Albuterol for improved CPAP function?

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Albuterol for improved CPAP function?

Postby Janknitz » Tue Mar 02, 2010 3:06 pm

I am on my trial period of using a CPAP. I had a pulmonary function test the same day I started CPAP and that was the only night I did not have massive mask leakage due to very high pressures.

I think there are two possibilities to explain why:
1. I didn't sleep well at all that night and perhaps never went into REM sleep where most of my AHI's occur.
2. I had a massive dose of Levobuterol as part of the pulmonary function test that afternoon. I have asthma, and I think that medication really opened my airways much more than usual.

I decided to experiment last night and took Albuterol (inhaler that opens airways) before bed, even though I wasn't having the symptoms that usually require it. Interestingly, I did not have very high pressures last night and the mask didn't have a big leak. The morning pressure was only 8.9 instead of 10+. So I think I'm on to something.

So my question is whether taking Albuterol before bed every night will mess up the trial data for determining my long-term settings? I'm willing to take it on a regular basis if it helps--the high pressure leaks were really interrupting my sleep and driving me nuts.

One thing is that WITH the albuterol, I felt like I wasn't getting enough air when I first went to bed and the pressure was at 5.0. I was probably able to breathe more deeply and a little panicky from the medication. There's no way for me to turn up the pressure, so it was a little hard to go to sleep.

Mask is still not right, I'm going for a fitting to try other masks later today. No response to my request for help under masks about a good ff mask for a receding chin.
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receding chin

Postby Nellybliss » Tue Mar 02, 2010 3:15 pm

I'm sorry to hear you didn't get answers about masks. I, too, have a receding chin (in fact I'm guessing many people on this forum do, as I understand it is one condition which can close off airways and cause sleep apnea) and have struggled with masks. I'm still working on issues of pressure and enough oxygen related to yours (but without the asthma, just sinus issues) but, find that mask fit is best with a chin strap and nose mask.

I've also asked my primary doc to prescribe an oxymeter in order to try to keep track of oxygen levels at different pressures. Don't know if my insurance will cover it yet, or if it will help, but I'm excited!
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Postby CrohnieToo » Tue Mar 02, 2010 6:37 pm

Janknitz, I have COPD. I nebulize w/albuterol every night before I go to bed.

Does your CPAP have EPR or C- or A-Flex? They can be turned down to up the expiration pressure and that might help.

Does your CPAP have Ramp? Most do now. Ramp time can be shortened or totally turned off. That would allow more pressure when you go to bed.

MellyBliss, insurance will not buy an oximeter. However, if your doctor scripts an overnight oximetry for one night now and then, insurance will almost always pay for that.

You can buy a Contec CMS 50D+ (has to be the Plus) recording wrist oximeter complete w/the software for around $150 or a bit less. The SPO 7500 wrist recording oximeter complete w/software costs a bit more than that but both are FDA approved. They are NOT professional grade but many apneans have bought them, use them and are pleased w/them.
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Postby Mrs Rip Van Winkle » Tue Mar 02, 2010 6:55 pm

Janknitz, I would ask the Dr. I too have COPD and use Albuterol..though my Dr told me to inform him if I need to use it more than 3 times a week. That he does nto want me using it more often than that. I did not question why so can not back up the reasons. Just in case though...speak to the Dr, he/she may not want you on it that often.

Tami
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Thanks!

Postby Janknitz » Tue Mar 02, 2010 8:20 pm

I had a mask fitting appointment and a meeting with the Pulmonary NP today. The RT who did the mask fitting thought that albuterol was a great idea, but the NP nixed it. She said that apnea is an UPPER airway issue and the albuterol won't do anything for it. I'm not sure I agree, but I'll try the new mask with out and give that a try without albuterol. I can experiment later if I'm still having issues.

I have a nasal mask to try but I have a lot of nasal congestion. I was just given a script for Singulair, which might help the nasal stuff if it's allergy related so that I can have more success with the nasal mask.

