APAP experiment without official OSA/UARS

[Geer1]

Yes you have to be careful using 95th percentile for analysis.

Simplest way to explain it in this application is that your worst flow limitation is going to occur during specific periods, either when your pressure is too low or possibly related to sleep stage or position and if you only look at the 95th percentile then you are only looking at those bad times and not the big picture. The only way to see the big picture is to look at the graph.

In your specific case your flow limitation has been its worst when the machine hits your max pressure (either sleep stage or position is causing flow limitation during those periods). If you increased max pressure then these would decrease.

Half of your obstructive apneas happen when pressure is near minimum.

Raising EPAP minimum to 6 should help get rid of the obstructive apneas. Raising IPAP should help with flow limitations, you can let it run wild like palerider recommended or increase it in steps (if your pressure is maxing out especially for any significant amount of time increase it). Increasing PS to 4 may make it more comfortable to exhale at higher pressures, leaving PS at 3 will result in a lower max pressure if that does in fact bother you although as stated it may not be the high pressure that is the issue.

[slowriter]

If it were me and I had UARS going on I would be learning how to spot arousal breathing and counting that arousal breathing manually to best judge my overall sleep quality. I wouldn't be counting FLs or really even bothering to look at them.
For it to be UARS it has to have an arousal associated with it....and then there's the whole idea of spontaneous arousals mucking up the waters. CPAP won't do anything for spontaneous arousals.

Yes, I agree.

But I don't think they're mutually exclusive: keep a general eye on the FL info to figure out how to get yourself pointed in the right direction, and more detailed analysis for fine-tuning.

[Pugsy]

Yes, I agree.

But I don't think they're mutually exclusive: keep a general eye on the FL info to figure out how to get yourself pointed in the right direction, and more detailed analysis for fine-tuning.

I think the arousals are more important because they reflect actual sleep quality with or without accompanying FL data that is or isn't exciting.
I rarely ever have any FLs worth looking at but I get a ton of arousal breathing on a bad night and on a good night still more than I really want.

[slowriter]

Yes, I agree.

But I don't think they're mutually exclusive: keep a general eye on the FL info to figure out how to get yourself pointed in the right direction, and more detailed analysis for fine-tuning.

I think the arousals are more important because they reflect actual sleep quality with or without accompanying FL data that is or isn't exciting.

Sure. You can't have a RERA without the A part of that acronym.

But you also can't have one without the RER part.

I was just assuming that, at a general level, less FL (cleaner graph, and lower 95% and max numbers) would tend to correlate to less RE, and so less RERAs, in people who are prone to RERAs.

I rarely ever have any FLs worth looking at but I get a ton of arousal breathing on a bad night and on a good night still more than I really want.

That's interesting. Those arousals are breathing-induced, but without any flagging from the machine of FL preceding them?

If so, perhaps it's one of those things that does indeed vary by individual.

[Pugsy]

That's interesting. Those arousals are breathing-induced, but without any flagging from the machine of FL preceding them?

My point is that not all arousals are breathing induced. There are other reasons for arousals than just some sort of airway issue.
Often people want to blame all bad sleep on the airway problem but in truth there's a very long list of potential causes for arousals.
CPAP can only maybe fix arousals related to airway issues. Can't do a damn thing if the arousal is caused by something else.

UARS people tend to be sort of hypersensitive to a lot of things in general. It's their nature. There's nothing stopping them from having an arousal simply related to something else that they are sensitive to. UARS is more complicated and we are only recently seeing the medical profession really start to address the UARS situation. It's really in its infancy in terms of understanding and treatment.
I really wish that just evaluation the FLs was enough and in the future it could very well be a better guideline but right now the machine is flagging an FL based on OSA criteria and not necessarily some other criteria which might be better suited for UARS patients.

I just don't like putting all my UARS eggs in the FL basket and the FL basket was made to hold OSA eggs.
FLs can also simply be some sort of nasal congestion going on...the machine doesn't know what or where the flow reduction is.

We tend to use the FL data because that's really all we have that maybe will maybe help us because people really need to have something to see that they can lay their eyes on to evaluate. They need a numerical value so they have some sort of marker to point them in any direction. It's the nature of people. I understand that.
I just hate to see people put all their eggs in one basket especially when that basket isn't necessarily the best basket to hold them and they end up here with very clean reports and still sleeping like crap and feeling like crap.

[rosie1231]

Hi again all,

Another question: what does a double peaked exhale portion of the flow curve indicate? I attached an example of what I'm talking about with weird exhales circled.

I also wanted to share that on Saturday night my power went out right before bedtime and stayed off for 12 hours, so I slept without PAP for the first time since I started in early November. I woke up with a headache and feeling awful, like I had stuck my finger in an electric socket (or at least the way I imagine minor electrocution would feel). Since I've been sleeping well lately, I thought one night without PAP wouldn't be a big deal (especially since I don't technically have UARS or OSA) but I was shocked at how bad I felt the entire next day.

[slowriter]

Maybe this?

viewtopic.php?f=1&t=177820&p=1335547#p1335527

On another note, what PS are you using? Have you tried raising it?

[palerider]

I woke up with a headache and feeling awful, like I had stuck my finger in an electric socket (or at least the way I imagine minor electrocution would feel).

Having experienced quite a few shocks over the years (though never sticking my finger in an electric socket (working on TVs, phone equipment (ring voltage hits over 100v, nothing quite like wiring up a phone and having someone call right then), playing with fence chargers, etc) I can say that it really feels nothing like a headache and feeling awful

[rosie1231]

Maybe this?

viewtopic.php?f=1&t=177820&p=1335547#p1335527

On another note, what PS are you using? Have you tried raising it?

I noticed that post but got the impression that particular class of squiggles occurs when flow rate is near zero. But mine seem to occur near peak expiratory flow. It doesn't happen on every breath so probably no big deal, I was just curious whether anyone had seen it too.

I'm on PS 3.2 right now. I decided not to change my settings over the holidays because I was traveling a lot and sleeping in uncomfortable places and I'm already so dang sensitive to sleep change. I bumped PS from 3.0 to 3.2 recently and plan to try up to 4.0. Maybe the squiggles will go away with higher PS, who knows.