Poll: Best pressure, algorithm, and settings to treat UARS/RERA

[reinvigorated]

What algorithm was most successful in your specific situation for treatment of UARS/RERA?

1. Pressure settings you use. E.g. 7-14, EPR 2 or 7-12 EPR off.

2 Algorithm: assuming that most of you used Airset Autoset 10 For Her... please response with one of the three:
- AutoSet for Her
- AutoSet for Him
- CPAP (the third setting on AirSet Autoset 10 For Her)

3. Other settings if relevant

4. Also, please don't forget to mention your gender (relevant to algorithm selection)

Thank you!

[LSAT]

Useless information

[jpop]

fullsizeoutput_db1.jpeg (153.43 KiB) Viewed 1141 times

[Snoregone Conclusion]

You’re unique, just like everyone else: collecting this data about others is only potentially useful for entertainment purposes.

[AmSleepnBetta]

Not much substance in my reply, but thought I'd toss this in.

I can imagine my asking those OP questions, among others for example, if I had been trying to apply the usual strategies (for reducing OSA, say) and not getting the desired results for UARS. In that state of mind I would be interested to know if others' successful but varied treatments of UARS was commonly greatly different from, say, how I had reduced OSA: pressure ranges and mix being the focus. Sure, the OP can be read--maybe should be read--as suggesting that a "silver bullet" for UARS could be found, a "one size fits all" approach that is successful for most sufferers.

Thanks to sleep forums, I'm one who has his 12-month AHI down to 0.5, from a beginning RDI near 60 three years ago. My focus has only recently shifted from AHI to UARS because I still see lots of Flow Limitation and Snore (No scored RERA). It is not clear whether Snore (almost always) causes the many coinciding bodily movements I make or if bodily movements trigger a breathing signal that is falsely interpreted by the Autoset and the ResScan and Sleepyhead software. Further, graphed Snore indications immediately upon pressurizations at the beginning of a sleep session and upon returning to bed after a break indicate that flow irregularity is sometimes erroneously shown as Snore though I was awake; I suspect those Snore indications are a kind of artifact that accompanies my (others', too?) settling-in upon initiation of pressurization.

With an upcoming follow-up of results from testing ordered by my pulmonologist I'm leaving pressure settings alone with AHI well below 0.5 for the past 6 months. If I read the sleep experts correctly on the two major sleep forums, it seems likely the ResMed vauto may be what comes next. When using the F10 FFM as I began treatment there was some (newbie?) trouble with aerophagia.

I do believe my sleep is not as restful as it should be, though it is much much better after getting AHI down. My Flow Rate curve has lots of spikes (mostly, and naturally of course) concurrent with spikes of Snore (predominant over FL), of Tidal Volume and of bodily movement. Pulse rate spikes (big and small), though fewer, are typically coincident, too.

Anyway, its good seeing quite a bit of discussion about UARS, a more or less continuous and significant breathing irregularity that robs rest and SpO2, as I understand it, though it is only scored at high levels when presenting intermittently amid a typically higher Flow Rate. It is not scored, I don't think, when it fairly continuously keeps flow suppressed without scoreable dips which last for some certain number of seconds . I hope more discussion by experts will help us understand it.

[dogsarelife]

the thing about UARS is that it seems to be very dependent on personal preference, what makes you comfortable, etc. But I will tell my story so you have an idea of things.

peeling back my UARS sleep onion:

I still haven't really figured this out, but when using a nasal mask, according to my machine, my AHI was never higher than 1 with an apap set from 4-20. Somehow I was staying mostly at 4-5 all night, with some occasional jumps up to 10. I felt a little better than no therapy at all, but still woke up choking, nightmares, apnea symptoms. first doctor was confused and I fired him.

At that point I learned about cpaptalk and sleepyhead, and decided to try a new mask, a full face, and brought my minimum pressure up to the minimum level to catch all events - 12 cm H2O.

I also made an appointment with another sleep doctor who wanted to do a titration.

Well, what do you know - when i had a pressure esophageal manometry during my sleep study to cover UARS, the minimum pressure needed to cover events was 12! However I did best on pressures of 14-15 cm H2O. The pressure esophageal manometry is a tube put through your nose and down your throat to measure the pressure needed to overcome airway resistance, and the sleep tech had instructions to keep raising pressure until that pressure was flat. When the pressure is too low, the pressure esophageal manometry measurement is all over the place. but once the pressure is correct, that Pressure esophageal manometry measurement is flat. That is what my sleep doctor explained to me when I got my results, which if you click on my name, you can see my very first post, where I posted the results of my first and 2nd sleep studies.

so titrating to the pressure esophageal manometry but also titrating until my respiratory effort was stable, resulted in a need for 14-15 cm H2O.

I ended up with a bilevel pap, because apap at minimum pressure of 14-15 cm H2O and which occasionally jumped to 18 cm H2O, gave me a lot of aerophagia and also randomly difficulty breathing over that pressure. Some nights it was fine some nights it was really uncomfortable. For some reason I need a decent amount of pressure support (difference between Inhalatory positive airway pressure and exhilatory positive airway pressure on bilevel pap) as well for comfort. Don't know why - I just do.

I do wish I had been prescribed a vpap (Resmed auto bilevel pap) because pressure needs vary based on so many things.

I also realized that my nose is often congested and that was a big part of improving my sleep. Recently I realized my nostrils completely collapse and that is causing me problems such that no matter how hard I try my brain resorts to mouth breathing. that sucks :/

I tried nose pillows but because I had a lot of teeth out for braces - 4 - as well as 4 wisdom teeth, my lower jaw is pushed back. and having a nasal mask or pillow causes subconscious teeth grinding / jutting forward of my jaw to enlarge my airway when I use nasal pillows or a nasal mask, which then wakes me up.

From pugsy I learned that UARS means subjectivity - keeping a journal, perhaps a higher pressure than sleepyhead would say, but mostly centering comfort, not AHI.