I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?

[Jay51]

Thank you very much for all of that Rubicon.  I will try the FOT test to see if that is the cause of my "buzzing" (vibrations).  Sorry, the oximetry posted twice.  I will post the Cap/ox from the other week here.  I will try to get all the PFT testing I can and say to PCP, "Surely more tests will be needed than just simply spirometry to see where the excess CO2 is coming from?"

[Crimson Nape]

Jay51 - If you use a ".jpg" or ".png" graphics format instead of the ".tiff" you would be able to post the image here.  Also, you need to select the Insert Into Post to get it to display within the post.

[Jay51]

Thank you very much for explaining that Red.  

   

[Crimson Nape]

Good job!

[Rubicon]

That ETCO2 study a lot cleaner than the previous one and shows the improvement over the prior study.

AAMOF if you take out the artifact (1:00AM - 2:15AM) I think its hard to justify any hypoventilation here at all (ETCO2 normally drifts up a little during sleep).

You get normal PFT and lytes and you tell her just get that hypoventilation thing out of her mind.

With the messiness of the 10/21/21 study, I would be tempted to say some of that ETCO2 could be spurious.  That said, it looks like there's a lot of desaturation, so I don't think it can be summarily dismissed.

[Jay51]

Thank you very much for that interpretation Rubicon.  I feel the same way you do.  I stated the same thing to my RT, but she continually pushes hypoventilation and the Trilogy Evo ventilator (AVAPS-AE auto titrating).  

I want to give the ASV a try.  OSCAR should show if I am hypoventilating too much or not (will either confirm or deny the results of the last capnometry/oximetry home sleep study I took 2 weeks ago).  I am going to try to build up my tolerance to it so as to get a full night's data to look at.  

As far as how I feel after a night of these options:  1.  No pap or ventilator - I fall asleep quickly and sleep about 4 or 5 hours straight, then wake up and sleep maybe 2 or 3 more hours and I feel pretty good.   2.  Trilogy Evo ventilator - I used it back in early February for  3 straight nights.  It took awhile to fall asleep each time, and I didn't sleep much at all those nights (was either a 1 or 2 hour chunk at most; then up a few hours to try to fall back asleep again).  I felt worse after a night of the ventilator than sleeping with no vent or pap.    3.  ASV - it remains to be seen.  I will give it a good shot.  It could work well.   Time will tell.  

I am working on sleep continuity like you suggested (Sleeprider and Dave suggested to me that this is important also - how do I feel after a night's sleep?  Actual time spent sleeping is important.  And listen to how my body is reacting).  The metabolic alkalosis/pulmonary function tests should clear up the picture also.  Thank you again for all of your help.

[SarcasticDave94]

Which aspects of ASV therapy do you need help adjusting to? A regular, even breathing cadence needs to be attained before masking up to ASV.

Beyond that, is this a pressure issue that edits to settings can help you? Describe the issue as best as you can.

[Jay51]

Thank you very much for the reply Dave.  I think it is simply the fact that I have not slept with any pap/vent. since early February.  My body has become adjusted to sleeping without any pap or vent in the meantime, and it is just going to take me some time using the ASV during the day and for shorter periods at night until I build up both the endurance and tolerance to use it for an entire night.  

I don't think it is a pressure issue at all Dave.  The pressures on the Trilogy Evo were much much lower this time when I tested it yesterday at a 45 degree angle.  I assume the ASV will be the same thing:  much much lower pressures needed sleeping at 45 degrees vs. sleeping flat on my back in bed.  When I did the CPAP at 5, 6, and 7 the other night, I didn't feel air starved.  Just not used to sleeping with a mask and a pap or vent.  

I will wait a few minutes (even up to 10 minutes) before I mask up with the ASV at night so that it does not set my initial rate too high or too fast.  It will take me some practice also.  

Dave, you have helped me so much here (especially with the cardiac stuff), I want to try to return the favor to you.  In the medical community, this capnometry/oximetry (cap.ox) test seems to be the ticket to getting a ventilator.  Have you ever had one?  I have seen used/refurbished capnometers on ebay also.  Would PCP write an order for one?  

Much appreciation Dave.  Stay Sarcastic!

[SarcasticDave94]

No I've not had that test yet. Thanks for the tip. My newest pulmonary doc has me slated for a new diagnosic sleep study and a PFT in the next few months. I'll ask him about that test when I'm seen in June. He has talked about oxygen at night might be upcoming.

As for your ASV, EPAP and PS Max settings that make up IPAP can be dialed back if it's found necessary. Just let us know progress, and keep swinging for the fences.

[Jay51]

Rubicon, I had another question for you when you get a chance.  (The FOT did not trigger the buzzing or vibrating in me yesterday).  

The PR Trilogy Evo ventilator encrypts its data.  The only thing I could think of to possibly gauge its effectiveness was my own oximetry/heart rate overnight monitoring while using it. 

Page 13 post #122 (to save you time looking these up) of this thread shows oximetry/heart rate for an entire night of using the ventilator.  I was in recliner. 

Pages 13 and 14 (posts #123, #126, #128, and #131) are all nights that I did not use the ventilator or any pap.  In recliner (#126) once and in bed with 45 degree wedge and soft cervical collar the last 3 nights (#126, #128, and #131).

Which SPO2 do you like better (#122 using vent. or #123, #126, #128, and #131 not using vent.) and why?  

Which Heart Rate do you like better using the same criteria (using vent. vs. not using it)?  and why?

Thank you very much, Rubicon.