upper airway resistance

[dreamsofsleep]

Hi everyone. This is a great forum. So many knowledgeable people!

After recently getting good health insurance for the first time in a few years, I'm back to trying to figure out why CPAP hasn't done the trick for me. I've been diagnosed with mild OSA and moderate UARS. I've tried CPAP (and APAP) at various pressures and oral appliances without any significant relief from my exhaustion. My most recent sleep study from a couple of months ago showed that my oral appliance was reducing my AHI to under 5, but my RAI was still 18.9. My last sleep study with CPAP showed a similar number of "spontaneous arousals," which I suspect were still respiratory arousals. I've now asked my doctor if I can try the Goodnight 420E, which I hear tends to be more sensitive to UARS than some of the other machines. One question I have, though... if the problem with some of us UARS people is that APAPs don't respond to all of our flow restrictions, why would a fixed pressure CPAP with a pressure high enough to respond to all apneas, hypopneas, and airway resistance not be a better solution? Is it because central apneas can start to occur at those higher pressures? Or it's just really hard to determine a fixed pressure that does an adequate job of covering all events? Anyway, I've tried fixed pressure CPAP at pressures ranging from 6 to 11 with no luck, but never had a titration at a fixed level, so no real way of knowing what went on.

This whole UARS thing is so confusing. Just hoping someone might be able to give me some guidance! Thanks in advance!

[Rachael]

I think you are right, that a fixed pressure, at a higher pressure should do the trick. Do a medline search for patient led titration for cpap, I can't remember the author or title, but it was a very interesting study (of sleep apnea patients, mind, but still relevant I think.) The upshot was, patients who tracked their symptoms and made small changes in their own fixed pressure were able to come up with a pressure similar to their lab-titrated pressure. Though if you have insurance that will cover it seems to me you should try to find a lab that will titrate to eliminate any RERAs and tell you that pressure.

I have recently gone back to the self titration process, I am trying one centimeter higher per week till I wake feeling fully rested. I made up a little scale of my various symptoms, headache, day time sleepiness, etc. and am charting them each day so I can be as objective as possible. I had done this before but stopped at a pressure of 7 (7-12 on an apap, but my pressure rarely changes.) But after reading Dr. Krakow's posts about patients settling for "better" rather than "well" I decided to set my sights higher.