Low O2 and Snoring

[Sleeprider]

If you find that pressure reasonably comfortable, the only suggestion would be to increase minimum pressure to see if it improves the RERA or flow limitation. We tend to track the 95% flow limitation as a metric of airway resistance. At 13-20 EPR 3 your flow limit is an incredible 0.58. So try minimum pressure of 14 or 15 as you can tolerate easily and see if it helps reduce that.

[cmpman1974]

Bigdonpaul, have you discussed hypoventilation syndrome with your doctor? You are clearly a candidate for a bilevel positive pressure therapy device, and perhaps ST which is designed for obesity hypoventilation syndrome.  No large man can subsist on a tidal volume of 200 mL and minute vent of only 2.75 L/min.  You need pressure support to push air into your lungs and help with those flow limits.  You are trying HARD to breath as indicated by the long inspiration times relative to expiration. You need pressure support.  Call your doctor about a BiPAP trial.

Exactly what I was thinking too.  I'm shocked the doctor isn't recognizing it quickly.

[Bigdonpaul]

I didn't find an AirCurves in my area but I did find this, a new Philips Bipap Dreamstation without humidifier in Des Moines. I don't know if it's good or not:


I checked with my local DME and they have BiPAPs in stock. I just have to get the prescription which is hopefully soon. My sleep doctor appointment is Monday.

[Sleeprider]

Get the prescription. I prefer Resmed over Philips, but you can certainly use either. I looked at the Marketplace BiPAP listing in Des Moines for $500. the machine is likely a warranty replacement under the Philips recall. The seller indicates it is new and wants cash only. We don't know if it is the BiPAP Pro or Auto. It's a good deal and would work much better for you than CPAP, however it looks like you would have to transact this in person due to the cash requirement. Also no pictures of the actual item. Are you close to that location? I can look around for other deals in that region if you are.

Try to get a prescription for bilevel or BiPAP from your doctor. Your very low tidal volume, minute vent and comorbidities should be sufficient for the script. That may or may not be sufficient for insurance coverage. Your local DME could ask your doctor for a prescription on your behalf, and I see no reason he would not provide it.

[Bigdonpaul]

Get the prescription. I prefer Resmed over Philips, but you can certainly use either.  I looked at the Marketplace BiPAP listing in Des Moines for $500. the machine is likely a warranty replacement under the Philips recall. The seller indicates it is new and wants cash only. We don't know if it is the BiPAP Pro or Auto. It's a good deal and would work much better for you than CPAP, however it looks like you would have to transact this in person due to the cash requirement. Also no pictures of the actual item.  Are you close to that location?  I can look around for other deals in that region if you are.

I'm in Des Moines and there isn't anything within a 40 mile radius besides that one. It seems suspicious to me. I can get the machine quickly once I get the prescription so hopefully the sleep doctor appointment goes well and they won't request a sleep study based on all the info I'm going to bring with me.

[Sleeprider]

You qualify for bilevel based on every insurance guideline I know, and your results clearly point to the need. Ask the doctor to allow self-titration. We can coach you along you can provide your doctor with oversight and progress reports. Our objective is to raise respiratory volume. mitigate obstructive flow limitation and mitigate the effects of your weight by increasing pressure support, using the CPAP data your subjective feedback of how you feel as feedback to guide that process. If he insists on bilevel titration, the study must be designed to minimize arousal and achieve improved respiratory volume, rather than use AHI as an endpoint.

[Bigdonpaul]

You qualify for bilevel based on every insurance guideline I know, and your results clearly point to the need.  Ask the doctor to allow self-titration. We can coach you along you can provide your doctor with oversight and progress reports.  Our objective is to raise respiratory volume. mitigate obstructive flow limitation and mitigate the effects of your weight by increasing pressure support, using the CPAP data your subjective feedback of how you feel as feedback to guide that process.  If he insists on bilevel titration, the study must be designed to minimize arousal and achieve improved respiratory volume, rather than use AHI as an endpoint.

With the amount of data I'm bringing with me, hopefully they are a good doctor and we can get the process rolling quickly. The less time I can wait, the better. I'm down 16 pounds since February 13 but better sleep will obviously help me in my journey.

[Sleeprider]

Bigdonpaul, one last request on your data.  I'd like you to provide a zoomed image that shows the flow-rate, mask pressure, tidal volume and minute vent.  The zoom should be at a resolution of about 3-minutes, and can be a random choice of your therapy.  Here is an example of what the chart should look like, but yours will clearly show the impact of the flow limits and long inspiration time.  This kind of image might be useful to your doctor to visualize your breathing.  Post one, and we will discuss.

   

[Bigdonpaul]

Here is a 3 minute zoom in. I used Sleep HQ for this since I'm at work. Additionally, I changed the response setting from Soft to Standard. It made my pressure basically run at 20 for most of the night which obviously indicates a problem.

       

[Sleeprider]

The flow rate graphs is about what I expected.  Notice how the inspiration peaks above zero-flow are flattened and struggle to rise, above zero flow, even with pressure at 20 cm. This is what I meant by survival breathing.  In the other charts, minute vent is varying around 2.5 L/min which is really low.  I was hoping to see the mask pressure chart, because it would show the variation between IPAP and EPAP on your machine, and I don't see any indication you are using EPR in this image.  Take another look at the example I posted. The summary data that graphs might help us better explain your issues to your doctor.