afib and sleep apnea

[Sleeprider]

I went back and checked from the beginning of this thread and your AHI has been all over the place and seems to have no relationship to the pressures we set.  At every pressure, high or low, your AHI has ranged from 11 to 30 and it has nothing to do with settings. 

At this point you need ASV and a bilevel ST machine is a distant backup choice in the event your heart health does not support the ASV.  What is your diagnostic AHI from your original test?  If it is lower than the treated AHI, you should quit CPAP and seek a different solution.  If CPAP is reducing your AHI, continue use, but invest in a cheap oximeter.  That will either your are okay, show the need for supplemental oxygen, or press the need to move to ASV.  You cannot continue to let your doctors play with your health.  It's not entirely your choice, but you can somewhat control the outcome.

[poppypete]

Sleeprider...

re:
1): "What is your diagnostic AHI from your original test? If it is lower than the treated AHI, you should quit CPAP and seek a different solution.  If CPAP is reducing your AHI, continue use, It was >30, and so yes, CPAP has reduced that number

2): but invest in a cheap oximeter.  That will either you are okay, show the need for supplemental oxygen, or press the need to move to ASV." I ordered one on 10 April...and have been notified that it was posted to me on Friday. A ChoiceMMed MD300W314 wrist style, it isn't what I now understand through the Forum, is what others using SleepyHead recommend, so I'm waiting to evaluate it before ordering another, more compatible with SleepyHead:
[font=.Lucida Grande UI](copy and pasted from SleepyHead)[/font]
[font=.Lucida Grande UI]SleepyHead is currently compatible with Contec CMS50D+, CMS50E, CMS50F and CMS50I serial oximeters.
(Note: Direct importing from bluetooth models is [font=.Lucida Grande UI]probaby not[font=.Lucida Grande UI] possible yet)[/font][/font]
[/font]
[font=.Lucida Grande UI]You may wish to note, other companies, such as Pulox, simply rebadge Contec CMS50's under new names, such as the Pulox PO-200, PO-300, PO-400. These should also work.[/font]
[font=.Lucida Grande UI]It also can read from ChoiceMMed MD300W1 oximeter .dat files.[/font]

I came to this conclusion (about understanding these 3 options...and also, that I need to also understand if even during the day, my shallow breathing means I desaturate. My test revealed it went down to 77% on the test night!!!)

I will continue tonight, and try 7-11 with EPR off, and hopefully within a couple of days with oximetry readings, know more.

Cheers...poppypete 

[poppypete]

Sleeprider...

Still waiting on the oximetry reader...

...so no spO2 or PC data yet.

5hr 49min...AHI 14.51 last night...still persevering until I get the oximetry readings into the mix.
.......................
In the meantime, could you comment on the meaning implied (and if correctly inferred by me) by these flow graph queries please.

In attachment 1, I'm showing the first H of last night, when the flow is around 39 before dipping into this H event (= "overly shallow breathing or an abnormally low respiratory rate"), before recovering to the 30 minute period before another event happens...the next H. 

In 2, the first CA event ("the effort to breathe is diminished or absent...and is usually associated with a reduction in blood oxygen saturation...usually due to an instability in the body's feedback mechanisms that control respiration.")...is showing as flatlining almost...the total cessation of flow?

In 3, the first OS of the night, the wavelength pattern is different yet again, but ultimately does flatline almost also.

What I don't quite understand, is what happens to change what is happening as each of these events is reversed/stopped...in other words how does this current machine bring my breathing somehow back to 'normal'...at least until the next event (of any variety)?

I can't interpret that in the pressure graph (on 7-9), or am I missing something you see???

I can understand why a machine with a different style of reaction (such as an ASV or bilevel style), would perform differently in response (to preventing these events before they occur), but to educate me for these discussions I'm to have with the cardiologists and the sleep physician, I'd like to better understand why this current CPAP auto machine doesn't work for me/my 'condition'.

Can you explain this to me???

Cheers...poppypete.  

[poppypete]

Further attachments...

[Hojo]

Yep, still looks like on target for ASV or a good AFIB treatment.

[Sleeprider]

May 14 session at a pressure of 9.0 (actually 7 to 9 on auto, but your flow limitations make that a fixed pressure) with no EPR.

Attachment 1: Severe flow limitation throughout with possible snores.  The image does not show a low respiratory rate (breaths per minute) but does show a significant flow reduction. It appears that some kind of restriction is severely impairing inspiration here, however, we know from prior experiments that higher pressure or pressure difference between IPAP/EPAP does not remedy this situation for you.  ASV would provide up to 15 cm of pressure support timed to coincide with your breathing rate to make these full breaths.  The problem with bilevel alone is that the pressure support would result in central apnea.



Image 2: Continued flow limitation with possible snoring, gradually diminishing flow rate to an apnea greater than 20 seconds duration, preceded by hypopnea. Respiration gradually increases and begins to show a periodic pattern.



Image 3: The apnea shows a gradual diminishing of flow rate characteristic of central apnea, but terminates with strong recovery breathing and arousal more typical of OA.  This may be a mixed apnea. With regard to your question, "how does the machine bring my breathing back to normal"; it doesn't.  You can find a mask pressure graph in Sleepyhead and put that underneath the flow rate graph. You will see that during apnea, the machine remains at EPAP until you spontaneously begin breathing.  In your case you are not using EPR so pressure simply does not change.  It was at 9.0 before, during and after the event.  The CPAP is fully unintelligent in providing support to restart breathing.  An ASV wi

ll provide increasing IPAP pressure at your normal respiratory rate in an attempt to cause you to inhale.  It provides as much pressure support as necessary to cause a breath up to 15 cm above your EPAP pressure.




Maybe Hojo or one of the other ASV guys can post a graphic showing mask pressure response to events.

[poppypete]

Sleeprider...

re: "With regard to your question, "how does the machine bring my breathing back to normal"; it doesn't.  You can find a mask pressure graph in Sleepyhead and put that underneath the flow rate graph. You will see that during apnea, the machine remains at EPAP until you spontaneously begin breathing.  In your case you are not using EPR so pressure simply does not change.  It was at 9.0 before, during and after the event.  The CPAP is fully unintelligent in providing support to restart breathing."

Thank you for such a comprehensive reply, and I attach a graph revealing the data referred to above (mask pressure).

Cheers...poppypete. 

[Sleeprider]

If you zoom in to where you can see the apnea and the mask pressure you will see a flat line on the mask pressure until you breathe. With CPAP, the pressure follows your lead; with ASV it can lead the way.

[poppypete]

re:
 
"If you zoom in to where you can see the apnea and the mask pressure you will see a flat line on the mask pressure until you breathe. With CPAP, the pressure follows your lead; with ASV it can lead the way."

Thanks Sleeprider, attached graphs show I understand.

Cheers...poppypete 
Ps...
The prime question remains for me to decide...do I continue with machine up until Afib issue resolved, or am I not getting as good a rest/sleep by persevering with it, as I could be getting without using it...for the moment???

The secondary question is also still (if I do remain on the machine)...do I now revert back to 6 minimum and say 17 maximum, with EPR on @ 3 (albeit with lower AHI, but with CSR periods), until then???

[Sleeprider]

If your AHI is less than the diagnostic test, then stick with it. If CPAP makes it worse, don't use it. I suspect a return to 6-17 with EPR 3 will look pretty awful. I don't know that I have ever seen your results with EPR 3, but I suspect it will be over 30 AHI. Up to you. You need ASV.