afib and sleep apnea

[poppypete]

First session 'events' zoomed in on...

[poppypete]

Second ('awake') session...

[poppypete]

Sleeprider...

Have had a call from my sleep physician, giving me a cancellation appointment for this afternoon.

I'll report the outcome from it later today. 

Cheers...poppypete 

[Sleeprider]

I look forward to hearing what he has to say. I have never seen such recalcitrant hypopnea. Your machine is hitting you with all the pressure support has available and you still are not taking a decent breath. This is honestly beyond my experience or ability to mitigate.

[poppypete]

Sleeprider...

re: doctor visit and last night's results

The doctor visit was a bit of an anti-climax, as it soon became apparent to him, that you had educated me well and I could discuss and debate intelligently with him about what and why setting changes were made since I started on ASV. In the end I think he capitulated to my freedom to make setting changes, and not to be 'totally dependant' on either him, or more particularly the CPAP folk (whose support, whilst seen as good initially by me, has failed me in this final analysis).

Suffice to say, he withdrew on his advice which failed to reach me..."EPAP of 12 cm of water with pressure support of 3-10 cm water should be adequate" (the CPAP supplier was the recipient, and didn't advise me), after my enquiry about the CPAP supplier's settings on delivery (EPAP 4-15 with PS 3-15)...and that failure to set the machine correctly (?) in the first place!!!

I suspect even his advice "EPAP of 12 cm" implies he's thinking fixed pressure too...and this fixed vs auto needed clarifying to him too!!!

He was more than happy by the end, to allow me to run with what is where we've reached now, as I able to show all that information to him...

...AND the progressions you have helped me make over these past 6 nights...

...to get the final 2 nights good results...

...now further improved last night.

As for the hypopnea, he's not concerned that they are a problem, as he still believes that resolving the Afib will eventually see further improvement still. He's predicting the machine will 'get to know me' as time passes now, and if last night is any indication, that's already the case!!!

Last night's results are very good (comparatively, for me), in my humble view. The UAs towards the end of session 2 I'd dismiss as meaningful, as they occurred while I was awake and hoping to get back into slumber, a good 20min after waking would be my guess.

I'll follow this post, with the separate sessions' graphs.

Cheers...poppypete   but now 

...however, now I'm advised I've reached my attachment quota of 20MB and can't add more.

What now???

[poppypete]

Sleeprider...

In the absence of graphs...last night's result:

Overall:
6hr 14m  AHI 2.25 (11 H and 3 UA)

1st 
4hr 22m  AHI  1.37 (6  H  and zero!!!)

2nd       
1h  52m  AHI  4.29 (5  H  and  3 UA)

[jmjm28]

PP: I would like some advice on whether to continue on APAP in the early hours of the morning, as it seems to trigger/interact adversely with my afib.

---------------------------------------------------------
Could you define "trigger/interact adversely with my afib"? I ask because you are scheduled for cardioversion in June which suggests you are in
afib 24/7.

Jim

[Sleeprider]

Peter, I think we will be trying some higher EPAP pressures soon to eliminate the UA events. You're therapy seems to be evolving for the better whether we intervene or not. I think your discussion with the doctor reflects a man with an open mind that appreciates your pursuit of effective treatment. Perhaps if you're feeling better, that works for him. That's the same kind of rapport I enjoy with my own doctor. I don't expect much more.

[poppypete]

PP: I would like some advice on whether to continue on APAP in the early hours of the morning, as it seems to trigger/interact adversely with my afib.

---------------------------------------------------------
Could you define "trigger/interact adversely with my afib"? I ask because you are scheduled for cardioversion in June which suggests you are in
afib 24/7.

Jim

Jim...

Not easy to 'simply' answer for you this question, but if you follow my tread's content you will see that Sleeprider in particular led me to understand how the type of CPAP I was using, did seem to, for a variety of reasons.

re: the cardioversion/in afib 24/7

I do seem to be in afib 24/7, and it was only detected after I recommenced trying CPAP after a lapse in use. I was probably however, a prime candidate for it, given family and past personal history. The cardioversion has been delayed for a good reason, again which is explained in the thread...but thankfully now I know in what condition and content (a possible clot) was/is my heart, and I'm making changes now to support a better health outcome than being in afib 24/7...including a trial of ASV therapy.

My week-long use on ASV so far has led me to much better nights' sleep for the last few nights, supported with SpO2 levels above 90% now...and during which rest I note the afib is less volatile in range than while struggling on CPAP. Finally, my heart is getting some decent recovery opportunity...while the doctors have me taking a beta blocker and a blood thinner in further support of that objective (heart health recovery...like any muscle needs after exertion).

In closing, I/we came to understand (for without Sleeprider's support, I'd never have got to understand), the basis of my initial enquiry to the Forum, about "what comes first, the afib or the apneas?"...that like the chicken and the egg question, who has the answer?

If you work with these Forum folk, help for your personal tale is here, believe me.

Good luck...poppypete 

[poppypete]

Peter, I think we will be trying some higher EPAP pressures soon to eliminate the UA events.  You're therapy seems to be evolving for the better whether we intervene or not.  I think your discussion with the doctor reflects a man with an open mind that appreciates your pursuit of effective treatment.  Perhaps if you're feeling better, that works for him.  That's the same kind of rapport I enjoy with my own doctor.  I don't expect much more.

Last night's results:

Overall:
Sleep 20.43.39pm
Wake 03.41am

1st session
Wake 23.43.39pm (how's that for timing?) = 3.00.00hrs
AHI 3.00 
all 9 hypopnea events occurring in a 11m 31sec period @ 22.57.05pm...
no apparent change occurring on the oximetry graph...but 

• Sorry, but you cannot attach this file because you have reached your attachment quota of 20 MB
  

in the absence of a graph, @ 22.56.40pm there's a blip variation in the flow rate (similar to what lies under 'H' @ 22.57.05pm, the first hypopnea event of the night).
Pressure goes to IPAP 24.92

What to make of that data...unfortunately I don't know...but it excites me!!!

2nd session
Sleep 23.49.47pm
Wake 03.41.48am
= 3hr 52min

AHI 5.17 with
15 hypopnea
5 Unclassified apneas (with 4 of these, and 4 of the hyponeas registered within minutes of putting on the mask). The first "(10)" as is the 5th...while the other 3 = (19), (17), and (18)...giving comfort to the why of "how I'm feeling this morning" after a night's rest/sleep like this.

re:
"I think your discussion with the doctor reflects a man with an open mind that appreciates your pursuit of effective treatment.  Perhaps if you're feeling better, that works for him.  That's the same kind of rapport I enjoy with my own doctor.  I don't expect much more."

I'm pleased to read these comments, as previously you were not too impressed with what appeared to be going on in our (my doctor and my) newish relationship.

I came away with the same kind of understanding...that he too wants (like you have immensely), to help me understand my own personal treatment needs, and not to simply rely on him or a CPAP supplier...to give me the prescription.

Yes Tom, you've hit the nail on the head..."I don't expect much more."...as I shouldn't (remain dependent and ignorant of my own personal health needs).

I may not be able to upload graphs to you now, but I came away from my appointment with an understanding that I can now send my doctor graphs from SleepyHead, and not have him solely supplied with ResScan data from the CPAP supplier.

Once I finally resolve the SpO2 syncing issue, from here on (after my cardioversion), I should be comfortable with his guidance and our discussions (either personally or by email).

I'll close now, and have a cup of real tea and a crumpet while waiting for both the sun and my partner to rise, before we walk to the beach and have breakfast at the local surf club...

...having only had a camomile when I came to the computer an hour and a half ago.

Cheers...poppypete