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+--- Thread: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? (/Thread-COSA-hypoxemia-AFIB-high-BP-polycythemia-and-CBTI)
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? - emmylouwho - 06-22-2023
Motorheadrulz,
Thank you for sharing the link to your journey. I just read through all of your posts. I admire and celebrate your tenacity and resilience in this whole process. I am unable to interpret all the data as you. It is definitely a skill. I was happy to hear a hopeful good ending with real answers for you. I'm looking forward to an update.
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? - Motorheadrulz - 07-14-2023
Hello gurus!
I finally got my titration results and they were as expected. Low AHIs, low leaks, some minor pressure changes, and I feel like sh*t. Requesting you folks compare the recommendations with last night's screenshot for a sanity check. I'll make the changes, but I don't expect any improvement.
Caveat- I'm on 4L of oxy at home, and will keep that setting for the hypoxia.
I'm still working my way through the GI testing and surgical consults to fix the hernia. I'm sick of this, but I see the light...
TY, MHR
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? - Jay51 - 07-14-2023
Hello MHR.
Congratulations on getting some health problems fixed.
3 things jump out at me.
1. Very good AHI. Your Dr.'s may be reluctant to change anything since it is so good.
2. Your respiratory rate is a bit on the low side. A 9.6 median and low of 5. I had a low of 5 on my poly also. Normal is around 12 to 20 at night. You have a good health 560 tidal volume, so your minute vent is ok (rr + vt = minute vent.). Your ASV machine can't raise your respiratory rate any based on it's algorithm (it only goes by your normal rate to calculate it). A machine like an ST, ST(A), or vaps (ivaps or avaps - for respiratory disease) all have options to program in a specific rate for you (example 15). This doesn't appear to be too big of a problem since your minute vent and AHI are both good.
3. You have a very long inspiration time of 3.3 seconds. You may be encountering resistance somewhere along your anatomy from nose to lungs that is causing you to have to inhale for a longer period of time to take in a good tidal volume (the amount of air taken in in one single breath). With a vaps machine, you can program in a tidal volume #. This can help you get to that specific tidal volume a little quicker (less inspiration time). I use it on my Evo to give me a boost. A possible reason for your fatigue is the extra effort it is taking you to make every inhale during the night. I have spent many hours with my RT tweaking everything just right so every night's sleep is as tiring as going for a jog (lots of effort).
I hope I have not confused you. Overall your therapy looks good to me though. Maybe I am just nitpicking. Your spo2 levels look good on the sleep study. Maybe your fatigue is caused by health issues unrelated to sleep apnea? What do you think?
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? - Jay51 - 07-15-2023
Hello again MHR.
I reread through your sleep study and wanted to post again to clarify some things. When I wrote: "I have spent many hours with my RT tweaking everything just right so every night's sleep is as tiring as going for a jog (lots of effort)." I forgot to put in the word not. By many many many tweaks, every night now for me is not as tiring as going for a jog. My apologies.
Your Dr.'s are concluding that ASV therapy with supplemental oxygen is working well for you. I agree with them. 1. You have a very low AHI. Your spo2 (with 2 liters during the sleep study) looked good. Sleeprider liked your ASV therapy also (I went back and reread all of your posts).
This time what jumped out at me during your sleep study was the abnormally high number of arousals during the night. Much more than normal. Not many of them were due to PLM's. 17 total awakenings. 24 limb movements. 2 respiratory arousals. 5 PLM arousals. 7 isolated limb arousals. 47 spontaneous arousals. For a total of 61 total arousals during your sleep. That is a lot!!! I am not a Dr. and don't give medical advice, but decreasing these during sleep should help you feel better IMO. Most likely most of these arousals come from the prostate removal and/or acid reflux all of these arousals don't you think?
In a nutshell, what I posted last night was basically, if your respiratory rate increased a little bit (you breathed more often during sleep), then you might not have to expend as much energy with each inhalation (your median on OSCAR was 3.3 seconds.) The much bigger problem seems to be all the arousals you are having at night during sleep.
