Vauto mode vs S mode for UARS

[gobucks]

Hi Everyone,

Would the Vauto mode or S mode be more beneficial for UARS?

Thanks!

[Dog Slobber]

I don't think there is a definitive answer. Everyone is unique in their treatment.

Try both, set your AirCurve to VAuto Mode, run with it for a few weeks, note how you feel. Then switch to S Mode, for a few weeks. Compare your numbers and how you feel.

[gobucks]

I don't think there is a definitive answer. Everyone is unique in their treatment.

Try both, set your AirCurve to VAuto Mode, run with it for a few weeks, note how you feel. Then switch to S Mode, for a few weeks. Compare your numbers and how you feel.

I figured but I appreciate the reply! Ill give both a shot and a fair chance.

I finally got my AHI down to under .5 (from 7 in study, 3 on my old machine) on Vauto mode but still dont feel well rested. Think I will see a difference on the apnea side of things from ~3 dropping to .5 in itself if I give it time? Its been about a week and a half.

[Pugsy]

I have always felt that auto mode of anything isn't particularly beneficial for UARS only people because what these machine respond to isn't UARS related in most cases. The auto adjusting algorithms were never designed for the very subtle changes that UARS by itself represent.
Historically people with UARS only tend to need a higher baseline pressure than what an auto adjusting machine will want to deliver so when auto adjusting mode is used with a higher minimum (baseline) to give the desired results then the auto adjusting mode essentially becomes a fixed mode because the machine simply won't sense anything to cause it to go higher anyway.

[gobucks]

I have always felt that auto mode of anything isn't particularly beneficial for UARS only people because what these machine respond to isn't UARS related in most cases. The auto adjusting algorithms were never designed for the very subtle changes that UARS by itself represent.
Historically people with UARS only tend to need a higher baseline pressure than what an auto adjusting machine will want to deliver so when auto adjusting mode is used with a higher minimum (baseline) to give the desired results then the auto adjusting mode essentially becomes a fixed mode because the machine simply won't sense anything to cause it to go higher anyway.

I understand what you are saying. For example, my pressures in Auto stayed pretty constant throughout the night, which essentially becomes fixed mode. Would it still make sense to go to fixed mode regardless?

Im definitely getting to the end of my rope with my fatigue though. Is there anything else I can change or do to help this? Any charts that would be helpful to look at?

[Miss Emerita]

Gobucks, try posting a recent chart with these graphs all in one screenshot:

Events
Flow rate
Pressure
Leaks
Snores
Flow limitations.

[slowriter]

I have UARS, and a VAuto. I strongly suggest VAuto mode, for the following reasons:

• just because you predominantly have RERAs doesn't mean you don't have, or won't develop, obstructive apneas
• S mode does not include FL tracking, which is arguably the most useful data for UARS folks
• VAuto is flexible; it can be set to operate at fixed pressure, if for some reason you feel the need

In my case, I use VAuto, but just constrain the EPAP to a relatively narrow range.

And per Miss Emerita, definitely post your data.

[Pugsy]

I understand what you are saying. For example, my pressures in Auto stayed pretty constant throughout the night, which essentially becomes fixed mode. Would it still make sense to go to fixed mode regardless?

Im definitely getting to the end of my rope with my fatigue though. Is there anything else I can change or do to help this? Any charts that would be helpful to look at?

I see no sense in going to fixed mode if in auto mode it is essentially fixed anyway....end result is the same either way you go.
There's not going to be a lot of data that the machine can gather or respond to that is going to be able to point you in how to go or the settings to use because the machine is designed to respond to OSA stuff ...not UARS stuff. So your software reports aren't going to really help you out a lot unless you are seeing a lot of flow limitations and that's a maybe.
UARS people always have a low AHI if they don't have OSA.

If I had UARS or suspected I had UARS this is what I would do.
Take the software reports with a grain of salt unless I was seeing a lot of FLs and I wasn't having any nasal congestion to blame them on.
Then I would systematically start increasing the minimum EPAP and choose a PS (when using bilevel) that I was the most comfortable with and do one week experiments at that EPAP minimum and keep a detailed log of the results in terms of sleep quality and how I felt.
Historically pretty much all the people here who have documented UARS end up needing a lot more minimum EPAP than the machine will want to give you you just force the machine to give you more either in fixed mode or in auto mode with a higher minimum and the machine won't move the pressure. There are people who have reported having the pressure titrated using a Pes device in place in a lab and the pressure needed to deal with UARS might end up being a lot higher. One person I remember said they needed 13 cm and the machine in auto mode only would go to 7 cm.

So sometimes a lot more pressure and I know we want to look at the software data for direction and not rely on just how we feel but the cold hard fact of life is that is that the machine data isn't going to help us out much because it was never designed to deal with UARS.
The presence of FLs....may or may not be related to UARS but if you see a lot of FLs it always perks us up because FLs can cause sleep disturbances themselves. It is possible to have UARS stuff and it not meet criteria for even a FL. So the absence of FLs doesn't mean much either. We try to deal with the FLs if we see them just because it might help.

