Soon to start CPAP - Question on dehydration

[picante]

Regardless of the type of apnea, the objective is to achieve better sleep and prevent oxygen desaturation that can be damaging to health. Oxygen is the first and most important step.

Thanks for setting the priorities so clearly! If I have any say, I'll have a prescription for O2 this coming week. If the sleep doc is unreachable, I'm SOL.

I've seen a lot of specialists this year, and all of the worst problems I've confronted have been communication snafus. Either the communication technology has failed, or the people have not been paying attention to important information.

It's like the system has dementia.

[picante]

Just FYI, guys: Sleepyhead is more than doubling the number of SpO2 events when it imports from the CMS50F oximeter. I posted about it here, where they were discussing it.
http://www.apneaboard.com/forums/Thread-...#pid280821

[picante]

Just FYI, guys: Sleepyhead is more than doubling the number of SpO2 events when it imports from the CMS50F oximeter. 

I found how to change the analysis parameters in SpO2 Assistant. When I set it to a drop of 3% (it's set on 4%), I get about the same number of events on importing to Sleepyhead.

I also set the "desaturation criteria level" for 89% (SpO2 Assistant has it set on 88%). It draws a dotted line on the graph and gives the number of minutes below that threshold. 

I am no longer importing oximetry data to Sleepyhead because it winds up on the wrong day's charts sometimes, superposing a new graph on the one that's already there! I can purge the oximetry data from that day, but I can't recover the original oximetry graph since it won't let me import from SpO2 Assistant, and the data is no longer on the oximeter. 

The second time I did that (yesterday) it superposed on Dec. 24th, and I purged the oximetry data. This morning all my Sleepyhead data was gone for Dec. 24th!

Here's the oximetry report for 12/22:
   
I had mild to moderate brain fog off and on the 23rd.

CPAP:
First session on L side (or semi-prone tilt) at 6 cm pressure.
Second session on R side + raised pressure to 7 cm with EPR 2.
First session AHI: 22.64   CPAP off at 1:07
Second session AHI: 0.73   CPAP back on at 1:33, off at 4:20  (aerophagia)

[picante]

On Christmas Eve I called and the sleep doc answered the phone! He wanted to know how much time I'm spending at less than 89% oximetry. SpO2 Assistant had it set at 88%, and I had faxed him reports for 2 days with that data.

He says that the insurance needs to see a sleep study where the apneas are effectively addressed, but where I'm still at under 89% or less for 5 minutes or more. I can see that on my current data, but I'm still lacking a prescription for oxygen, whether covered or not.

He was unwilling to prescribe O2 before seeing me on the 3rd. After I hung up, I figured out how to change that parameter, which radically increased the number of minutes below the threshold. Both nights were over 5 minutes. I faxed the new reports. No action.

I did not care for him downplaying my apnea data, either, although he is thinking of ordering a bilevel sleep study. For now I just decided to focus on data gathering and pressure experiments and getting aerophagia minimized. Which I've now figured out, pretty much.

7 cm triggered too much aerophagia and more apneas than 6 cm, but I found that the EPR of 2 was helpful, so I left it there when I lowered back to 6.6, then 6.0. Sleeping on my R side dispenses with most my apneas of both kinds, but doesn't get rid of my brain fog. Cognitive and physical energy are usually better after I've slept part of the night on my L side, despite the sharp increase in apneas.

I tried 7 1/2 hours Christmas night, but wound up with aerophagia again for a day. 4-5 hours is better for my guts.
[attachment=9575]

[Sleeprider]

While your doctor will not believe us, your events are predominately central and higher pressure makes them, and your aerophagia worse. Ultimately, your solution will not be bilevel, but possibly ASV, and most likely your intolerance of of higher pressures means your best option remains low CPAP pressure with oxygen supplement.

[picante]

Thanks, Sleeprider. I'm going to ask him whether he's sure of this strategy: The patient is suffocating, but you're going to find out the cause of the suffocation before you treat it.

I'll also ask him what happens when they recommend yet another pressure level I can't tolerate. That had already occurred to me, that it might be pointless to get a different, fancier machine if I'm still having aerophagia.

I spoke too soon on this: 

For now I just decided to focus on data gathering and pressure experiments and getting aerophagia minimized. Which I've now figured out, pretty much.

I've been taking aspirin an hour before bed to reduce sinus inflammation. But last night my sinus constriction was far worse, and I'm more brain-fogged this morning. Apnea stats are worse (sleeping on the R side still), but perplexingly, oximeter stats are better, except for the ODI, which is up a lot. Bleaaaaah.
[attachment=9581]                
I think the sinus constriction is the key here -- to aerophagia and hypoxia. I suppose he'll recommend seeing the ear-nose-throat doc, which I'll do, but I'll also ask him how many hurdles do I have to jump over while I'm hypoxic?

[Sleeprider]

It seems to me, your doctor can expertly identify some scheme to provide enough pressure to solve your apnea and tidal volume problems. I know I could. But, therapy is only effective if you use it, and you can't tolerate just about anything near 8-cm pressure. At that point, it seems to me, there needs to be a trade-off that considers priorities. The point is to keep you healthy and comfortable enough to sleep, and I think that takes you to CPAP at low pressures with an oxygen bleed. JMHO.

[picante]

Everything you're saying makes sense to me. And in fact, I got air down the digestive tract from doing 7 1/2 hours one night on only 6 cm constant pressure with EPR of 2. I got optimistic that night, from a couple of nights' low apneas on 6 cm/EPR 2.

And I did 7 cm pressure 2 hours last Saturday night, 5 hours Sunday, and 6.6 cm 2 1/2 hours Sunday night. I lowered it back to 6 cm due to gut pain on the inhale, and then spent a couple of days eating very little as it worked its way through, aided by baking soda.

Question: Is the doc more likely to look at tidal volume or minute ventilation?
Question: Is a different machine likely to make a difference with aerophagia? Or does that depend on the reason for the aerophagia?

[Sleeprider]

Minute vent is more meaningful, but I have no idea what your doctor will look at if anything. The point is your SpO2 is chronically low and you don't tolerate pressures that let us manipulate tidal volume or minute vent.

[picante]

Just copying this here so I'll be able to find it again later. It worked.
http://www.apneaboard.com/forums/Thread-...#pid249647

Crimson Nape
There is a time issue with the direct SpO2 data import.  The best way to import it in SH version 1.0 is to use the SpO2 file.  You will need to copy the original SpO2 file to another directory. This is due to file permissions set by the SpO2 Assistant program which prohibit data files from being imported from its home directory.