I was also given a chin strap today to try with the nasal mask--I'm not sure this particular one is going to keep my mouth closed in sleep though--Nelly, do you have a particular chin strap that works best for the receding chin? I would like to wear less mask, but if I get that sucking sensation from the nose mask it's going to make me crazy. How is it having all this stuff on your face and head on hot summer nights--I'm dreading that!

Crossing fingers that the new Quattro mask will work in the meantime. It's got lots of adjustable points, so I'm hoping . . .

Good news! I had 77 AHI events on pre-CPAP testing, but since Friday when I began using the CPAP only ONE event. So it does seem to be working. Based on the days I've used it so far, the RT narrowed the pressure range--so hopefully that will cut down on the blast attacks and I will feel like I have enough air at the beginning.
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Postby Nellybliss » Tue Mar 02, 2010 9:24 pm

Crohnietoo, huge thank you!
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Sorry, Chronie, I didn't answer your questions

Postby Janknitz » Tue Mar 02, 2010 9:43 pm

I am on a trial machine right now, so I don't know for sure what I'll get but I was led to believe I'd get the same. I'm a Kaiser patient, so I don't have much choice in machine since they are their own DME provider as well.

It's a Resperonics AFlex. Right now I'm in "Therapy" mode and not supposed to play around on my own, so I'm not using (as far as I know) the A-Flex Function. It does have a ramp button, but I get the feeling it's programmed to ramp right now no matter what, and I can't change the settings. But, the RT did narrow the range for me today, and she brought the bottom range to 7 and the high range down to 11 since I only went over it once in the days I've had the machine (I woke up at 13.9 one night, but the mask was leaking like crazy). It'll be checked again next week to make sure that setting is correct for me.

I can see that this machine will be a pain because it doesn't have much info for the patient other than compliance data and that's the part I already know. I understand (correct me if I'm wrong) that Encore 2 software isn't really obtainable at this point and not sure I could afford to buy it anyway. But I'm keeping a diary and will bug the heck out of the RT at Kaiser if I have questions or concerns about the therapy. I'm really good at that!
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Postby CrohnieToo » Tue Mar 02, 2010 9:53 pm

In my situation I'd rather use albuterol than Singulair. I don't like the steroid unless absolutely necessary as I have both glaucoma and osteoporosis. My albuterol for the nebulizer is the 0.042%. But even when I was on the 0.083% my scripted dosage was "Use via nebulizer 4 x daily". Mind you now, I have COPD, not asthma. My ProAir HC inhaler I can use up to 6 x daily. (Thank goodness have never needed to use either that often!).
ResScan 3.10 - Resmed S8 ResLink & oximeter
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Postby CrohnieToo » Wed Mar 03, 2010 1:31 pm

I would tend to rely on the RRT in this matter rather than an NP!!! And I wouldn't expect albuterol to improve CPAP function except that it DOES improve breathing and that in itself could POSSIBLY improve CPAP therapy by reducing the number of hypopneas. After all recognition of hypopneas means a certain % drop in 02 saturation for a specified period of time. But - I'm just a patient, a patient w/COPD, not asthma. Still I would lend more weight to a respiratory therapist's suggestion than a nurse practitioners when it comes to asthma and even CPAP therapy despite OSA is NOT a pulmonary problem.
ResScan 3.10 - Resmed S8 ResLink & oximeter
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Just wanted to report back

Postby Janknitz » Wed Mar 03, 2010 4:30 pm

I didn't sleep well last night, but I think it was just getting used to new things again.

Anyway, I think the Mirage Quattro mask is THE mask for me. It has that dial at the top that allows me to adjust the angle of the mask so it will seal against my receded chin, and that made all the difference. This mask really fit and leaks were minor. Furthermore, I could open and close my mouth and cough in it without losing the seal--with the F&P 432, I had to hold my mouth in a particular position to get any seal at all--that's really hard to do all night!

My one complaint with the MQ is that the stream of air is directed to my mouth or slightly below, not my nose. My mouth and throat got pretty dry (I don't have a humidifier on this machine because it's only a trial) and I felt like it took more effort than usual to breathe through my nose. Oh, and it's not as soft and cushiony as the F&P, but I'll live.

