Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

[Egg Yolkeo]

is that due to his scoliosis combined with a kyphosis and associated poor neck posture and hunched over shoulders, his lung capacity/function is posturally limited in some way.

You could chase some expensive, complicated, time-consuming geese. When faced with these types of situations, it's best to first try some cheap, simple, quick, solutions.

I offer this possible solution with the consideration that the condition of his spine will allow him to try it.

When the head drops from normal posture so that it is tilted downward toward the chest, the airway tends to be crimped and is more subject to collapse and flow limitations. Many of us, without spinal or posture issues, wear foam cervical collars for use with CPAP. Foam cervical collars keep the head/chin up in a healthy position. Personally, I have been wearing one every night since starting CPAP. The results for me are amazingly good. A trial is inexpensive and quick.

Thanks ChicagoGranny. Your solution is a good one, in fact I had come across it on this forum before I started posting here and bought one for my Dad as his chin does drop down. I am very sure he does have have a crimped airway as due to the forward head posture his neck posure phsycally has a kink to it. In more recent times as his posture has woresened further, he does occasionally choke on food or drink and I believe that is anatomic misalignment thats going on in his neck. I suspect that may possibly be the cause of the flow limiations?

The collar did seem to improve his CPAP figures and he uses that every night.

[Egg Yolkeo]

In the U.S., I would recommend that the expert eyes of an experienced Registered Respiratory Therapist be involved in (1) estimating possible benefits and (2) customizing the settings for the distance between IPAP and EPAP and the other settings. That level of help isn't always easy to get in any country, though. I am aware of only one set of eyes on this board that may have special insights on that deeper level.

Considering Egg Yokel's predicament - NHS and all - has this "one set of eyes on this board" weighed in on this thread?
If not, can you contact the "one eyes" as ask him for help for Egg and his Dad?

Thanks for your(and eveyone else on here) support and suggestion of other members expertise, this forum has some really great helpful people here.

[Egg Yolkeo]

If Egg's Dad's kyphosis is anything like my father in law's, cervical collars will not prevent his chest cavity from being compressed, even if his chin is tilted upwards as much as possible.
kyphosis.jpg

Hi Max46,

My father has a combination of scoliosis and kyphosis. The kyphosis is similar to the image you show. He has really poor neck posture similar to the 3rd image on the right of the second picture below with the green marking in the throat area. I would say its probably slightly worse than the image in that his neck kind of goes forward, then has a prounounced bend and then up almost as if it has a kink in it due to him trying to elevate his head to compensate.

The collar didnt help with his breathing wave form which as you point out is likely due to a compressed chest, but it helps keep his mouth closed when using his face mask and seems to help reduce AHI and mask leaks.

[Egg Yolkeo]

If Egg's Dad's kyphosis is anything like my father in law's, cervical collars will not prevent his chest cavity from being compressed, even if his chin is tilted upwards as much as possible.

As far as I know, cervical collars do not prevent compression of the chest cavity. As previously stated, they can keep the head/chin from dropping toward the chest. This dropping tends to crimp and compromise the part of the airway that is in the throat. This part of the airway is where the most common problems are in OSA.

In the illustration you provided,
it appears to me that the chin could drop toward the chest, and that a cervical collar could prevent this.

But, this would be something Egg Yolkeo could easily check with a trial.

Agree with your comments, when he sleeps on his side, his head does tend to drop down towards his chest. His jaw has a tendency to "hang" partially open even if his lips are closed during the day, and when he sleeps his jaw always drops open. The collar definately helps keep his mouth closed and minimise his mask leaks so it is helping mitigate the neck aspect of his issues.

There is one strange issue I am still trying to figure out, in that whenever he gets up in the night to go to the toilet, without fail when he goes back to sleep he will get a load of flow limitations and his machine will go to max pressure. I thought it might be positional apnea related as thats was his report said, when he first goes to bed he says he lays on his back, and usually when he wakes up in the night he goes back to sleep on his side, but I asked him to try going to sleep on his back yet the same issue occurs regardless. Strangely his sleep report said his positional apnea is on his back and not on his side, yet his first bout of sleep on his back is always his best and he always has more issues in the second half of his sleep. i guess that might be because the sleep test is done without the cpap machine and once he has the machine in use it may be more effective when he is on his back. Ive attached a screenshot of what would be a good night sleep for him, with the spike starting around 2:50

[Egg Yolkeo]

I’d agree. If throat compression by dropping the chin, is the principle problem. But as I said, my FIL’s issue was that the kyphosis compressed his chest cavity and made inspiration very halting (as Egg had previously described for his Dad). My FIL described inhalation as taking a lot of effort and occasionally painful. The OP’s flow charts looked much like my FIL. Spikey and halting, incomplete inspiration.
Interestingly, the FIL said that lying down, and being on his back made breathing less of an effort.

