Flow Limitation and UARS?

[jwuzy]

Hi guys,

I was diagnosed with UARS a couple years ago and did a study recently with a different doctor and was determined no apnea (hooray!).

But I'm still waking up anywhere from 6-9 times a night. I've used Sleepyhead and I've got quite a bit of events of Flow Limitation. Is this a sign something's going on still? Anyway to improve this. I'm so tired all the time.

Here's yesterday's data, I used the APAP for about 4 hours then took it off.

http://imgur.com/242tfKp

Thanks for any advice!

[tan]

You hit your max pressure all the time. I think it should be increased

[Pugsy]

UARS is hard to evaluate with software.
You have to go mainly on how you feel because there's likely more flow limitations going on than what gets flagged by the machine.
Remember the FLs have to be so long in duration and a certain % of reduction in air flow to get a flag and there's likely more happening that didn't make criteria.

The one's you see flagged are probably the tip of the iceberg when it comes to UARS.
From what I have read UARS patients often have to use more pressure to better hold the airway open than is needed for regular OSA control.
So you have to go by how you feel more than what you see as adequate therapy for OSA on these reports.
Makes it tough because there are also other things that cause us to wake up that are unrelated to UARS or OSA.
Rule out the other potential culprits just to make sure..meds, insomnia, general health issues, mask comfort, bed comfort, etc and maybe try more pressure.
In case you are sensitive to pressure changes maybe set minimum to equal maximum with your machine so you don't lose the FL flags (that feature to flag them is turned off in cpap mode).
From what I have read it seems like UARS people tend to be on the sensitive side anyway...wouldn't hurt to try.
Your pressure isn't moving around much now but maybe it would help.

Looks like you are using low pressures with a tight range...4 to 6 maybe? I see the pressure line flat lining at 6..is that because it can't go any higher or it just didn't?
If so you might open the range up to see where it wants to go because if you look at the flat line times...that's also when you have some FL flagged and flow limitations is something the APAP will try to prevent with more pressure.

If me...I would increase the minimum a little and also open the max up a little and find out where it wants to go and then maybe pick a compromise and do minimum to equal maximum to eliminate the chance that the changing pressures are also a factor in the poor sleep quality.

[tan]

Looks like you are using low pressures with a tight range...4 to 6 maybe? I see the pressure line flat lining at 6..is that because it can't go any higher or it just didn't?

That is his pre-set (RX) pressure (see on the left side of the picture third line after the big "AHI 0.23" with orange font background), which does not make much sense to me.

[Pugsy]

That is his pre-set (RX) pressure (see on the left side of the picture third line after the big "AHI 0.23" with orange font background), which does not make much sense to me.

I don't have my glasses handy and couldn't quite make out the statistics settings.

It might make sense if someone was having aerophagia issues if the pressure went higher but that would be the only reason I could think of for such a tiny low range. And I do know people who get bad aerophagia at the lower pressures...doesn't have to be all that high to cause problems.

[tan]

I could think of for such a tiny low range. And I do know people who get bad aerophagia at the lower pressures...doesn't have to be all that high to cause problems.

may be so (aerophagia), or very likely whoever prescribed the setting just decided that keeping AHI that low is sufficient. But to overcome flow limitations higher pressures are needed, right? which means that CPAP at currently set pressure won't be efficient, regardless of aerophagia. I would set the upper limit to 20 (temporarily), just to see how high it can go.

[Pugsy]

may be so (aerophagia), or very likely whoever prescribed the setting just decided that keeping AHI that low is sufficient. But to overcome flow limitations higher pressures are needed, right? which means that CPAP at currently set pressure won't be efficient, regardless of aerophagia. I would set the upper limit to 20 (temporarily), just to see how high it can go.

Yes, most likely more pressure is needed to prevent Flow Limitations...how much more is anyone's guess but if we were dealing with plain OSA I suspect only a little more pressure is needed.

But UARS doesn't seem to follow the normal guidelines so all bets are off.
Normally I am all for wide open APAP as long as pressure changes don't bug a person but given what I have read about UARS I would actually lean towards a tight range for people with UARS or those who might be sensitive to pressure changes.

