Please Review The Data & Give Recommendations

[Hojo]

Sleepyhead:  I agree, I want to move to the next (required) step, which I believe will be a sleep study with BIPAP before ASV.  I don't think I will wait the full month before my next appointment with the sleep doctor before I call to inquire about the next step.

I wonder, and I might give this a try; if I can't exhale against the CPAP pressure, is the machine picking up the air movement and thinking it is my respirator rate....

The first few nights that I woke up and felt like I was panting like a dog but then during another episode I realized I was 'panting', I wasn't even breathing.  I wasn't breathing because I couldn't exhale against the pressure, but I was actually bucking the excessive (air) pressure.   Once my wife even noticed the noise of me 'panting' and put her hand on my back (I was on my side) to wake me bu she noticed that I wasn't panting, I wasn't breathing, so she went to wake me but I was already awake (in a daze).

All in all I'm happy I'm on CPAP, I'm not waking up feeling like I just finished running a marathon.  I noticed my blood pressure was going up this year and with the start of CPAP, my blood pressure has dropped like a rock.  Now to continue to fine tune this therapy.

[Sleeprider]

First of all, not Sleepyhead or Sleepyrider...Sleeprider.  

It is not uncommon that people fail CPAP for a variety of reasons.  In your case it is not for lack of trying or compliance.  You don't tolerate this therapy as reflected by your poor AHI results and amazing side-effects like "Tachypenea".  Search it, and use the term with your doctor. Show him the graphs, he'll get it!

This problem may go away in time, but we're a couple months in, so I think you have given it a fair shot, and I don't see this as an anxiety disorder. In your case, you like the therapy and want to succeed. It's entirely possible you will do great with pressure support on bilevel, or a paced breathing on ASV. Hard to know at this point, but I'll follow your progress.

[Hojo]

Oops, sorry, I'm the sleepyhead today!

[Sleeprider]

Hojo, I edited...re-read the previous post.

[Hojo]

Sleeprider:  THANK YOU for all your help!   I have breaking news on my tachypnea: I have been analyzing my data on a daily basis, hour by hour, minute by minute, and at times, second by second, trying to find a common denominator for a sudden increase in my respiratory rate.    After your post last night I got to thinking that I should look into tachypnea as being a side effect of CPAP and before even looking into it, I had a light bulb go off;  FILTER!

I had changed the standard (screen) filter that the came with the ResMed to a hypoallergenic filter, and low and behold, that is exactly the night that my tachpynea started.  I went to the machine, opened up the door to the filter and turned the machine on, wow, it almost got sucked in, that is how hard the machine had to pull to get air.  I put in the normal screen filter that comes with the machine and it it allowed a lot of air to enter the machine without any restriction.

Next test:  And I did this under the observation of my wife so to see if she could tell the difference in the effects on me.  I did not tell her what I was doing to the machine (I made her turn away), I put one filter in, turned the machine on with the FFM mask on.  I took several normal breaths (CPAP at 12 with no ramp), then held my breath.  Changed filters and repeated the test.

The results were as I suspected; the screen filter allowed the machine to work normally and the air to escape out the vent in the FFM without any problems.  To my wife, it looked like I was holding my breath (I was).  With the hypoallergenic filter I had difficulty exhaling against the pressure of 12 (after several minutes I can not exhale).  When I held my breath with the hypo filter in place my wife thought I was panting, I wasn't, the machine was bucking the pressure and my body was jerking with it.

So, now I have to wonder what is up with this filter, is it normal.  I won't name the filter (it did come from a CPAP supplier) while I look into the matter, but I would caution in using a hypoallergenic filter until the cause can be determined (bad lot number???).

So last night with the normal screen filter, my tachypnea was absent, and the results were back to where they were pretty much before.  Still being a bit nervous, I didn't want to run 12 all night so I went with 8/12 with EPR of 2.  Here are the results.

https://imgur.com/a/eTzg5

[Gideon]

I have to ask, Can you please repeat the test with a new hypoallergenic filter, a different package if possible. Would like to see if that causes the issue again. Not questioning you but am looking for a repeat occurrence (the analyst in me).

That said I have never heard of this happening before.

Fred

[Sleeprider]

Resp rate median at 13...we can live with that. I have no idea what filter you had in there, and of course any filter with that kind of pressure drop would be bad for the blower as well as the user. Without using a link, what filter was this? I guess from now on we will have to look at machine operation if we see this issue again. As I have said, I have never seen it before, and hope never to see it again.

[Gideon]

I'm wondering if somehow some of the filter was covered with plastic.

[Sleeprider]

I have some trouble visualizing this. If a very restrictive filter is placed on the intake side of the CPAP, the machine would never develop pressure and it should not be blowing through the mask. Without pressure, the anti-asphyxia valve would open to let air in, and you would exhale through the mask vent with no CPAP pressure. If the filter is between the machine and user, then the machine would show pressure, but it would not reach the user. The feedback would be very muted and that could explain very unusual shallow respiration. I don't doubt it, just trying to work out the mechanics of it.

[Walla Walla]

It should show up in the mask pressure chart if this was the problem.