[Pressure] Help! Have respiratory alkalosis on CPAP

[LaylaRose]

I was diagnosed used with mixed sleep apneas and temporal lobe nocturnal seizures about a month ago. I was put on a CPAP on a pressure of 9, struggled a lot, and a blood gas test revealed I have respiratoryThe alkalosis. CPAP pressure was reduced to 7, but latest blood gas test is even worse! Tried a BiPAP machine last night but cannot tolerate it as it is not matching my breathing pattern, so it feels like I am fighting it all the time and I cannot fall asleep. Have tried for two nights. It is a BiPAP autoSV Advanced machine, so it should adjust to my breathing,  not so? But that hasn't  happened. Need help/advice! I can't not be on a machine, I nearly died before my diagnosis and had respiratory acidosis. The alkalosis makes me shake all day!

[Gideon]

Are you using a Philips Respuronics machine by any chance? That brand tends to try and anticipate your breathing where ResMed follows it.

To get better advice post your daily charts. And settings
We have many users here using ASV BiLevel machines and while it takes some time to get used to them they do work.

[LaylaRose]

Thanks. Do they work for alkalosis, though? That is my main concern at present, since a CPAP works just fine for my apneas.

[Sleeprider]

Layla Rose, your condition is not what the auto sv (servo-ventilation) machine is used for. Your complaint of respiratory alkalosis infers that CO2 levels are low in your blood stream from hyperventilation, or loss of CO2 during respiration (hypocapnea). BiPAP or ASV therapy, are used to increase ventilation and treat central apnea related to central or complex apnea. These bilevel therapies actually decrease CO2 and would likely further decrease CO2. It would help if you posted actual results PaCO2 or pH so we are certain we are talking about the same thing. If your doctor intends to increase CO2, the solutions you have tried so far, increased CPAP pressure, BiPAP and Auto SV are all going to take you the wrong direction. These therapies would be appropriate for hypoventilation and hypercapnea.

To alleviate this condition, the objective should be to preserve CO2 in the breathing cycle. The technique that does this in combination with CPAP is called Enhanced Expiratory Rebreathing Space (EERS), and we have a wiki article on the subject. http://www.apneaboard.com/wiki/index.php...ace_(EERS) . In EERS, a fraction of the exhaled air is reserved in a section of tubing between the mask and the vent. This exhaled air is richer in CO2 and is re-breathed increasing CO2 and restoring your natural balance, eliminating hypocapnea.

[ardenum]

Alkalosis passes after some time, its normal that after getting on treatment your acidosis turned into alkalosis. You're body was already trying to remove it through other pathways and struggling to do so, your on Resmed ASV which is the best you can get right now in non-invasive ventilation. Post some charts and your settings we can help you adjust the machine to your breathing pattern.

I suspect that because your fighting the machine breath by breath your actually hyperventilating as a result.

[LaylaRose]

Thanks, Sleeprider. Yes, the BiPAP didn't work for me, I don't need something like that. 

My pH on 10 May was:
7.567
pC02 was 21.8
P02 was 113.11

Also my F02Hb was 97.6 (elevated) - don't really know what that means

This is worse than on 17 April, when it was:
7.496
pC02 was 28.6
P02 was 88.4

I am seeing a pulmonologist on the 31st but I think rebreathing is probably the solution. I was on a CPAP that was set on 9 originally and reduced to 6. Now I am on the CPAP auto (for the past three nights), set between 5 and 10. I have fewer apneas on the CPAP auto. But I don't think it will help me with the respiratory alkalosis! I need to preserve more C02. My question is, does anyone in South Africa know enough about this to assist me?? 

---

I will ask my sleep clinic to print out results. Is there software I can download here at home? What would that be, for the ResMed products? I am seeing a pulmonologist on the 31st, do you think they would have some answers/suggestios? I don't know how much they know about sleep apnea, really - but surely they must know quite a bit??