afib and sleep apnea

[poppypete]

re:
1): "Did the way you feel reflect the improved results?"
I woke feeling/thinking/comforted that I'd at least slept through until 5.30am...a huge difference to previous nights. Feeling fine too. I was surprised that I'd removed/'lost' the mask at times, as I hadn't realised that...had the breaks in therapy.

2): "With regard to ASV, Afib is not a counter-indication or risk for the therapy. Only low left ventricular ejection fraction has been identified as a disqualifying risk. Large numbers of apnea are more stressful on your heart, so if you can get the echocardiogram and it works out, I will be glad to work with you to give you convincing arguments and documents for your sleep specialist."

Thanks for these comments, and I do understand how a lay person has difficulty in sorting out the various points of view...but these comments all add to that knowledge acquisition by me. I'll be very glad to have your knowledge and input before I see medical people again.

3): "It is your cardiologists call and your decision to assume the risk; not the sleep specialist to create risks that don't exist."
My clinician is working diligently to help, but her hands are somewhat tied by the ethical considerations of my being under a sleep physician/specialist, with whom I have only consulted once (having changed from a previous, some years ago, specialist less locally situated). I think you and her are somewhat on the same page however, and this is why I asked the question about your own background in this field.

I see my cardiologist again on 28 May, so hopefully within these next 5 weeks some sort of reasonable sleep will have been achieved while using the machine throughout the night.

I don't see the 'new' sleep specialist again until July 19, which will be after a possible cardioversion has been conducted.

Cheers...and thanks again.

[Sleeprider]

Peter, make sure you get echocardiogram to determine LVEF. This automatically qualifies you for ASV if LEVF is greater than 45%. https://my.clevelandclinic.org/health/di...n-fraction

This will take the wind out of the sails of any sleep specialist trying to keep you from the treatment you need. If your cardiologist will write an opinion that you are in good enough health and it is her opinion you will benefit form ASV therapy, then that would be check-mate.

[ardenum]

I dont know if its a standard but a doppler echo is the one id recommend. Personally I had both MRI and CT with contrast.

[Hojo]

So much to cover so I'll try to use bullet points;

-Yes, you need to know your EF (ejection fraction) of your heart in order to 'qualify' for possible ASV therapy.
-No one can really truly explain why ASV seems to cause problems in patients with low EF, some of their postulations I do not buy into.
-Your "CSR" patterns looked just like mine; do you have this breathing pattern during the day, have you had a stroke, if no, then it more than likely isn't true CSR but but very rhythmic (irregular) breathing caused by blowing off of carbon dioxide from CPAP.  Hence, the more pressure you add the more likely you are to see this breathing pattern.

-I could not tolerate a CPAP pressure of anything higher than 4, once I hit 5 it felt like I was fighting to exhale (I'm not overweight) and CPAP was just AWFUL for me.  When I took the BIPAP titration study, I failed that too; still had central apnea events.


-Do you sleep on your left side; this can cause some heart arrhythmias.  I had to put a pillow to my left to keep me from rolling over, and my sleep study showed that I had fewer CA events when sleeping on my right side.


-You have so few OA events, you may want to try a cervical collar to help lift your chin up to keep from causing restriction in your airway.  I didn't have any OA events in my initial sleep study, not until I had to put a mask on (full face) and tighten it enough to prevents leaks, then it caused my chin to be tucked.  Once I used a (small) collar, I haven't had a single OA event since. 

-I could not tolerate CPAP at all and and while waiting for my ASV study I ended up just setting my alarm every two hours so that I wouldn't go into a deep sleep, trying to avoid to many CA minutes (I would go 30-50 seconds without breathing).

-Some say ASV can be uncomfortable, I didn't find that to be true, it actually made me feel at ease knowing that I was being 'ventilated' when I stopped breathing.  My blood pressure has dropped, I can sleep through the night, and I feel so much better.

-As long as your OA events under control, I would try dropping your IPAP down to 4 and go from there, the machine may be blowing off too much carbon dioxide and this will cause you to stop breathing to build the CO2 back up, then the machine blows CO2 off again, you stop breathing, on and on.

-I would go in and get an ECHO done ASAP to determine your EF, then go from there for an ASV.

[Sleeprider]

Hojo...


This is the guy that lived your misery and solved it. It wasn't easy, but he finally got the treatment he needed.

Hojo's statement "-You have so few OA events, you may want to try a cervical collar to help lift your chin up to keep from causing restriction in your airway. I didn't have any OA events in my initial sleep study, not until I had to put a mask on (full face) and tighten it enough to prevents leaks, then it caused my chin to be tucked. Once I used a (small) collar, I haven't had a single OA event since. "

is a suggestion to toss your CPAP treatment. I agree that it's useless except to demonstrate a determination (compliance) to make some form of therapy work. Your current sleep specialist is a hack that needs to come clean with his rationale and back that up with the studies that contraindicate the use of ASV. We can work with that.

[poppypete]

Thanks Hojo and Sleeprider...

• All points noted...and appreciate your time and interest.
  

Will try again tonight on same settings (8-10; EPR On @ 1), but I'm thinking to go without after initial sleep session.

Don't think I can do anything else at this point...until 28 May heart specialist visit and discussion.

Cheers...poppypete 
Ps...emailed graphs from last night.

[poppypete]

[attachment=5516]

Result last night suggests a 'tweeting to settings'...

poppypete 

[Sleeprider]

You will find that with central apnea results are consistently inconsistent. You need ASV. Hopefully we can help you get that.

[poppypete]

Sleeprider...

re: "You need ASV. Hopefully we can help you get that."

Thanks for quick response.

Question remaining unanswered for me:

In the meantime (until I have Afib treatment outcome),

• a decision on whether to keep on with current CPAP (and if so, on what settings) I need to make.
  

Obviously something has improved (as I stay undisturbed for a longer period...over 5 hours again last night)...

...so is it

1. the lower settings, or 
   
2. changing the EPR factors...
   

...which is making the difference, to what was happening previously???

Your thoughts???

poppypete 
Ps...Hojo's comments were helpful, as was your comment on them:
"Hojo's statement....is a suggestion to toss your CPAP treatment. I agree that it's useless except to demonstrate a determination (compliance) to make some form of therapy work."

[Sleeprider]

The EPR at 1 may make breathing slightly more comfortable, but it likely increases central events slightly. You have to be the judge of what works best.  Part of this experiment was to see how much of an effect the EPR would have, and really it is not a huge increase in events.  Once you get situated with ASV, it is very easy to dial you in.  Here is the protocol for titration to establish your pressure on ASV. Start in ASVauto mode at EPAP min 5.0, EPAP max 15.0, PS min 3.0, PS max 15.0 and see where the auto adjusting pressure goes. Fine-tuning is easy after collecting data a couple days.