End result is you have to try to evaluate for UARS with a lot of subjective how you feel stuff and not so much what is shown on the software reports. Or get an in lab titration using the Pes device which not many labs do.
Be prepared to take the EPAP pressure fairly high and keep that detailed log and take a hefty dose of patience.

All this is of course assuming UARS is the culprit. There are other reasons for feeling like crap though and we have to realize that not everything we don't like happening to us is related to the airway and if our problem isn't airway related...and not UARS...then the use of the machine isn't going to fix the problem no matter what the settings.

[Pugsy]

S mode does not include FL tracking, which is arguably the most useful data for UARS folks

My ResMed AirCurve VAuto gives me a FL graph in S mode. I am wondering why yours doesn't.
Now Respironics machines in fixed mode...no FL flagging.

[gobucks]

Gobucks, try posting a recent chart with these graphs all in one screenshot:

Events
Flow rate
Pressure
Leaks
Snores
Flow limitations.

Here is everything minus the snores from the past few nights:

https://imgur.com/a/Bm5lKvc

Heres the most recent night snores:

https://imgur.com/a/LYOwFQ5

Which I didnt see any? It has been similar every night so far

[Pugsy]

As expected...your software reports aren't particularly helpful. Boring...nothing to see.

Why the PS of 6? Any special reason?

Do you take any medications of any kind, even OTC? If so,what?

Why the obvious breaks in therapy? Is this common for you? Do you wake up frequently during the night or remember a lot of tossing and turning?

Any other physical or mental health issues that might be a factor in your unwanted daytime symptoms...and exactly what are those unwanted daytime symptoms?

[gobucks]

I understand what you are saying. For example, my pressures in Auto stayed pretty constant throughout the night, which essentially becomes fixed mode. Would it still make sense to go to fixed mode regardless?

Im definitely getting to the end of my rope with my fatigue though. Is there anything else I can change or do to help this? Any charts that would be helpful to look at?

I see no sense in going to fixed mode if in auto mode it is essentially fixed anyway....end result is the same either way you go.
There's not going to be a lot of data that the machine can gather or respond to that is going to be able to point you in how to go or the settings to use because the machine is designed to respond to OSA stuff ...not UARS stuff. So your software reports aren't going to really help you out a lot unless you are seeing a lot of flow limitations and that's a maybe.
UARS people always have a low AHI if they don't have OSA.

If I had UARS or suspected I had UARS this is what I would do.
Take the software reports with a grain of salt unless I was seeing a lot of FLs and I wasn't having any nasal congestion to blame them on.
Then I would systematically start increasing the minimum EPAP and choose a PS (when using bilevel) that I was the most comfortable with and do one week experiments at that EPAP minimum and keep a detailed log of the results in terms of sleep quality and how I felt.
Historically pretty much all the people here who have documented UARS end up needing a lot more minimum EPAP than the machine will want to give you you just force the machine to give you more either in fixed mode or in auto mode with a higher minimum and the machine won't move the pressure. There are people who have reported having the pressure titrated using a Pes device in place in a lab and the pressure needed to deal with UARS might end up being a lot higher. One person I remember said they needed 13 cm and the machine in auto mode only would go to 7 cm.

So sometimes a lot more pressure and I know we want to look at the software data for direction and not rely on just how we feel but the cold hard fact of life is that is that the machine data isn't going to help us out much because it was never designed to deal with UARS.
The presence of FLs....may or may not be related to UARS but if you see a lot of FLs it always perks us up because FLs can cause sleep disturbances themselves. It is possible to have UARS stuff and it not meet criteria for even a FL. So the absence of FLs doesn't mean much either. We try to deal with the FLs if we see them just because it might help.

End result is you have to try to evaluate for UARS with a lot of subjective how you feel stuff and not so much what is shown on the software reports. Or get an in lab titration using the Pes device which not many labs do.
Be prepared to take the EPAP pressure fairly high and keep that detailed log and take a hefty dose of patience.

All this is of course assuming UARS is the culprit. There are other reasons for feeling like crap though and we have to realize that not everything we don't like happening to us is related to the airway and if our problem isn't airway related...and not UARS...then the use of the machine isn't going to fix the problem no matter what the settings.

I was just able to post my charts. My flow limitations didnt *seem* high but I dont know exactly what high is.

Im glad you informed me that flow limitations only 'might' be an indicator as I had been stressing about why I wasn't feeling better despite my flow limitations not seeming high.

I will take your advice to increase EPAP with all of your experience and what you have seen. Im curious though as to why increasing EPAP has seemed to help. The resmed titration guide says to increase IPAP until RERAS are gone.