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? - Motorheadrulz - 07-18-2023
Jay- thx for the feedback. Staying asleep is a next to impossible... and finding a competent sleep dr to explain the arousals or treatment is also frustrating. We have tweaked my pressures all over the place with limited improvement.
In a nutshell... I'm racing around the track, with a clogged air filter, missing on 2 cylinders, and no pit stops...
I'll update once I get some misbehaving body parts back in line.
MHR
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? - Sleeprider - 07-18-2023
Motorhead, try dropping PS min to 3.0. It will increase the contrast without stimulating central events and might feel better. We will watch flow limits to see if there is any difference.
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? - Motorheadrulz - 07-31-2023
Had a consult with sleep dr. last week with no surprises. According to the lab test, my numbers are excellent even though my sleep quality is sh*t. I'm using the prescribed settings from the titration report above. I'm not planning to upload any charts since they will be as expected.
I complained about the excessive arousals and awakenings. She stated there wasn't much to do for severe insomnia since the apnea is "controlled". She prescribed 5 mg of doxepin + 1 mg melatonin, and to follow up with a CBTI guru (again...). CBTI is supposed to work within a couple of months, but I seem to be too damned hard headed...
Still waiting for the GI surgery consult.
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? - Sleepy Quixote - 07-31-2023
@Motorheadrulz
Yeah couldn't be the machine causing sh*tty sleep... cause good numbers, must be... (nebulous) "insomnia" /snaaark
I only chimed in because I'm going through the bullsh*t mill trying to get PLMD addressed, aaaaand they just prescribed the miracle melatonin for me too, told them I'd give it a two week trial.
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? - Motorheadrulz - 09-28-2023
Update on my saga...
I had my turbinates trimmed and the hiatal hernia repaired. I'm completely off of Prilosec, and am in the 1+ month healing phase. I've noticed quite a difference in that I'm not a complete zombie all day. I still have the cough, shortness of breath, limited exertion, and my sleep is sh*t. I am getting better, but it will take 2-3 mo for my lungs to heal. I'm still on ASV + nightly O2.
I had a sleep dr consult this week. She reduced my pressures a little since I've been getting aerophagia, and waking up completely bloated, gassy, and I could inflate a hot air balloon out my arse. I'll try it for a week or 2 then post my Oscar. Another dr buddy told me to wear an abdominal belt (lifting support belt) in bed to help hold everything tight since I have 6 holes in my belly and am healing- it works! I'm still gassy and bloated, but not as bad as before.
I'll start walking, hiking, and riding a stationary bike asap and get good air thru my lungs. After ~ 3 yrs, I finally see the end of the tunnel.
Next up is to tackle this CSA and insomnia BS. I finally got referred to a clinical psychologist who is licensed in PTSD and insomnia for my state. Not holding my breath... but will see how it goes.
RE: COSA, hypoxemia, AFIB, high BP, polycythemia, and CBTI? - Motorheadrulz - 10-12-2023
just checking in and requesting advice:
It's been 6 weeks since surgery, and 3+ weeks since my sleep therapist adjusted my ASV pressures. I'm still waiting on the CBTI dr consult.
New pressures: EPAP= 8.0; PS min= 3.0; PS max= 8.0
Since we changed my pressures, my AHIs are still good but my fatigue has increased and I'm struggling with aerophagia. I still get 2-3 hrs of hard sleep, then wake up gassy, bloated, and have sleep-wake junk for several hours until the alarm dings. I'm using a full face mask with a pretty good seal- my leaks are minimal. I actually caught myself drifting off and felt my throat open and the air compressor inflate my stomach.
Attached is a screenshot from last night, and is pretty consistent with the past 3 weeks. The leaks from 0430-0700 are me waking up, passing gas, scratching my nose, etc.
Any recommendations on fixing this are appreciated. MHR