I really need more information here...I don't know what mask is being used.
Is it a full face or nasal?
Would the FLs be better addressed with simply a little more minimum to prevent them in the first place?
There's obviously plenty of room to do either...open up the max or just simply add more minimum and I am wondering if more minimum might benefit a person with UARS better than more maximum would.
Better prevent the collapse in the first place type of thing so not as much need to fix it after it happened.

[tan]

Would the FLs be better addressed with simply a little more minimum to prevent them in the first place?
There's obviously plenty of room to do either...open up the max or just simply add more minimum and I am wondering if more minimum might benefit a person with UARS better than more maximum would.
Better prevent the collapse in the first place type of thing so not as much need to fix it after it happened.

I wonder whether the "aerophagia" issue is trainable... I certainly have it at 9cm, maybe just adding little by little every day can do the trick??

I am fairly certain that limiting the max pressure at 6 is a mistake in this particular case.

[musculus]

UARS is hard to evaluate with software.
You have to go mainly on how you feel because there's likely more flow limitations going on than what gets flagged by the machine.
Remember the FLs have to be so long in duration and a certain % of reduction in air flow to get a flag and there's likely more happening that didn't make criteria.

The one's you see flagged are probably the tip of the iceberg when it comes to UARS.
From what I have read UARS patients often have to use more pressure to better hold the airway open than is needed for regular OSA control.
So you have to go by how you feel more than what you see as adequate therapy for OSA on these reports.
Makes it tough because there are also other things that cause us to wake up that are unrelated to UARS or OSA.
Rule out the other potential culprits just to make sure..meds, insomnia, general health issues, mask comfort, bed comfort, etc and maybe try more pressure.
In case you are sensitive to pressure changes maybe set minimum to equal maximum with your machine so you don't lose the FL flags (that feature to flag them is turned off in cpap mode).
From what I have read it seems like UARS people tend to be on the sensitive side anyway...wouldn't hurt to try.
Your pressure isn't moving around much now but maybe it would help.

Looks like you are using low pressures with a tight range...4 to 6 maybe? I see the pressure line flat lining at 6..is that because it can't go any higher or it just didn't?
If so you might open the range up to see where it wants to go because if you look at the flat line times...that's also when you have some FL flagged and flow limitations is something the APAP will try to prevent with more pressure.

If me...I would increase the minimum a little and also open the max up a little and find out where it wants to go and then maybe pick a compromise and do minimum to equal maximum to eliminate the chance that the changing pressures are also a factor in the poor sleep quality.

I have UARS and I totally agree with the above. Most of the UARS airway events are hidden (since UARS patients react much faster to airway resistance) from machine's detection algorithm and you only see the tip of iceberg.

I suggest gradually raise pressure and pay more attention to the resp rate, tidal volume, inspiration time reports (the smoother the better), and most importantly, the sleep quality. AHI is useless for us.

[tan]

I have UARS and I totally agree with the above. Most of the UARS airway events are hidden (since UARS patients react much faster to airway resistance) from machine's detection algorithm and you only see the tip of iceberg.

I suggest gradually raise pressure and pay more attention to the resp rate, tidal volume, inspiration time reports (the smoother the better), and most importantly, the sleep quality. AHI is useless for us.

can you please share your story and how successful you have been in overcoming your UARS? A few people here, including me, are dying to know

[Day_Dreamer]

Tan,

some interesting stuff here

wiki/index.php/Upper_Airway_Resistance_Syndrome

[tan]

Tan,

some interesting stuff here

wiki/index.php/Upper_Airway_Resistance_Syndrome

I have read that article too many times already

[Day_Dreamer]

There is a member that went to him for URAS but I do not think he has gotten any relief....

[palerider]

There is a member that went to him for URAS but I do not think he has gotten any relief....

he had his wallet relieved of quite a load of heavy cash.

[Day_Dreamer]

There is a member that went to him for URAS but I do not think he has gotten any relief....

he had his wallet relieved of quite a load of heavy cash.

yeah... some people suffer so much they'll try just about anything to get some rest.

I guess BIPAP for URAS's is not approved by insurances.....