ASV for UARS Help with Settings Question

[2Tired4This]

feel like sleep is improving and waking less now

[palerider]

feel like sleep is improving and waking less now

excellent.

[2Tired4This]

What is the best way to get professional PAP therapy guidance? I have insurance and ideally would like a titration study and more importantly someone to monitor my data for awhile to make any needed adjustments or coaching. I dont know where to go. Any suggestions would be appreciated. Im in southern california. Thanks

[2Tired4This]

I adjusted my open settings to ASV Auto EPAP 5-6, IPAP max to 11.
Any advice on settings? Should I have a bigger range for EPAP?

Good news is I have my mask leak under control, am making it through the night easily with the machine, with low AHI....
but am wondering if the UARS is still causing problems because the flow limitations seem active on my sleepyhead chart.

Again im feeling like im getting improved sleep but still not great. Just want to make sure I optimize my PAP treatment before moving on to other possible solutions.

[Pugsy]

There comes a point where the data available from the machine isn't much help in figuring out what other potential settings might be tried to offer different results. You have reached that point...on paper things look really good.

The flow limitation graph looking rather "active" is most likely not really from flow limitations.
I noticed this myself with my S9 Adapt 36037 in auto mode....that flow limitation graph is pretty ugly in auto mode and is real boring in regular mode. Others have reported this also. I have never had an issue with flow limitations no matter what brand or model machine I have used but with the 36037 in auto mode...it's plain ugly and I know that it really isn't ugly. So I tend to shrug off FL graphs on the 36037 model when in auto mode.

With your EPAP settings and the max IPAP set to 11 and PS max at 5...the machine doesn't really have all that much room to roam around...not that there is evidence that it needs more room.
UARS is difficult to evaluate because the machines really don't flag enough stuff that totally relates to UARS in an easy to see manner and the AHI is totally useless since your AHI is probably already low anyway.
So that leaves going by just how you feel for evaluation and subjective feelings are hard to quantify. We tend to want to fall back on numbers for a guideline but UARS people can't rely on the normal numbers that OSA people rely on for evaluation.

I don't know what to offer in this situation except that I am not so sure that the FL graph means anything at all.
I would want to see the FL graph in non Auto mode first.
I don't know that changing the changing the settings so that the machine has more room to vary the pressures will help or not. In my mind though...if I were in the same situation then I would probably want to at least try something and see if it helped or not. Maybe not tie its little hands so much with the restrictive settings.
Give it a little more room to roam around with EPAP (I have read that UARS people tend to need more pressure EPAP to feel better past what the data on the report shows)...and maybe allow IPAP to move up a little if it senses anything it feels more IPAP is needed to address.

Maybe try non auto EPAP mode...and set it to maybe 6 and leave PS at 0 to 5 range and move IPAP max to maybe 14 or so. It's a guess...there's no need for these changes.
I personally like PS minimum around 3 or 4...and don't care for PS of 0...so that's an option.
In non auto EPAP mode you would get a more realistic FL graph though.

Give me a little bit and I will try to find a FL graph in non auto mode and auto EPAP mode. My first S9 Adapt didn't offer auto EPAP so that's how I know that my past FL graphs didn't show much activity at all and now that I am using auto EPAP mode with this new machine...that I see ugly FL graphs.
I never had ugly FLs with my S9 VAuto or my various Respironics machines.
Since UARs is more flow limitation...I think I would want to see what the FL graph looks like in the other mode though...just to make sure.
If it's ugly in non auto mode...then more EPAP is the way to go.

[2Tired4This]

Thanks Pugsy! That is good to know about the FL graphs. I looked at the times I was trying straight CPAP pressures and it is negligible.

And I will play around with the higher EPAP. I did not know that might be helpful for UARS.

[palerider]

I second what Pugsy says about the flow limitations on the 36037 machines, I think every one I've seen has those wild FL charts... maybe it's a sleepyhead bug, I'll have to compare a SH chart against one from resscan...

[2Tired4This]

Thx palerider.

Another question on ASV settings for UARS.
I thought I read some people recommending keeping ranges tighter so there isnt as much jumping around by the machine.
I have a min EPAP 6, max EPAP 8. What is a suggested PS. what is too much?
I know everyone is different but general guideline suggestions would be appreciated. Thanks

[palerider]

Thx palerider.

Another question on ASV settings for UARS.
I thought I read some people recommending keeping ranges tighter so there isnt as much jumping around by the machine.
I have a min EPAP 6, max EPAP 8. What is a suggested PS. what is too much?
I know everyone is different but general guideline suggestions would be appreciated. Thanks

the whole point of an ASV is jumping around... that's what they're built for... now, the EPAP, basically, just set that to what takes care of the majority of your obstructives, if you have any, and watch the data, and if the machine wants to go higher sometimes to keep down obstructives, you might want to let it do so.