Soon to start CPAP - Question on dehydration

[picante]

Charts from Wed. night: I woke up twice to find my lower lip was below the mask rim with air blowing on my lower teeth/gums. Swallowed a lot of air due to this, and had another all-day gut-ache. I didn't have this problem last night.

Although apnea stats look good, I had substantial brain fog & blurry vision all day. Tidal volume hovered right at 260-300 for a while.

[attachment=9488]           [attachment=9489]

[picante]

Charts from last night (Thurs.): Although apneas are much worse, I have less brain fog than yesterday. The same deal happened back up the thread, Tues. when I had 61 obstructive events. My brain fog/fatigue was less than on Mon., when my AHI was 3.12. I'm not seeing any direct or indirect correlation between apnea stats and brain function/exhaustion.

[attachment=9490]          [attachment=9491]

Tonight I'll try out the pulse oximeter. I was too wasted last night, after a day of pleading with medical offices for an appointment. Looks like I'll finally get to see the sleep doc on January 3rd, the week before my appt. with my PCP.

Test results I got this week: I definitely don't have SIBO. I do have GERD, confirmed by the endoscopy.

Fancy new med I found that gets air venting out of my digestive tract in both directions: baking soda. 

[Gideon]

I would like to see your O2 results and see if there is a correlation there that we do not see here. I do notice that your Flow Rate and Tidal Volume are not moving as wildly as it did before. I would lock my Max Tidal Volume at a value (say 1000) to make day to day comparisons easier. That way the excursions would work against similarly scaled graphs.

Fred

[picante]

Bonjour Fred! I woke up with epic brain fog, in a stupor, asleep on my feet. That started to clear about 11:30 am.

I kinda sorta figured out this import process: SpO2 graph starts at the same time as the CPAP, but it must be stretched out, since I took it off at 7:50 am, not 9:41. I had to give it the starting time, since the wizard wanted to import it into Saturday Dec. 22, 4 sessions starting at 6:03:01 am (maybe a time zone thing????)

Anyway, you've gotta mentally compress the graph down:

[attachment=9494]           [attachment=9495]

The pulse ox definitely explains my brain exhaustion. It's just as bad as my pre-CPAP August readings. What should I be looking at here? Some of those drops were long duration.

Would I be correct in saying that my pulse ox looks better when I'm not on the CPAP machine? I see gaps in the graph, and one of them is followed by higher O2 levels. That is probably when I got up to do a sinus rinse (the gap) and put the mask back on, 5:49 CPAP machine time, but offset in the SpO2 graph.

The main thing I've noticed is that this was a night when my Centrals far outnumbered my Obstructives. Those tend to yield the worst brain exhaustion next day.

[Sleeprider]

Pretty much confirms a need for an oxygen bleed to the CPAP.
I think you need to get on oxygen NOW and longer-term, have ASV titration. Although you have a diagnosis of obstructive sleep apnea, your events are all central and I simply doubt the sleep clinic results. I'm thining Auto ASV at EPAP min 4, with PS 3 to 15, max pressure 20. ASV may resolve events, at much lower pressures, but your tolerance for any elevated pressure is in question due to GERD/aerophagia. Your existing sleep test verified you qualify for supplemental oxygen and ongoing oximetry confirms the need. Get it soon; those are pretty bad readings.

On your SpO2 graphs I think you can add a dashed line by right-clicking the left column and formatting the Y-axis. I would add a dashed line at 92% which is a pretty low SpO2, or 88% which is the threshold for Medicare supplemental oxygen. With your doctor's prescription of 3-L/min of oxygen bleed, your DME can setup the oxygen generator and CPAP adapter.

[Gideon]

sk him how quickly can we start this?

[Gideon]

Talking about a truncated post.

As I have posted previously you qualify for an ASV machine.  Your O2 is Low.  That has been documented in your previous studies.  You should be able to get ASV AND supplemental oxygen.

Your one constant complaint has been a "brain fog" that takes at least half the day to clear.  You NEED to be on supplemental oxygen, at least at night.
IF your doctor doesn't see this CALL HIM EVERY MORNING and ask him what can you do about it?  (and do mention "Brain Fog").  Ask him how quickly and how soon you can start ASV AND supplemental oxygen.


Fred

[picante]

Dear Sleeprider, no, I'm oscillating between mostly OAs and mostly CAs. I don't think you've had a chance to look at graphs from Dec. 18 and 20, which I posted on the 19th and 21st (yesterday):

http://www.apneaboard.com/forums/Thread-...#pid280559

http://www.apneaboard.com/forums/Thread-...#pid280722

I'm observing that my brain is in much better shape after a night full of Obstructives than a night full of Centrals! Why on earth would that be?

I've observed that the 18th I had 61 OAs while lying on my left side (or possibly on a partly supine angle).
And I observe that the 20th I had 33 OAs (14 on my right side and the rest on my left side-to-partly supine).

[picante]

Pretty much confirms a need for an oxygen bleed to the CPAP.
I think you need to get on oxygen NOW and longer-term, have ASV titration. 

As I have posted previously you qualify for an ASV machine.  Your O2 is Low.  That has been documented in your previous studies.  You should be able to get ASV AND supplemental oxygen.

Your one constant complaint has been a "brain fog" that takes at least half the day to clear.  You NEED to be on supplemental oxygen, at least at night.
IF your doctor doesn't see this CALL HIM EVERY MORNING and ask him what can you do about it?  (and do mention "Brain Fog").  Ask him how quickly and how soon you can start ASV AND supplemental oxygen.

Fred

Well, that's what I think, too. I don't know if you saw, but I've been pleading with numerous docs for an appointment. The sleep doc's office gal just called 2 days ago to book me an appointment Jan. 3rd. I've had a lot of talks with her, but I don't think any of the info gets through to the doc.

As for calling every morning, well, everyone including the DME is closed until Wednesday. I suppose I can start leaving messages for the sleep doc before then. I will also mention what my pulse ox says.

Meanwhile, I think what we will see is: better pulse oximetry on nights when I'm having more OAs, fewer CAs. The one factor I have not mentioned much is Post-exertional Neuro-exhaustion (aka PENE). Last night I went to international folk dancing. The CAs, I think, reflect neuro-exhaustion. It doesn't take much exertion to trigger a heck of a lot of autonomic symptoms in Myalgic Encephalomyelitis. Too many phone calls in a day will do it, too.

Throwing that in FWIW. Thank you both so much for your concern and care. As I mentioned in the Merry Christmas thread, you ARE my Christmas present this year.

[Sleeprider]

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. It's obvious that you have a problem that is already medically documented in a sleep study, and qualified for targeted therapy. Improving apnea is a good idea, but maintaining oxygen during sleep is more urgent.

You have pretty clearly failed CPAP. A change in therapy will require a titration sleep study that evaluates bilevel and ASV. Your intolerance of high pressures affects both of those choices. It will be interesting to see how the clinic sees it, but resolving the oxygen deficit immediately, seems like the most important and enduring change for now.