Help with UARS

[lu342]

Hey, I have been diagnosed with mild sleep apnea and uars. My sleep study report shows AHI of 10/hr and Arousals/awakenings 25/hr. My sleep doctor prescribed for me Dreamstation apap and I have been using it for about a month. I noticed some improvement in my symptoms but I still feel like I should feel better. My initial pressure was min: 5 max: 15. I increased that to min:8 max:15. But I didn't feel any difference. Based on what I read in this forum, I'm considering switching to Resmed Aircure 10 Vauto. Does that sound like something that could potentially help me? Or maybe it's a better idea to keep experimenting with my pressure?

[slowriter]

I'm considering switching to Resmed Aircure 10 Vauto. Does that sound like something that could potentially help me?

Yes. The Resmed algorithm is more responsive to flow limitations characteristic of UARS, and the VAuto offers you the bilevel pressure support that is also helpful for treating UARS.

But could you post a two-minute close-up of your flow rate graph, during a time when you know you're asleep?

Also, you have two obvious breaks in your therapy. Do you think that's significant?

[Miss Emerita]

I agree with slowriter that you are more likely to benefit from a VAuto Aircurve. Even a ResMed Airsense 10 Autoset would give you some true bilevel pressure support, though it would be limited to 3. But if you need to self-fund a replacement machine, I'd suggest going straight for the VAuto. You may not need its full capacities, but it's nice to have them available.

I notice that your OAs tend to come in clusters. They might be due to REM sleep, but they might also be due to chin-tucking (positioning your chin down toward your chest). An inexpensive and easy experiment is to buy a soft cervical collar to keep your head in a better position and see whether that makes a difference. If you sleep on a high pillow, you might also try a lower one.

If those measures don't help, then you should probably continue to raise your minimum to head off more OAs. A higher minimum might also help a bit with the hypopneas, though pressure support is more likely to help with Hs (and flow limitations and RERAs).

[lu342]

Thanks for your replies.

I attach two two-minute close-ups of the flow chart. One showing RERA and one taken at a random time. I believe that if I get my doctor on board, my insurance should cover Aircure 10 Vauto. I just don't know if I will be able to convince him. What arguments could I use?

Also, you have two obvious breaks in your therapy. Do you think that's significant?

I think that's just when I happened to be awake. I don't see similar breaks during other nights.

[slowriter]

For UARS, the machine main data that can be useful are:

1. the "flow limitation" summary numbers in that "statistics" table in the sidebar. I don't see those on your screenshot.
2. the detailed FR graph; see this article, and in particular figure 5/table1; if you compare the closeups you posted to those examples, you'll see that evidence of flow limitation

As for dealing with your doctor, hard to know because they're all individuals.

I can tell you my story though, which may give you some ideas.

I went in for the followup compliance visit about a month after starting CPAP with basically two types of information.

One was data from OSCAR that I argued showed objective evidence a bilevel was worth a try. The doctor was dismissive, and seemed only focused on the low AHI number.

The other was subjective: I explained I not only didn't feel better, but probably felt worse. Even here she was dismissive, at one point saying something to the effect that CPAP didn't work for everyone.

The moment that broke the standoff was my suggestion we do a titration study to test CPAP vs bilevel. That study provided the evidence that justified the bilevel.

But ... I found it so frustrating I bought a used VAuto on my own!

[Pugsy]

the "flow limitation" summary numbers in that "statistics" table in the sidebar. I don't see those on your screenshot.

It's not available as a graph so there won't be the statistical data like the ResMed machine gives for FLs.
Respironics machines just flag FLs (and only in auto adjusting modes) up on the events graph like they do OAs or hyponeas or snores or RERAs. I see maybe one flagged on the report above.

[Miss Emerita]

A titration on both kinds of machines would be great. The part of the night with the bilevel machine should of course include trying various levels of pressure support. For UARS patients, the PS is often what makes the most difference. The titration study should include measures of flow limitation and RERAs.

Your report of your subjective daytime state should certainly be part of what you present to your doctor. Examples often help in that communication, e.g., it is taking me too long to think through xyx at work; I am constantly needed to pause while I think of the word for something; I tend to get drowsy when I'm driving; I feel strong urges to nap. You get the idea.

The other thing you could do is to show your doctor images of some stretches of typical flow-limited breathing. If you want to do that, I'd suggest reformatting the flow rate graph so it runs from, say, +55 to -55. It'll be easier to see the shapes that way. Post some if you like.

