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Morgannon, I need to see a baseline at the settings I outlined in order to analyze any issues and suggest changes to pressure or pressure support. The problem with your previous graphs are that they represent a shotgun approach to therapy. There is just no methodology at play that can get you to a good place. My intention is to introduce you to a slow, methodical titration that achieves comfort and efficacy while identifying possible extraneous influences. If we can do that, you should not need to change settings every time you move in bed.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Sleeprider, everyone, I appreciate you guys so much. I'm sorry about the scattershot approach to the settings. Whatever disease I have, my breathing weakness fluctuates every night. That's why on some nights I'm good with 12/7, and on other nights I can't breathe out against more than 5 and I need more pressure support.
Sleeprider, does the auto set feature on the ResMed AirCurve 10 act somewhat like an IVAPS? I feel that is what I need, something that is going to guarantee me a specific tidal volume with every breath while I sleep. Or is the set pressure better?
Regarding the capnometer, yes, it was expensive. I'm going to wear the cannula under the mask. I know it's not optimal but it's what I got for now. Can also get some co2 baseline during wake hours.
I wouldn't be spending so much money if I didn't have a muscle weakening disease at work in me. I've got no desire to die while awaiting diagnosis.
Sleep rider is there anything on those charts that suggests true central apneas or neuromuscular weakness of any sort? Anything I can take to my neuro and show her? Or is the data too muddy?
04-02-2023, 11:15 PM (This post was last modified: 04-02-2023, 11:31 PM by cmpman1974.)
RE: Sorry to start new thread but need nap
How are you blowing out 800 mL Vt breaths with weakness? That's the perplexing part. Most with Neuromuscular Diseases can't generate sufficient Tidal Volume hence the ST-A machine or even more aggressive. I do see the volume figures vary by night, but all in the 550-800 mL range in general. Maybe RR a bit on the low end with MV close to normal. As I asked before, did a Pulmonary Function Test indicate weakened pulmonary muscles? I recall that was one of several test parameters done. It centered around Forced Vital Capacity, FEV1, FVC/FE1 Ratio, Slow Vital Capacity (SVC), Muscle Strength (MVV) and another I believe. Any insight on that part? Those would seem to be a crucial aspect of a diagnosis from a neuro doc or pulmonologist throwing out serious diagnoses.
A BPAP S does not react like IVAPS. IVAPS is meeting an assured volume target. BPAP S is a fixed IPAP / EPAP level breath. The VAuto offers automatic adjustments based on what I read, but still cannot accomplish the goal of trying meet min volume based on the last minute of breathing like IVAPS. IVAPS kicks in that extra breath or amount of air when you don't have enough, but it's hard to tell if that's an issue with the higher reported Vt numbers. If you set on VAuto, at least you'll get some idea where the machine leads you pressure wise instead of randomly changing the settings night to night. If I understand right, VAuto's downfall is PS is fixed between EPAP / IPAP and the machine auto-titrates (example: 11/7 gets moved up to 13/9 up to 15/11 (PS always 4). Is a PS of 4 is not enough to ventilate well......may not work.
My weakness fluctuates from night to night. The neuro thinks it could be Myasthenia Gravis which fluctuates from night to night. Also my diaphragm seems to be unaffected so far but my expiration is affected. Regarding the PFTs they are all slightly below average but I have very big lungs, so my values are low for my size. Regarding the muscle testing, it was on the low normal side too. But Pulmo won't let me establish a baseline..
I'm going to get back to basics. We can tell how your respiration actually varies from night to night, but not if the variables or settings keep changing in a wide range. The goal is to find settings that work on both the good nights and bad nights. If you need a volume assured bilevel PAP we can likely identify that from the Oscar graphs and respiratory results. Just need you to stick with it for a few nights. At this point your anxiety is running away with your settings, and you are making changes based on perceived respiration. You don't have a ventilator (yet) and no matter what settings you use, the machine you own relies on spontaneous effort and follows that. We have to first work within those limitations to see if we can optimize or identify the need for more advanced PAP.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Machine: Lowenstein Luisa Mask Type: Full face mask Mask Make & Model: Resmed Quattro FX Humidifier: separate F&P humidifier CPAP Pressure: Epap 4-20 PS 4-20; "auto" rate CPAP Software: Not using software
Other Comments: Using 45 degree angle upper body wedge (36"x36") and 4.5"soft cervical collar; 500 assured tidal vol
Just follow Sleeprider's suggestions and you will get there quicker. Sorry to add one more thing, but a capnometer reading is only supposed to be done on room air (with no cpap or pap, or mask, etc.). Baseline is established this way.
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.
Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
You guys are wonderful and amazing. Im sorry my anxiety is so bad. Im trying to get it treated with limited success.
Sleeprider your settings worked! I think I put in a little additional pressure support because I felt I wasnt getting quite enough air.
Also, look how damn long I slept almost 12 hours. I think I'm catching up on many years' worth of bad sleep.
Here's another thing - I can't seem to sleep on my side. It doesnt feel like I get enough air in that way. Which has never been a problem for me before. Not sure how to interpret this.
BUT...a nice low AHI. Also tracked my O2 on my WellVue. Average O2 96% with the help of some supplemental o2 (very little probably don't need it). Only dipped down to 89% once. My heart rate had some bumps and jumps but nothing I think I should be concerned about.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
One question - if I start having more AHIs does that mean I am having fluctuating weakness? My neuro needs to see some sort of variation in my stats before she can start prescribing something more powerful.
Alternatively if I don't see a variation does that mean I don't have muscular weakness?
Or can we even draw any conclusions from these readings?
I'll stick with it Sleeprider - I'm on the same settings and I feel so under ventilated. I'm going to stick with it for a few nights I promise. O2 is still good but I'm bleeding in extra o2 like last night. I'm hoping I can get a better machine. I want a breathing cuirass so bad. Or an IVAPS. I want relief so bad...
