Influence of EPR-Level on Central Apnea

[richb]

Thanks vsheline for this reply. I am aware of the fact that EPR is not the term used in the operation of a bi-pap machine. I used the term because EPR is very similar to the operation of a bi-pap machine. Others have experienced my issue to some degree using strictly EPR settings. The pressure differential is what may be causing the CO2 washout in my case. An ASV machine is not yet indicated because the first goal is to figure out what it is that is related to the PAP therapy and my CAs. The Dr suspects that the machine may be sending out false signals. Therefore he just wants to change machines. I seriously doubt that the machine is at fault. The data is just too convincing. You are probably aware of other threads that address the AirSense10's sensitivity to CAs vs OAs and HAs. I also don't think my case fits that description. It won't be long before I can post some data images. I also want to keep the Board up to date with whatever we find.

[vsheline]

The Dr suspects that the machine may be sending out false signals. Therefore he just wants to change machines. I seriously doubt that the machine is at fault. The data is just too convincing.

By zooming in on the Flow waveform (with 1 or 2 minutes filling the horizontal axis, and the vertical scale adjusted to perhaps -50 L/m to +50 L/m, to show good detail) around the time of a flagged CA, you will be able to see whether there is much chance that the machine mis-scored the event.

The only times I have seen false CAs scored were times when big leaks were starting or ending, which for a short time prevented the machine from properly detecting the normal cycling between inhalation and exhalation.

If Leak was fairly steady during the Central Apnea and if the normal inhale/exhale cycle is obviously not present in the Flow waveform, then the machine was very likely correct in flagging the CA event.

So I think the doctor should be inspecting the Flow waveform, if he wants to know whether the machine is falsely flagging CA events.

[quiescence at last]

so if you get up close to the CA in the flow rate graph you'll see one of these things:

REAL


FAKE


you can usually tell if the machine mis-scored them.

QAL

ps. note that the top one is a real halt in breathing, but likely I was awake (given the waveform of inhales and exhales without pause.)

[vsheline]

so if you get up close to the CA in the flow rate graph you'll see one of these things:

FAKE


you can usually tell if the machine mis-scored them.

Hi quiescence at last,

No idea what caused the PRS1 Auto machine to get faked out there. The inhales and exhales are fairly consistent throughout the 52 second period and are not much different than in earlier or later periods. Pretty wild software bug, I guess.

For your PRS1 Auto, can you tell us what percentage of CA events are like this one, completely fake?

[pizza41466]

Thanks vsheline for this reply. I am aware of the fact that EPR is not the term used in the operation of a bi-pap machine. I used the term because EPR is very similar to the operation of a bi-pap machine. Others have experienced my issue to some degree using strictly EPR settings. The pressure differential is what may be causing the CO2 washout in my case. An ASV machine is not yet indicated because the first goal is to figure out what it is that is related to the PAP therapy and my CAs. The Dr suspects that the machine may be sending out false signals. Therefore he just wants to change machines. I seriously doubt that the machine is at fault. The data is just too convincing. You are probably aware of other threads that address the AirSense10's sensitivity to CAs vs OAs and HAs. I also don't think my case fits that description. It won't be long before I can post some data images. I also want to keep the Board up to date with whatever we find.

There is a post from dgossman, that has a completely different approach:

As a chemist I also looked closely at how the chemoreceptors work to trigger respiration. I have noticed that even during the day and especially in the evening if I am sitting quietly I can have periods when I "forget to breath" - best way I can describe it. When I was younger I was an active swimmer and could always swim further underwater than just about anyone I knew - three full lengths of a pool even when I was in my late 40s and teaching life saving - so I figure that I have a poorly functioning chemoreceptor for triggering the breathing response to the pH shift that happens with the build up of dissolved CO2 in the blood. I now take 1 gram of C when I go to bed and another in the middle of the night whenever I wake up to reduce my blood pH. (Vitamin C has a relatively short half life in the blood and that is the reason for the second dose in the middle of the night). This seems to have significantly reduced the number of instances when my blood dissolved oxygen levels drop below 90. I now stay at 94-96 for most of the night whereas without this treatment I was in the low 90s with instances dropping into the mid 80s. I also seem to have had my hemoglobin levels not increase as fast as they were before. I suspect the low O2 conditions at night were pushing them up and the higher viscosity of the blood may have also been a factor in the afib susceptibility.

I am wondering if there is anyone else with this sort of experience? I have also heard of taking vinegar as a way of treating central sleep apnea and it may work via the same blood pH shift mechanism so anyone who has tried that I would be curious to hear from as well.

[richb]

"There is a post from dgossman, that has a completely different approach:"

Blood PH is the trigger that stimulates breathing. It might be worth a try to see if raising blood pH with supplements can work. A search for research on raising blood pH might be helpful. At this point I am going to try machine adjustments (with Dr approval) first.

[richb]

[attachment=1556]
[quote='quiescence at last' pid='118857' dateline='1434943668']
so if you get up close to the CA in the flow rate graph you'll see one of these things:

Here is a screenshot of a brief period of my CAs

[pizza41466]

You should show that to your doctor. It's very similar to the Cheyne-Stokes pattern.

[tedburnsIII]

"At this point I am going to try machine adjustments (with Dr approval) first.

At least on my machine, changing RESLEX is considered a 'user comfort' adjustment to reduce exhalation pressure and is left to discretion of the patient.

The default is '0".

It's similar to changing the humidification settings for patient comfort in the sense that accessing the Clinician Setup is not required.

Has richb ever set 'FLEX' to 0 or other 'default' setting on his machine?

One might speculate if reducing exhalation pressure 1-3cm for comfort is all that clinically significant.

[tedburnsIII]

I found the following informative for general knowledge and pp.14-20, 39 in particular:

http://www.daveburrows.com/cpap/sleepstu...pstudy.pdf