The description you write does sound similar. My father has no pain when breathing and when he is at rest he is completely oblivious to his own issue or shallow breathing. For whatever reason, unlike what I have read for other people his scoliosis has not resulted in any kind of pain or discomfort through his life. He has always been someone quite fit and healthy for most of his life, never visited a doctor until he was about 69 and then kind of had an avalanche of issues all descend on him at the same time. I suspect sleep apnea has been at the core of all his issues but didnt manifest itself fully until later when his scoliosis and posture significantly declined in more recent years.

I can believe that your FIL found breathing on his back less of an effort, it makes sense, as the forward head posture from kyphosis amplifies the weight of the head signifcantly and as I understand its then compressing down on the chest when you are in a standing position or seated position. Laying down must relieve some of that pressure.

https://physiofalmouthplus.co.uk/42-pound-head/

I notice that when he is laying down and using his CPAP machine, the expansion and contraction of the chest is far more pronounced than when he is sitting. His lungs are filling much more, with the halting slightly present, but much less so than when his is sitting.

I think in my fathers case its a combination of throat compression and compressed chest cavity thats causing his issues.

[Egg Yolkeo]

I'm sure Gran didn't mean anything by it.

Gran seems to recommend the collar to everyone--dead, alive, unborn, nonhuman, other dimensions, etc. I think she must have stock in the company, or something.

(Nothing untoward meant by the winking emoji.)

This post is mostly meant to serve as a bump of the thread to the top.

Thanks Lazarus, just added a few bumps of my own

[Rubicon]

can you contact the "one eyes"

I assume he'll see the thread when he ain't fishing and then decide for himself whether to wade/weigh in.

I seen it.

But since o. told you everything you needed to know, and given the health system there's probably nothing that can be done, didn't see much point in adding (or subtracting) anything.

That said, I suppose I'm stuck now.

See history:

...when breating in the daytime normally, during the inhalation phase its almost like he inhales in small steps.

I notice that when he is laying down and using his CPAP machine, the expansion and contraction of the chest is far more pronounced than when he is sitting. His lungs are filling much more, with the halting slightly present, but much less so than when his is sitting.

Since this apparently not only happens all the time, but is in fact worse during sitting and wake, go get a bronchoscopy. You'll find out everything you need to know in about 30 seconds.

[Rubicon]

Meanwhile, for discussion purposes, try to identify precisely when this breathing difficulty started and if there is any flow data prior to that.

For example, if it started after surgery, could be a vocal cord paralysis or tracheo/laryngomalacia deal.

While those waveforms look like severe palatal interference, if an ENT already looked (albeit 4 years ago) perhaps not.

Yet that would be assuming, and you know what happens when you do that.

[Egg Yolkeo]

Meanwhile, for discussion purposes, try to identify precisely when this breathing difficulty started and if there is any flow data prior to that.

For example, if it started after surgery, could be a vocal cord paralysis or tracheo/laryngomalacia deal.

While those waveforms look like severe palatal interference, if an ENT already looked (albeit 4 years ago) perhaps not.

Yet that would be assuming, and you know what happens when you do that.

Thanks for your reply Rubicon, I think the issue is worse when sitting or standing is because of gravity. He has the "42 pound head syndrome" which is applying pressure down onto his chest cavity and lungs. Laying on his back eliminates that.

When the ENT was looking him, I will add the caveat, that at the time they were trying to understand why he had a cough for so long, which was actually the beginning of his heart problems. How thorough they checked his throat/palate I dont know, but they did check him with an endoscope.

I gave him one of those incentive spirometer tests and on first use he was able to get into a normal range for his age and over time he was able to improve his performance further. The surgery he had required "good enough" lung capacity which again he passed the test for.

Anyway, everything I have written is just my theories on the cause and I am far from knowledgable on this subject. I am interested to hear your thoughts in regards to the severe palatal interference you mentioned? Does this mean an issue caused by the tongue, uvula or tonsils, would it be a case of soft tissue or tongue flapping about during the inhalation and exhalations?

