Soon to start CPAP - Question on dehydration

[picante]

First Two Nights of Alternating CPAP + O2 bleed and the new O2 cannula. 
Wow, look at the results. They are superb:
                   

Notice that I have lower and more erratic SpO2 on CPAP + O2 than on the O2 alone through the cannula.
That happens whether I'm having a lot of CAs or not.

[attachment=10027]          [attachment=10028]

It's pretty clear that I haven't gotten this much oxygen at night for at least 3 years, possibly longer. I had no brain fog on waking Friday, but it did come on after eating in the aft. So I used the O2 for my physical therapy exercises on the floor and for a rest.

Today (Sat.), no brain fog on waking, more physical energy: I took a walk with DH and the dog!

No idea if I'll be able to tolerate 4 hours of CPAP tonight, because my guts are like a helium balloon just from eating more than they could deal with. (This is the gut problem that predates CPAP aerophagia.) I got over-eager.

But now I've got oxygen regardless! How wonderful it is to feel better!

[Sleeprider]

You will certainly feel the difference after a few nights of proper oxygenation. Even your baseline before desaturation was too low. Using a canula delivers a very high oxygen content at 2-L/min directly to your nose. With CPAP, there is a significant dilution of the oxygen as described in the oxygen bleed wiki. You may need a higher oxygen feed rate of 3-L/min to get a similar effect on CPAP. Whether you ultimately tolerate CPAP or not, I think you have solved a big problem.

I don't recall what your baseline AHI or other factors were without CPAP. Can you summarize your diagnostic results?

[Saxon]

I too had that problem in the beginning years ago. Every single morning I was parched. Worried about the damage it could do to my teeth, I started to use a chin strap and it solved that problem.
I tried everything else such as XyliMelts but the chin strap was the solution.

Everyone is different but there are many different styles of chin straps on the market and I have tried them all. Some of the thicker banded ones start to give me a headache after using them for a few nights.
This particular style below is the one that doesnt. It has a hole in the chin and velocro on the straps at the top of your head.


** I am unable to post a picture of it as I am too new to the board. Just look them up. Always in black.

[picante]

You will certainly feel the difference after a few nights of proper oxygenation.  Even your baseline before desaturation was too low.  Using a canula delivers a very high oxygen content at 2-L/min directly to your nose.  With CPAP, there is a significant dilution of the oxygen as described in the oxygen bleed wiki. You may need a higher oxygen feed rate of 3-L/min to get a similar effect on CPAP.  Whether you ultimately tolerate CPAP or not, I think you have solved a big problem.

I don't recall what your baseline AHI or other factors were without CPAP. Can you summarize your diagnostic results?

http://www.apneaboard.com/forums/attachm...p?aid=9418

Is this the info you're looking for, Sleeprider? I copied the link from Fred's post on p. 9 of this thread. It's the summary page of my first sleep study.

I apologize for not typing out the summary for you to make it easier to see. Unfortunately, I've been in a post-exertional state since I got up this morning. That includes swollen/congested lymphatic channels in my neck, a result of CNS immune activation. Also brain exhaustion (despite stellar oximetry readings), polyuria, worse dehydration, and a dozen other symptoms.

I should not have been on CPAP the 4 hours before waking. It added the aerophagia gut-ache to the gut-ache I already had from eating dinner. I'm just worried about non-compliance and losing the insurance coverage for the machine. 

The more I consider the sleep study data, the more persuaded I am that the data are not at all representative.
1) Total sleep time was 153.5 minutes. That was 36.3% sleep efficiency.
2) The wake/sleep junk I get now must have been ongoing all night. Therefore, the AHI of 41 is questionable.
3) It is not possible to do a truly representative sleep study in the hospital on me:
   a) because getting ready to go there requires exertion, thus throwing me into the post-exertional symptom flare I get from having Myalgic Encephalomyelitis
  b) because the hospital air dehydrates me twice as badly as the air at home, thus constricting my nasal passages and larynx even more (the laryngo-pharyngeal reflux / apnea).

I think the nighttime oximetry from last August was a bit more representative than either sleep study, since it was done at home.

[picante]

I've just had a brutal, crazy week where I got diagnosed with a deviated septum and scheduled for surgery April 3rd.

