Suddenly my Centrals got a lot more disruptive

[tcinoz]

Best Sleeping Positions After Open-Heart Surgery
Sleep comfortably and move around with confidence as you recover.

By Lisa Esposito

• Reclining. Resting in a recliner is an option. However, having to rely on a recliner continually may indicate health concerns that should be addressed, Cohen says. It could be that a patient isn't breathing well or isn't comfortable lying flat, which might be related to fluid buildup around the heart or lungs. Other patients are simply more comfortable in a recliner, which prevents them from rolling around too much or sleeping flat on their stomach. "But in all honesty, I don't think that a recliner is a great place to get a good night's sleep," he says.
  
  
• The first thing that popped into my head when reading your thread was a "heart valve".  I have very mild mitral valve prolapse.  The heart valves may function slightly better in a more upright position as opposed to lying down.  The heart's pumping action may be slightly improved also.  Take a look at a picture of the heart and valves and see how gravity affects blood flow through the different valves of the heart (and also from the left ventricle - which pumps blood to the body). My Cardiologist has taught me a lot.  I am not a Dr. though; and I am just trying to pass along some information that you might want to pass along to your Dr.s.  YMMV. 
  

Thanks Jay - yes, that's interesting and probably has some relevance to my condition.

One thing I did notice from last night's graph was that the period I spent on my recliner (from 6:00 onwards) was characterised by significantly lower flow limitation. However, my right leg plays up in the this position - even though I have it elevated - when it doesn't while I'm lying down normally.  I'm not sure why that is.

On an equally concerning note, my O2ring report, while great for O2, showed my heart rate going as low as 36. I think that's a new record! Even so, I felt OK during the day.

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[tcinoz]

Thank you too, Cam12. I intend to read your reply again at greater leisure tomorrow when I hopefully can absorb and process the content a bit more thoroughly.

[Jay51]

That's great that your Spo2 numbers are so good.  Definitely show Cardiologist this spo2 chart.  It shows your heart rate getting very low into the 30's.  That could be the reason for the fluid building up. Cardiologist might be able to adjust medications to help.

[tcinoz]

tcinoz, the Airsense 11 has no real tools on board to manage CA events. If you don't want to go all the way to ASV, the Aircurve 10/11 Vauto has a better bilevel therapy algorithm with trigger settings that make a CA much less likely to happen.  Trigger sensitivity lets us use the changeover from EPAP to IPAP (or trigger) to occur at a lower flow. Many people with CA do not completely stop breathing, they just have very low flow rates, but with higher trigger sensitivity, the IPAP pressure is triggered and this ca stimulate a spontaneous breath to occur reducing the CA rate.  We use the same principle with ASV when we use a relatively low maximum PS as a stimulus of inspiration, rather forcing a mechanically assisted breath.  These are pretty advanced concepts, but there are ways to cause inspiration to occur, in spite of low spontaneous effort, that do not involve brute force pressure support.

Things have taken a sudden bad turn, with the last three nights being the worst I've had.

Coincidentally they come immediately after an appointment with my sleep doctor, during which we discussed how my nights get progressively worse as the night goes on and I feel more tired each time I wake up, and that I think I may be dealing with hypercapnia. She ordered some tests for me, one of which is the arterial blood gas test, which involves taking blood from deep inside the wrist artery - twice! - during an overnight sleep study (before and after). I just can't handle the thought of that and I cancelled the appointment for that test. I had a normal blood test yesterday and there are lung function tests to come.

My O2 levels average out at 96% each night but my heart rate goes right down into the 30s. I measured my blood pressure as high as 167/121 in the middle of the night the other night and have upped my BP med dose since, but that also slows down my heart rate.

My breathing is very shallow and the CPAP machine is no longer working effectiely for me in those last few hours of each night. I pressed my sleep doctor on getting an ASV machine, but she replied that the ASV wouldn't be the right choice for me. She thinks a BIPAP machine would be what I need, but wants all the test results in first. Everything takes so long and this could take weeks, while my CAs veer out of control and my total time in apnea rises to dangerous levels. Added to that, now I'm getting Cheyne Stokes sequences to muddy the waters as to choice between ASV and BIPAP.

I checked in with Resmed on my way home and asked about BIPAP, and they immediately pointed me to the Lumis model, which costs about double the VAuto that you are a keen advocate for, Sleeprider. Any thoughts on all this would be appreciated.

