VS2 increasing when I switch from auto to fixed bipap (UARS)

[gobucks]

Hey Everyone,

I was wondering why my VS2 increases so much when I switch from my auto bipap settings to fixed settings with a slightly higher pressure.

Also, I was wondering how important VS2 is and whether I should put any focus on it. The change is very distinct. from near 0 to a vs2 index of like 14.

https://imgur.com/a/QKguNU1


Also if you guys have any tips for self titrating for UARS that would be great. I have been denied a titration study and I am going to have to beg and find another doctor to get one done. Im trying to feel better in the mean time.

I should add that I am still trying to get a titration study because I still feel like crap and dont get any sort of refreshing sleep still.

Thanks so much.

[jimbud]

Re: Seeing a lot of VS2 events the past 2 or 3 days
Post by robysue » Fri Apr 10, 2015 10:11 am

The difference between VS and VS2 snores on the PR machines is NOT well understood because PR has NOT made information about how these two events are scored.

What we DO know:

1) PR machine record only VS2 snores if they are run in fixed pressure mode. They record both the VS2 and VS snores only if when run in Auto mode.

2) Encore Daily Data Reports show the VS2 information ONLY. And Encore's VSI is NOT (number of VS events)/(run time). The VS data only shows up if you look at the wave flow (flow rate data) in Encore, and that's not part of the standard report.

3) The VS snores are used to (aggressively) increase the pressure setting when the machine is set in Auto mode.

4) The VS snores have no number attached to them in the raw data the way the apneas, hypopneas, flow limitations, etc. have. The VS2 snores do have a number attached to them, but what that number actually means has not been established.

5) There was some speculation earlier this year (see Re: Sleepyhead Question about Snoring) that the number associated with each VS2 event is the number of snores in the last two minutes of breathing. This hypothesis is based on the fact that when you have a whole string of VS2 snores, they're tagged in two minute intervals AND the numbers attached to them are always reasonable if thought of as "number of breaths in a two minute window that are associated with snoring." This hypothesis also "fits" with the way that Encore does compute the VSI in its Daily Detailed Data Reports: Encore sums up all of the VS2 numbers for the night and divides that sum by the run time. If the VS2 numbers do indeed represent the number of snores in the preceding two minutes, then the sum of those numbers would be the total snores for the night, and the Encore VSI index would then be the average number of snores per hour of run time.

The upshot of all this is: PR regards the VS2 snore data as important as, and perhaps more important than, the VS data since their machines always record VS2 data. So seeing a lot of VS2 snores probably does indicate that you are doing some real snoring. The VS2 data has nothing directly to do with mouth breathing or leaks: It is possible to snore with your mouth closed (I do it a lot myself).

If you are using a PR machine in auto mode AND you have a lot of VS2 snores without VS snores also being flagged, that may mean that your snoring is NOT accompanied by the subtle flow limitations that indicate the airway is compromised. In other words, if nasal congestion leads to nasal snoring, it's possible that the airway itself is not being affected and perhaps the PR machines use this distinction when deciding whether to increase the pressure in the presence of snoring.

Finally, the usual suggestion from a sleep doctor (or their PA or nurse) about what to do if you're seeing a lot of snoring (of any kind) is to increase the pressure slightly. Your own snores can be disruptive of your sleep even if you're not waking up because of them.

[gobucks]

Re: Seeing a lot of VS2 events the past 2 or 3 days
Post by robysue » Fri Apr 10, 2015 10:11 am

The difference between VS and VS2 snores on the PR machines is NOT well understood because PR has NOT made information about how these two events are scored.

What we DO know:

1) PR machine record only VS2 snores if they are run in fixed pressure mode. They record both the VS2 and VS snores only if when run in Auto mode.

2) Encore Daily Data Reports show the VS2 information ONLY. And Encore's VSI is NOT (number of VS events)/(run time). The VS data only shows up if you look at the wave flow (flow rate data) in Encore, and that's not part of the standard report.

3) The VS snores are used to (aggressively) increase the pressure setting when the machine is set in Auto mode.

4) The VS snores have no number attached to them in the raw data the way the apneas, hypopneas, flow limitations, etc. have. The VS2 snores do have a number attached to them, but what that number actually means has not been established.

5) There was some speculation earlier this year (see Re: Sleepyhead Question about Snoring) that the number associated with each VS2 event is the number of snores in the last two minutes of breathing. This hypothesis is based on the fact that when you have a whole string of VS2 snores, they're tagged in two minute intervals AND the numbers attached to them are always reasonable if thought of as "number of breaths in a two minute window that are associated with snoring." This hypothesis also "fits" with the way that Encore does compute the VSI in its Daily Detailed Data Reports: Encore sums up all of the VS2 numbers for the night and divides that sum by the run time. If the VS2 numbers do indeed represent the number of snores in the preceding two minutes, then the sum of those numbers would be the total snores for the night, and the Encore VSI index would then be the average number of snores per hour of run time.

The upshot of all this is: PR regards the VS2 snore data as important as, and perhaps more important than, the VS data since their machines always record VS2 data. So seeing a lot of VS2 snores probably does indicate that you are doing some real snoring. The VS2 data has nothing directly to do with mouth breathing or leaks: It is possible to snore with your mouth closed (I do it a lot myself).

If you are using a PR machine in auto mode AND you have a lot of VS2 snores without VS snores also being flagged, that may mean that your snoring is NOT accompanied by the subtle flow limitations that indicate the airway is compromised. In other words, if nasal congestion leads to nasal snoring, it's possible that the airway itself is not being affected and perhaps the PR machines use this distinction when deciding whether to increase the pressure in the presence of snoring.

Finally, the usual suggestion from a sleep doctor (or their PA or nurse) about what to do if you're seeing a lot of snoring (of any kind) is to increase the pressure slightly. Your own snores can be disruptive of your sleep even if you're not waking up because of them.

Maybe I should have clarified, I am not getting lots of snores in auto but I am getting a ton in fixed pressure mode with a slightly higher pressure.

Ive heard increasing the pressure is the answer too but it seemed odd that my snores increased drastically as I increased the pressure?

[chunkyfrog]

A possible reason behind Respironics' unwillingness to provide more information
about this reading may be because it is not always reliable.
---Covering their butt because even they are not sure how good it is.
Just my worthless opinion . . .

[gobucks]

A possible reason behind Respironics' unwillingness to provide more information
about this reading may be because it is not always reliable.
---Covering their butt because even they are not sure how good it is.
Just my worthless opinion . . .

So my best bet is to just ignore it then? Or maybe just not put very much weight in it at all?

[chunkyfrog]

Just my opinion, but if the doctor doesn't get excited, probably not worth a pickle.