I would love to get an in lab titration using a PES device. I am having such a hard time dealing with my doctor who is even apparently semi famous in the UARS/OSA world. Dr. David Kristo. I had to BEG for an in lab study with titration that scored RERAS. And guess what, they weren't even scored when I specifically asked them to. Might have to try to find whoever is "the best" no matter where they are or how much it costs.

Yes this is all assuming UARS is the culprit. Right now its the only thing that makes sense after about 2 years of doctors visits, blood tests, imaging etc. I would really just be happy cross this off the list even if it isnt UARS but I have been hitting roadblocks everywhere to flush out this theory.

Thanks so much for your help and I apologize for venting my frustration about my journey. I will slowly increase my EPAP and journal how I feel to see if I notice improvement.

[gobucks]

As expected...your software reports aren't particularly helpful. Boring...nothing to see.

Why the PS of 6? Any special reason?

Do you take any medications of any kind, even OTC? If so,what?

Why the obvious breaks in therapy? Is this common for you? Do you wake up frequently during the night or remember a lot of tossing and turning?

Any other physical or mental health issues that might be a factor in your unwanted daytime symptoms...and exactly what are those unwanted daytime symptoms?

I was using the resmed titration guide. I increased my EPAP until all obstructive, centrals and hypopneas went away. Then I started to increase IPAP until I would start feeling better but I havent.

Claritin at night but that is it. I worked very hard to stop all other medications to get a clear picture.

I do frequently wake up at night and toss and turn a lot. Most of the time I do not remember taking off my mask. Or if I do take my mask off I forget to put it back on in my sleepy daze. I would say its more common than not. I do need to work on it for sure. Sometimes I wonder if I should splurge on a nicer mattress.

I have some anxiety and some depression but it has largely been under control. Honestly I am just depressed now because I am so tired and dont have the energy to do the things I want. I would be 100% ready to live my life and have fun but I physically am limited. I have tried 2 anti depressants that did not help at all as well as Ketamine, which as far as I noticed, didnt help the exhaustion either.

No physical issues, aside from wrong diagnosis/treatment. So far all my bloodwork and tests have been excellent.

I already exercise consistently, meditate, spend time outdoors with lots of sunlight and socialize.

Unwanted daytime symptoms: Waking up unrefreshed, headaches, joint pain, muscle pain, general malaise, tiredness, sensitivity to light, strong urge to take naps every day (though I dont anymore to improve sleep hygiene), difficulty concentrating, low sex drive. And really just feeling super spaced out, sleepy and feeling like I need to be closing my eyes out of exhaustion constantly. I also feel like I dont recover from my workouts at all.

[Pugsy]

You pretty much have to toss that ResMed titration guide out the window. Remember it was written for OSA related issues.
People are just recently in the past few years recognizing UARS as a separate entity requiring specialized treatment or reviewing and there simply isn't much documentation out there for UARS therapy all by itself. It used to be a catch all diagnosis when they couldn't document anything else and people still felt like crap so they blamed UARS and threw up their arms and said "it is what it is".


EPAP is always the most critical setting because it is the baseline pressure holding the airway open during exhale which is the lowest pressure when any sort of pressure support or exhale relief is offered. EPAP does the bulk of the work holding the airway open.

[Pugsy]

Unwanted daytime symptoms: Waking up unrefreshed, headaches, joint pain, muscle pain, general malaise, tiredness, sensitivity to light, strong urge to take naps every day (though I dont anymore to improve sleep hygiene), difficulty concentrating, low sex drive. And really just feeling super spaced out, sleepy and feeling like I need to be closing my eyes out of exhaustion constantly. I also feel like I dont recover from my workouts at all.

Hmmmm....tossing and turning a lot during the night and remembering it...means fragmented sleep for sure. Been there and done that myself. Fragmented sleep for any reason will mean we don't feel so great during the day. We just don't get the normal sleep cycles for the restorative powers of sleep to work their magic.

Have you done the work to look for evidence of arousals in your flow rate breathing and maybe just counted the arousals?
http://freecpapadvice.com/sleepyhead-free-software
I have arthritis so some pain issues and I toss and turn a lot. I always have a lot more arousals than I might remember when I do the work and zoom in just to look for arousal/awake breathing. Give me a bit and I will get you some examples to look for.
On a "bad" night I might have 30 to 40 such times which means my sleep is highly fragmented. Now in my case I know pretty much what causes the arousals and it's a battle I realize I will always face. I am 68 years old now and my back and pelvis is eat up with arthritis and I hurt.

Your symptoms also sound a lot like Chronic Fatigue Syndrome or Fibromyalgia so you might look at those diagnoses as well.
Unfortunately a lot of the times the meds prescribed for those diagnoses also come with some pretty ugly baggage in terms of how they make us feel and actually mess with sleep quality as well. Been there and done that myself. Just tried one this past July that was horrible. Damned if you do and damned if you don't kind of thing.