[lu342]

Some time have passed since I last posted here.. I finally convinced my doctor to prescribe Aircurve 10 Vauto for me. He was initially against switching to bilevel machine because there is no scientific proof that it works better than apap for uars. But after telling him that I'm open to trying anything he thinks may help, even if the chance of success is small, he became much more open to trying different things out. He admitted that it's possible that resmed machines could be more sensitive to flow limitations and pressure support setting could be helpful in dealing with uars.

So I got the Aircurve 10 Vauto two days ago I used it both nights. The prescribed settings were Max IPAP: 20, Min EPAP: 6, PS: 2. But as soon as I started using it, breathing out felt too difficult so I increased PS to 3. After this first night I felt very tired. Much worse than APAP. So for the second night I increased PS to 4. And that seems to help.

[Julie]

You should have an exhalation relief feature to turn on... EPR or C/A Flex... and adjust to suit. Do you see it?

[Pugsy]

You should have an exhalation relief feature to turn on... EPR or C/A Flex... and adjust to suit. Do you see it?

ResMed AirCurve 10 VAuto (or any of the AirCurve models) only have PS/Pressure Support which is essentially what EPR does on the AirSense models. PS works like EPR but it isn't limited to 3 cm.

PS on ResMed bilevels is the only way to get exhale relief. Nothing else is available.
Respironics bilevels do have the Flex option available on top of PS but ResMed doesn't,

4 PS is like 4 EPR if EPR could go to 4.

[lu342]

It's been a week since I started using Vauto. I'm still on settings Min Epap: 6, Max Ipap: 200 and PS:4. I felt really good on some of the days, but not so much on other. The days when I don't feel good seem to correlate with large leaks in the oscar reports. I often wake up with dry mouth on those days. So my guess is that I'm mouth breathing.

I'm not sure what I can try to fix that.

[Miss Emerita]

I'm glad to hear you're having some better days with the VAuto. Here are some suggestions about mouth leaks.

1. Tongue position. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.

2. Collar. If your jaw tends to drop down during the night, pulling your mouth open, then a soft cervical collar, or a firmer snore collar, can be a big boon. More here:
http://www.apneaboard.com/wiki/index.php...cal_Collar

3. Although chin straps tend to pull the jaw back, which is not helpful, the Knightsbridge Dual Band strap has a design that pulls the jaw straight up, which makes it a possible alternative to a cervical collar.

4. Tape. Some people (including me) rely on tape to keep the lips from opening. (I can't rely entirely on the tongue thing.) When the lips open, all too often that eventually leads to a noisy and disruptive mouth leak. To see whether tape would be feasible for you, I recommend that you invest in a box of Somnifix strips. They are very gentle on the skin but hold very well. Be sure to curl your lips inward per instructions before placing the strip. If these work for you, then you can experiment with lower-cost options.

Note about tape: Some people avoid it, for two reasons. (1) If you suddenly need to vomit in the night, the tape could lead to your aspirating some vomitus, which would be bad. However, you can sacrifice one strip to see for yourself how well you can pull you mouth open in an emergency using only your jaw muscles. (2) If there is a power failure and your machine goes off while you're sleeping, you won't be able to do the natural thing and open your mouth to breathe. As for that, out of an abundance of caution, I've put a circuit alarm in a plug on the same circuit as my machine. It wakes me up immediately if I lose power to the machine.

[Needtosleep99!]

I have to open my mouth to let the air out....I have dentures, an underbite, and my mouth is not coming open...there is air that needs to come out of my mouth, so I open my mouth carefully on the side to let the air out, close mouth again, and within a vew breaths it happens again. I have not been able to use my machine, but I am supposed to get my pressure dropped tomorrow. I received my prescription for it last week, but the PA wrote down a higher pressure by mistake. I had already talked to the company where I received my ResMed BiPap from, so they were expecting the lowered pressure...maybe it will get better after the pressure is dropped..?? I have slept for years with my fist under my mouth, so I know the mouth is not coming open except when I open the corner. I am very discouraged at this point after having 2 sleep studies within the past 2 weeks, and here I am with no help sleeping. I can't remember when I slept a decent number of hours...desperate at this point. I have Dilated Cardiomyopathy and I need my machine to work for me. Anyone else have the mouth-air thingy like I do?

[zonker]

Anyone else have the mouth-air thingy like I do?

please start your own thread for this.

it's considered rude to hijack someone else's.

thank you.