Graph for last night attached (the previous two are similar): one interesting point is that flow limitations tend to be higher during the 'good' part of the night - the first few hours when there are far fewer events. I wonder why that is?

[attachment=63776]

[stevew168]

You wrote:
"Graph for last night attached (the previous two are similar): one interesting point is that flow limitations tend to be higher during the 'good' part of the night - the first few hours when there are far fewer events. I wonder why that is?"

Typically we have more N3 (deep sleep) in the first part of the night, when our breathing is more regular. Later in the night we have more REM sleep, when our breathing is less regular due to muscles being more paralyzed, which might explain having more central apneas. It appears many of your central clusters are spaced similar to REM sleep timing.

[SarcasticDave94]

The CPAP may read CSR during variable breathing, and for most this is an incorrect flag of CSR. For you, I can't say it by default. Nor can I tell you what to do, but I'd be inclined to take any reasonable test to diagnose the problem.

Hair splitting, ASV is a BPAP, although a specialized one. You may need to take the "BPAP", as long as it's named ResMed AirCurve 10 VAuto or ASV. ST wouldn't likely be a great fit, and maybe not ST-A either.

[Sleeprider]

The Lumis line is like the Aircurve line, and includes several different models. The Lumis 100 VPAP S is a fixed pressure bilevel device similar to the Aircurve 10 S, The Lumis 150 ST-A has modes for S (spontaneous), ST (spontaneous-timed), T (timed), PAC (Pressure Assist Control) and iVAPS (intelligent Volume Assured Pressure Support). The Lumihe ls 150 is a noninvasive ventilator similar to the Aircurve ST-A, however it is not really for central sleep apnea, but for pulmonary diseases, hypoventilation, etc. I'm not sure of the model designation for ASV in the Lumis lineup. Since there does not seem to be an ASV, I do not think the Lumis is your answer.

[tcinoz]

The Lumis line is like the Aircurve line, and includes several different models. The Lumis 100 VPAP S is a fixed pressure bilevel device similar to the Aircurve 10 S, The Lumis 150 ST-A has modes for S (spontaneous), ST (spontaneous-timed), T (timed), PAC (Pressure Assist Control) and iVAPS (intelligent Volume Assured Pressure Support). The Lumihe ls 150 is a noninvasive ventilator similar to the Aircurve ST-A, however it is not really for central sleep apnea, but for pulmonary diseases, hypoventilation, etc.  I'm not sure of the model designation for ASV in the Lumis lineup. Since there does not seem to be an ASV, I do not think the Lumis is your answer.

Thanks Sleeprider. My sleep doctor seemed firm in her opinion that an ASV was not for me and that a BPAP was what I needed. She said it would do my breathing for me! In the Resmed shop they indicated this would be the Lumis 150 (I found the note they wrote the model number on).

I'll certainly take the advice of the people on this forum on board before I come to any decision and I shall question my sleep doctor further about it. Main problem is getting access to her (and I'll need that for a script). I'm not a private patient (in the Australian health system) and the waiting list for appointments is long. What with more lung tests and a cardiologist appointment still weeks away I am expecting it'll be July before I get to change from my Airsense 11. I hope I can hold out. It's the waking up at 3:30 with high blood pressure and knowing that it's the next stage of sleep when all the action happens that is so challenging.

[tcinoz]

The CPAP may read CSR during variable breathing, and for most this is an incorrect flag of CSR. For you, I can't say it by default. Nor can I tell you what to do, but I'd be inclined to take any reasonable test to diagnose the problem.

Hair splitting, ASV is a BPAP, although a specialized one. You may need to take the "BPAP", as long as it's named ResMed AirCurve 10 VAuto or ASV. ST wouldn't likely be a great fit, and maybe not ST-A either.

Thanks Dave - noted.

[tcinoz]

You wrote:
"Graph for last night attached (the previous two are similar): one interesting point is that flow limitations tend to be higher during the 'good' part of the night - the first few hours when there are far fewer events. I wonder why that is?"

Typically we have more N3 (deep sleep) in the first part of the night, when our breathing is more regular. Later in the night we have more REM sleep, when our breathing is less regular due to muscles being more paralyzed, which might explain having more central apneas. It appears many of your central clusters are spaced similar to REM sleep timing.

Thanks Steve. Yep, those pesky centrals keep popping up mainly during the REM sleep. Yet counter-intuitively the flow limitations seem relatively settled by then compared to during the N3 stage.