[ChicagoGranny]

Maybe you should do a quick, easy trial to see if a cervical collar helps your FIL.

A laugh emogie?
My FIL died three years ago.

Sorry, but you spoke of your FIL in the present tense.

If Egg's Dad's kyphosis is anything like my father in law's

[Rubicon]

... identify precisely when this breathing difficulty started and if there is any flow data prior to that.

Also, add any/all information about this cough thing.

[Rubicon]

When the ENT was looking him, I will add the caveat, that at the time they were trying to understand why he had a cough for so long, which was actually the beginning of his heart problems. How thorough they checked his throat/palate I dont know, but they did check him with an endoscope.

Great, get that report.

[Egg Yolkeo]

... identify precisely when this breathing difficulty started and if there is any flow data prior to that.

Also, add any/all information about this cough thing.

I will look for the actual ENT letter but in the meatime to elaborate and provide a bit more detail:

Despite his scoliosis, my father has not had any health problems, never visited a doctor or hospital in his life until he was a pensioner. Despite having some restricted mobilily he never had any pain or issues with his scoliosis and could play sports without breathing issues.

About 4 years ago maybe a bit longer, he developed a persistent cough. After a period of ignorning it and trying a few things like cough medicines he was referred to an ENT. Tthe ENT examined him with an endoscope and said he was fine from his perspective so the issue must lay elsewhere. He ended up being seen by another doctor who thought it could be a heart issue and was referrted to a cardiologist who organised echo's and so forth and it was identified that he had moderate mitral valve regurgitation which was causing the cough due to blood flowing backwards into the lungs. The cardiologist suggested that he undergoes watchful waiting and leave things as they are.

I ended up doing a deep dive on the subject and read that mitral valve issues never improve and only get worse. In the following months I could see his phsysical capacity was rapidly declining and his cough getting worse. It was around this time I also observed a few occasions where he would fall asleep on the sofa and stop breathing briefly. This was something new to me. I asked my mum about it and she said she also thought she had seen him do something similar in the night. After reading up I realised this was sleep apnea at which point I got the cpap treatment organised. Due to lack of response from the NHS and a rapid decline on his side, I ended up getting a further echocardiogram done privately which confirmed he had gone from moderate to torrential regurgitation, which is the worst kind and needs surgical treatment asap.
I will cut the long and difficult story of getting medical investigations and surgery during the peak of Covid times, but to summarise he got surgery and it was performed successfully. It was down to the wire and in the week or so he could barely move and had developed Cheynes Stokes Respiration (this did not look the same as his "usual" shallow breathing that I refer to in my original post) and was categorised as having heart failure.
To aummarise the cough was due to his heart problem and stopped following his surgery.

He had had a number of echos and checks since and he was given the all clear and no need for further checkups, in terms of rhythm, structure, ejection fraction it all falls within normal parameters now. He checks his heart rate, blood pressure and spo2 every day and they are also all normal. AHI's are below 5 and often below 2. His physical performanece levels slowly returned post surgery and now he routinely plays gold and does 10-15k steps a day without issues. For things like walking up steep hills, I have seen him puffing and struggling a bit, but I think thats just natural age related decline in performance.

Outside of this breathing issue, he doesnt have any other "known" health issues. General bloodwork is good, doesnt smoke and stopped drinking alcohol post surgery. He was not a big drinker but even a beer makes his sleep apneas much worse on the night he drinks.

[Rubicon]

After reading up I realised this was sleep apnea at which point I got the cpap treatment organised.

Do you have the data from the start of CPAP?

Can you load data to SleepHQ?

Specifically, the nighttime breathing is a mess, but those are only snippets (the rest of the night is probably like that but I'm from Missouri).

While that looks like soft palate interference to me, since you had an ENT consult, they would have seen palate problems (or for that matter other airway problems) and would have noted that in their report.

Most important, sleep apnea problems occur when one is asleep. Airway issues during the day are an entirely different matter and must be analyzed by a pulmonologist or ENT guy.

My point in establishing a timeline is that this mess could be a complication of surgery, especially if he was intubated.

If that breathing pattern was present before surgery, then you wonder about the ENT competence.

The 90 Pound Head is an amusing cartoon and looks like it could generate a lot of chiropractic business.

[dataq1]

Quick question:
Was your Dad’s heart valve surgery done by open heart or trans catheter?