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+--- Thread: Hard to breath with CPAP and RSD(CRPS) (/Thread-Hard-to-breath-with-CPAP-and-RSD-CRPS)
RE: Hard to breath with CPAP and RSD(CRPS) - Biggz - 12-04-2018
I just got back from my local DME, She said that i was definitely not obstructive apnea but for sure primarily central apnea. Anyways she suggested that i find a new doctor fro my problem. She also said that i did the best just on oxygen then the bipap( this is from the recent sleep study i had done). So as of this moment i am just on oxygen.. I am confused,lol.
RE: Hard to breath with CPAP and RSD(CRPS) - Sleeprider - 12-04-2018
Oxygen therapy can be an alternative or addition to PAP therapy. Bilevel therapy without ASV would have made your central apnea worse. You do need a different doctor if yours cannot recognize this condition. Unfortunately we have doctors that are barely competent to treat common obstructive apnea, and they usually take great personal offense when patient does not conform to their expectations. Let's see what he says, but you need to confront him with your understanding that your problem is CA, and the best therapy for that is ASV. Be direct and ask if he has a plan to get there, or someone he trusts that he can refer you to for that expertise.
RE: Hard to breath with CPAP and RSD(CRPS) - Biggz - 12-17-2018
Now they put me on the Aircurve 10S . Seems like a lot more airflow pressure than the cpap one. I know everyone says this isnt the machine i need but I am trying to get to that point. I have a doctors appointment with a new family doctor tomorrow, I hope this one is competent ..last was a quack for sure. It sucks that i have to fail all these machines before you get the one you need.
Thank you
RE: Hard to breath with CPAP and RSD(CRPS) - Sleeprider - 12-17-2018
Failing bilevel without backup is part of the process. This won't take long. What are your IPAP/EPAP settings? On the 10S, you may need to turn on EasyBreathe. It makes the pressure transitions smoother.
RE: Hard to breath with CPAP and RSD(CRPS) - Gideon - 12-17-2018
This is what needs to be done to qualify for ASV. Where do you fit in this scenario?
Complex Sleep Apnea
For Complex Sleep Apnea the Medicare requirements for issuing an ASV machine.
- Titrate to minimize OSA, that is the obstructive AHI to less than 5 per hour. This typically is raising EPAP or pressure until obstructive AHI is less than 5 per hour, we expect this to make the Central and Complex Apnea worse thus failing the current treatment
- Record the central apnea-central hypopnea index (CAHI) (looking for greater than or equal to 5 per hour and greater than 50% of total AHI)
- Document the presence of at least one of the following symptoms: These symptoms are specifically noted by Medicare. These are key symptoms that we look for by asking "How do you feel?". Do not limit your answers to the following and do not fabricate the answers.
- Sleepiness, "How do you feel?"
- Awakening short of breath, "How do you feel?"
- Difficulty initiating or maintaining sleep, "How do you feel?"
- Frequent awakenings, or "How do you feel?"
- Nonrestorative sleep, "How do you feel?" Nonrestorative sleep is defined as the subjective feeling that sleep has been insufficiently refreshing
- Snoring, Can be documented on Sleepyhead
- Witnessed apneas - Most of us have this one with our significant others or during a sleep study
RE: Hard to breath with CPAP and RSD(CRPS) - Biggz - 12-18-2018
Thank you guys. Sleeprider IPAP is at 12.5 and EPAP 7. Bonjour thank you for all the good info you give me, I will explain everything to him tomorrow. I am bringing my sleep test results with me to my doctor appointment but hopefully he will just send me to a specialist. I am going to try and fall to sleep with thing on tonight, hope to get some results
Thanks again
RE: Hard to breath with CPAP and RSD(CRPS) - Sleeprider - 12-18-2018
Bilevel with PS at 4.5 cm is really going to make your CA blossom. You will have something to discuss with the doctor.
RE: Hard to breath with CPAP and RSD(CRPS) - Biggz - 12-18-2018
is 4.5 low? I was on IPAP of 12.5 but i could not breath that good, I moved it down to 10 which is what the cpap was set to and that helped a little bit cause i guess i did fall to sleep for a short period. If I have mostly CA why would i need so much air forced down my throat? If there was less forced air i would prob be able to wear the mask better.
RE: Hard to breath with CPAP and RSD(CRPS) - Sleeprider - 12-18-2018
Pressure support is the difference in pressure between IPAP and EPAP. At 12.5/7.0 your PS was 5.5 cm (I was mistaken). That is a lot of pressure support and will totally flush CO2 from your system which will in turn wreck your respiratory drive by lowering PaCO2. Read Chemical Control of Breathing in this article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287191/
Basically you are being hyperventilated by the pressure support. Compare your tidal volume and minute vent to previous CPAP. This lower CO2 and changes blood chemistry reducing respiratory drive. People with central apnea tend to be very sensitive to this effect and will show more symptoms (central apnea) as a result of using pressure support.
By reducing your IPAP pressure to 10, your PS is 3.5. This should still cause some central apnea, but the reason it feels like you can breathe better is because the higher PS caused central apnea. Putting someone with central apnea on a bilevel ventilator without a backup rate at 5+ pressure support is just ignorant! It will however rapidly demonstrate the need for ASV. Your reduction of that pressure support was a pretty instinctive survival response. The pressure support actually does much of the work of respiration, making it easier to breathe from a mechanical standpoint, but because it also suppresses your respiratory drive, you feel like breathing is actually harder.
RE: Hard to breath with CPAP and RSD(CRPS) - Biggz - 12-18-2018
That was some great information, thank you Sleeprider. Just got back from my 1st visit with the new family doctor. He said lets start off with the apnea problem i said ok. I told him that i was told apnea was apnea kinda just looked at me funny and says there is different apneas, right then i knew this guy was going to be a little better. Anyways he is going to send me to the person that read my sleep study report so that my help.