I dropped CPAP altogether: I haven't had 2 nights in a row without CPAP since I started, but on the 2nd morning this week my bowels normalized for the first time. They've been very reluctant to move, and moving incompletely. Not surprising, I guess they've had air in them since Nov. 29th. 

Everything is kind of a mess at this point (from the bureaucratic standpoint), but I really must reverse my weight loss in the next 2 months, and I have no time to lose with doctors dinking around trying to pawn me off on another doc instead of just doing the obvious thing and suspending my CPAP prescription until after surgery. My AHI has varied between 3 and 8 lately (very few OAs), but I just can't eat on a day after CPAP, and I didn't realize how much it was aggravating my reflux/clogging my airways until I skipped it 3 days in a row.

Here's my question today:
The oximetry reports all show my heart rate as very low, but it's never been as low as it was last night:
   

I had Post-exertional neuro-exhaustion (PENE) from my 3 appointments this week; perhaps it's just that? PENE really messes with other autonomic functions, such as BP, and I can't keep fluids in (polyuria).

Or is this low a pulse something that happens to people on oxygen? I mean, this is the highest I've seen my SpO2 as well; it's anomalously high.

[Sleeprider]

I can't find a relationship between supplemental oxygen and bradycardia, however it is a question for a cardiologist, not a forum. Your SpO2 is excellent but finally normal, at least compared to most of the rest of us. Omitting CPAP is an eventuality that was predictable given your complications. A deviated septum is not an emergency, and I would consider that April surgery a low priority.

[picante]

I can't find a relationship between supplemental oxygen and bradycardia, however it is a question for a cardiologist, not a forum.  Your SpO2 is excellent but finally normal, at least compared to most of the rest of us.  Omitting CPAP is an eventuality that was predictable given your complications.  A deviated septum is not an emergency, and I would consider that April surgery a low priority.

Thanks for the info and opinion, Sleeprider. What I don't understand yet is why my oximetry is so much worse on CPAP + O2 than on straight O2:
                          [attachment=10127]

Now that I'm just using the cannula, all I have are little dips as I fall asleep. If I were having longish apneas, like I did on Jan. 28th, it would look more like it does on CPAP + O2, just before 3:00 am.

[Gideon]

Thanks for the info and opinion, Sleeprider. What I don't understand yet is why my oximetry is so much worse on CPAP + O2 than on straight O2:

Easy, because the CPAP washes out, dilutes the Oxygen.  

You can talk to the doctor about increasing your Oxygen while on CPAP

[picante]

Thanks for the info and opinion, Sleeprider. What I don't understand yet is why my oximetry is so much worse on CPAP + O2 than on straight O2:

Easy, because the CPAP washes out, dilutes the Oxygen.  

You can talk to the doctor about increasing your Oxygen while on CPAP

Hi Fred, I've gone off CPAP because I need to reverse my weight loss. I'm down to 108 lbs., BMI 16.2.

I don't know if you saw my post from yesterday. I think the refluxate in my pharynx/larynx has inflamed my nasal passages, making the blockage complete at my (newly found) deviated septum. And the reflux is worse on CPAP.

My dentist sees the need to stop CPAP and stay on O2 until I can reverse the "anorexia aerophagia", as I call it, and he says the septoplasty will make it easier to breathe and possibly do away with the need for CPAP at some point. He is a DDS, and I don't know if his order would be acceptable to the insurance company. 

That leaves me with trying to persuade some other doc, the ENT being the obvious choice. I left a request for him Friday when I saw the nurse, but she said he was leaving for Africa the next day, and would be back in 2 weeks. Sigh. He is also reluctant to step outside his comfort zone. ("He doesn't usually deal with CPAP." That's nice, I think, no one does.)

The lack of an official prescription change is endangering my insurance status, but I'm not willing to wait and lose more pounds. I just hate dealing with the PCP, since she just wants to bounce me around the system rather than oversee my treatment, and I don't want to see the sleep doc, since problem-solving and oximetry don't seem to be part of his job description.

The system makes me so sick. Too many appointments, too much post-exertional neuro-exhaustion, too many days of my life spent trying to get people to listen in a bloody system that's designed for its own convenience, not for people who can't make it to appointments.

[Gideon]

A Dentist is allowed to treat sleep apnea, as long as he says to support the apnea should be no problem with the insurance.

Even when I am quiet I am following your progress closely.

Fred