2 levels instead of being more steady.  My Pulmonologist noted a kind of cyclical component to Capnography tests that I have taken. 

Great job on the supplemental O2.  If anyone has a good interpretation of the close up chart, please feel free to post.  Best thing to do might be to show this to Surgeon and PCP.  Neither may know much about these charts, but probably wouldn't hurt.  Ask Surgeon if you are on schedule with this surgery's timeline:  Is feeling this tired now based on all of my variable normal at this point in time?  It takes some time to recover from valve surgery, just not sure how long?

[SistineKid]

@Jay51,
thank you for the reply.  Glad that your valve prolapse is not significant enough to require intervention.  I hope that it stays that way for you!  

In addition to the valve and aorta replacements, I also had a PFO closure.  There are studies that indicate PFO closure reduces apnea events.  

Great recommendations on consulting with my surgeon and PCP.  I don't anticipate that they'll be familiar with waveforms (or even sleep disordered breathing).  They both know about my sleep apnea.  I received no guidance to have a new sleep study or make any adjustments.  

Given I had valve regurgitation that required surgery, and a PFO that allowed unoxygenated blood to bypass my lungs, who can say if tiredness and exhaustion was a result of disordered breathing while asleep or the efficiency of my heart/lungs?  

I have read about an exhaustion trough at the 4 to 6 month point (where I am), so this may be a typical healing trajectory.  

The surgical team did tell me "if you want to be on O2 at night, we'll prescribe it for you."  I'd like that to be a decision based on medical evidence/necessity rather than just "my preference." I hate my CPAP enough as it is without adding another device.  The wife hates my CPAP even more.  

My past experiences with sleep medicine have been to only look at my AHI (it's less than 1 so you're good) and compliance (it's 100%).  When complaining of still feeling washed out, I've been given provigil or other stimulants without regard to the causes.

Thanks again!