The adjusted pressures also seemed to help. I didn't use the albuterol but I don't think the pressures went to the highest setting--I'll have to wait until the data card is read next week to be sure. I'm fuzzy and exhausted today, but I think I only slept about 4 hours and I've been adding to my sleep debt all week (or maybe I uknowingly had some apneas and the pressure is set too low???). It sure would help a lot if that data was available for me to know.

For some reason every night with the CPAP I am waking about 3:30 but last night I couldn't go back to sleep and also woke at 1:30 for a while. I'm looking forward to sleeping (or at least perceiving that I'm sleeping) through the night again--this is kind of like having a new baby but without a cute little one to snuggle.
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Postby Mrs Rip Van Winkle » Wed Mar 03, 2010 4:46 pm

I would call the DME and tell them you need the humidifier...trial or not. If you are in the US, most likely this machine will be yours. They do not take it back and give you a new one.... unless they are using this only to titrate you. Asthmatics need humidified air. It is not much of an issue for them...the humidifier is just another part that attaches to the existing machine. If you do not have humidified air you could potentially be setting yourself up for adverse reactions to the therapy/trial. I am surprised they did not do it in the first place...it should be a 'no brainer' for them with an asthmatic patient.
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Postby CrohnieToo » Wed Mar 03, 2010 4:55 pm

Aw, come on, MrsRip!!!!! DME providers and a "no-brainer" in the same sentence?? They aren't even compatible! They are two different worlds. W/a very few exceptions, of course.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
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Postby Mrs Rip Van Winkle » Wed Mar 03, 2010 4:56 pm

Notice I said 'should' :-)
I'm only a sufferer, not a medical pro. What I post are my thoughts as a sufferer, not that of the ASAA. As a moderator on these forums I oversee the posting rules. This is the internet, always discuss what you read with your medical team.
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Postby Janknitz » Wed Mar 03, 2010 7:08 pm

Nope, actually, this machine belongs to Kaiser and will not be mine under any circumstances. It's just a loaner. They don't loan out the humidifier tanks because it's a pain to clean them on return.

They have a bunch of machines and when you have been diagnosed with SA they send you home with a trial machine so they can determine what the prescription and settings need to be. Once they determine your prescription, they arrange for you to get your own machine. The loaner goes back, gets cleaned, and sent out with the next group of individuals in the trial phase. They must diagnose about 30 people per week so these machines are well used. Fortunately, the machine I got for a trial is brand spanking new. I think it would bug me to know someone else had used it no matter how well they clean it.

The masks are samples marked "for short term use only" on the package. I was thinking that they clean them and reuse them (yuck!), but they don't (thank goodness!). They must have some sort of arrangement with manufacturers. When you return everything they throw away the used sample masks and include the mask on the rx for the DME provider.

I did find out that they do have a contracted DME provider after all, but you can't get any machine except the one Kaiser orders anyway. There is a single contracted DME provider for the entire Kaiser region, and you never see them personally. Kaiser does all the fitting and determinations, and you pick up your final machine at Kaiser after they set it up for you.

Kaiser will not pay unless the machine is exactly what is ordered because they want everyone standardized so they only need one type of software to read data, one type of machine to provide group education to patients, and to make standardized treatment recommendations. In terms of economy of scale it works for them, and probably most patients they see. If it doesn't work for an individual, it's really tough to fight Kaiser to get what you need. Most people give up.

I don't think Kaiser can argue if you buy and use your own machine (and I don't think they can withhold a prescription), but that's certainly not an affordable option for me right now. I think I'll be fine with the Respironics machine they use, but it does bug me not to have access to useful data so that I can be an active partner in my treatment. I'm not someone who can be happy being a sheep.
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Postby jrinker » Wed Mar 03, 2010 7:56 pm

They won't give you a humidifier during the trial because "it's a pain to clean on return"? Seriously? A humidifier is absolutely necessary for most people, a basic comfort item which helps tremendously in the adaptation process. Can you call your doctor and make a lot of noise and insist that you need one?

Sure glad I'm not dealing with Kaiser. #-o
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