Kinda lost - UARS

[Pugsy]

You've actually zoomed in a little to closely for optimal evaluation and it's best if you can put the flagged event more to the right side of the graph so you can better evaluate the flow rate pattern before the flag to see if it looks like asleep or arousal pattern.

Asleep pattern is very rhythmic and not irregular.

I have a good example here...Asleep is circled in red...everything after it is arousal/awake related and not real.



And this one is the same but more zoomed out. Again everything after the circled in red part isn't real asleep...just a bunch of junk.



Again here note the nice regular pattern and then a lot of irregularity....then some flagged stuff...all arousal related and then back to sleep.



And here...asleep...then some arousal breathing and back to sleep.

[Aprilia]

Thanks I’ll take a closer look to my data tomorrow

[Pugsy]

I don’t see the cpap increasing the flow to push me to breathe ... why?!

Because the machine won't do a darn thing during any apnea event. It can't...it can't move enough air to push the airway more open and if it is a central apnea (clear airway on this software) it won't ever do anything.

The optimal way to look at this therapy is that it works best by holding the airway open in the first place and preventing the collapse from ever happening. Fixing during the event won't happen and even after it might not cause the machine to do anything just for a single lone event.

Now you say you have UARS...the machine won't do a good job trying to auto adjust for UARS collapses which often fall under the auto adjusting algorithm criteria. It was never designed to auto adjust for UARS problems.
The for Her algorithm is specially designed to be more sensitive to Flow Limitations and you may or may not be having many flow limitations along with the UARS stuff. Your FL statistic isn't very high so I assume your flow limitation graph isn't all that remarkable but you didn't include it. The machine will respond to FLs if you have many even without a bunch of OAs or hyponeas but you may not be having many or very big ones.

The for Her algorithm isn't a UARS fighting algorithm... it's a gentler response to FLs mainly which sometimes is helpful for women . It's more sensitive to flow limitations.

If you had 2 OAs within 2 minutes it would increase the minimum baseline pressure for the rest of the night. UARS people typically have a low AHI and probably rarely have 2 OAs within 2 minutes.

Historically it's hard to try to titrate for an optimal pressure when using these machines because they simply can't give you much in terms of useful data to guide you. UARS people won't have the definitive 10 second long duration and 70% reduction in flow rate that would get a hyponea flag. Your flow reduction might be just 30%....not enough for the machine to do a darn thing but enough to disturb your sleep. That's what makes UARS such a bitch to try to fix...we don't know a good pressure to use because we don't have anything to really measure.

Historically from the people I have seen here with UARS....they always need more minimum pressure than the machine wants to give them because it doesn't know it should. Sometimes a little more...sometimes a lot more before they start actually feeling the benefits they want to feel.

My suggestion...increase your minimum pressure 2 cm...give it 2 weeks and see how you feel... your median average is around 8 anyway so the machine is spending a good bit of time up there anyway.
Then if you still don't feel any improvement....try another 1 cm increase for another 2 weeks...remember the machine works best when it is preventing a problem even with OSA and it is much more critical with UARS that the collapse gets prevented. The machine will never respond to anything less than a 50% reduction in air flow which is where most UARS falls into.
You are going to have to rely more on subjective feelings as a guide...the data from the machine other than letting you spot potential arousals isn't going to help you out much.

[Aprilia]

Hello there!!

I’m back!

I was finally called in July for a polysomnography, my penumologist called me with my result 2 weeks ago and confirmed I had UARS. She said it’s mild therefore we may not need to try to fix it.
She asked me about my symptoms, I said I had been diagnosed with severe depression a few months back, therefore, I wasn’t working and couldn’t really tell about my cognitive functions.
She asked me if I had lost weight (she never saw me in person) I said yes because I did lose 20kg since March. And she said well since you lost weight you may not have sleep apnea anymore and I was really confused because I had an healthy weight 2 years ago, I had an healthy weight in March and I still have an healthy weight (I just lost weight because I wanted too other than that it was not a necessity). She quickly looked at my file and confirmed I was never overweight.
I told her that I didn’t really used the CPAP I had purchased myself as she never gave me any information about what settings I would need to put it at and because I always had major leaks that would wake me up in the middle of the night. She told me to keep being active and to ask my GP for another referral if my symptoms worsened.

I hanged up a bit taken aback by the whole conversation because after 2 years fighting for a PSG and 6 months waiting for the result I thought « no news good news » I must not have Sleep apnea or UARS.

So here I am, severely depressed, with fatigue, difficulty remembering words or things, anxious/stressed out all the time trying to literally survive another day, everyday.
I’ve been given meds for depression who does absolutely nothing, therapy (can’t say it’s helping me) and my GP is at a loss, telling me that sleep apnea is most likely not the cause of my depression. She requested another follow-up with the pneumo but how long will it take?! Months? Years ?? Who knows.

I’m now reusing my cpap (or at least I’m trying) can’t tolerate it more than a couple of hours so far.
How can I find a doctor that will not dismiss UARS?! It looks like it’s really complicated to find someone competent with it

My PSG showed that my REM sleep was lower than usual (12%).
During REM sleep I had 33 spontaneous micro arousals per hour.
Apnea/hypopnea index 5/hour but elevated to 13/h if we count the UARS arousals (they don’t count the spontaneous arousals).
The events are in clusters during REM sleep.

Sorry for the long post but I feel really bad.
Any insight?

I’ve set my CPAP:

Max pressure: 14
Min pressure: 9
Initial pressure: 6
EPR: 3

(Again I apologize for any written mistakes)