Is this bad? Is it UARS? Flow rate questions

[Apneak]

Hi! I've attached a couple clips of my flow rate. I'm trying to optimize the curve, and wondering how you interpret these bits? Please help! Thanks.

[Miss Emerita]

Hello, Apniak. I see that you've started several threads about your flow rates. It'd be helpful if you could keep everything in one thread going forward so that people can see the history.

And speaking of history.... Could you give us some more information as context for your concerns and questions? What machine and mask are you using? (You can just put them into your profile and then they'll be visible each time you post.) How are you feeling during the night and during the day? And most helpful of all: could you post one or two typical Daily charts for the whole night, showing these graphs stacked:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

Please show the left-hand panel, but turn off the pie chart (Preferences..Appearance) and the calendar (little triangle to the left of the date).

I have a few thoughts about your flow rate close-ups, but I am reluctant to opine without a fuller picture.

[Apneak]

Hello, Apniak. I see that you've started several threads about your flow rates. It'd be helpful if you could keep everything in one thread going forward so that people can see the history.

And speaking of history.... Could you give us some more information as context for your concerns and questions? What machine and mask are you using? (You can just put them into your profile and then they'll be visible each time you post.) How are you feeling during the night and during the day? And most helpful of all: could you post one or two typical Daily charts for the whole night, showing these graphs stacked:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

Please show the left-hand panel, but turn off the pie chart (Preferences..Appearance) and the calendar (little triangle to the left of the date).

I have a few thoughts about your flow rate close-ups, but I am reluctant to opine without a fuller picture.

Hi Miss Emerita,

Thanks for getting back! I added my machine/mask. I feel tired during day, though the days I feel good I notice a nice, steady inspiratory time chart, without a lot of volatility. And when there is a lot of volatility on the inspiratory time chart, I feel not great. My events are solid, nothing really to see there. Generally below 1, sometimes 1-2. Currently I have an autoset pressure range of 10-11.6, with a relief of 3. Full night below. Last night, had a rdi of 2.45, but that is unusually high, not sure why that was.
I'm trying to figure out, do I need a BiPap, or a "for her" algorithm, or even a servo ventilation? I'm pretty sure I've got UARS.

[LSAT]

Oscar shows that you are using an Autoset, but your profile shows an Elite. You can find the Autoset listed in the R section for ResMed.
I personally do not see any reason to change machines.

[Julie]

Why on earth is your range so narrow? Most have their min. set to anywhere up (from the machine default low of 4 - which is very hard for anyone †o breathe at) and the max. setting at 20, or not a whole lot lower. You've almost turned your auto machine into a plain Cpap.

[zonker]

.

[Pugsy]

Folks....his minimum pressure is 10 cm....he's using the ramp feature which is why you all are seeing lower numbers in the statistics...
the statistics include the ramp usage.

So those of you telling him his minimum is god awful low.....please rethink your statements.

There's nothing wrong with using a tight range...some people prefer it for whatever reason.
His max is 11.8....the highest he went to on the above report is 11. 46.
Technically the machine didn't need or what to go higher. If he never hits the maximum then it really doesn't matter if he uses 11.8 or 12.0 or 14 or even 20. Changing the maximum won't do a thing if the machine never reaches it to start with.

To OP....
http://freecpapadvice.com/sleepyhead-free-software
go here and learn how to tell if those flagged centrals are real asleep centrals or awake centrals getting flagged by mistake.
Even if every single central is a real asleep central....not nearly enough of them for any doctor to raise an eyebrow and/or prescribe ASV. Not enough centrals to warrant ASV at least for centrals anyway.

I edited your topic line to get the attention of people who do flow rate looking and UARS stuff. I don't.

[Geer1]

Why on earth is your range so narrow? Most have their min. set to anywhere up (from the machine default low of 4 - which is very hard for anyone †o breathe at) and the max. setting at 20, or not a whole lot lower. You've almost turned your auto machine into a plain Cpap.

Almost turned his machine into a CPAP or turned it into an effective APAP?

He either has flow limitations, snores or apneas when his pressure drops to around 10 and most of the night the machine is maintaining a bit over 10 because of this. Setting a lower minimum pressure is only advantageous if he finds it more comfortable, otherwise all lowering the minimum pressure will do is cause more breathing issues. To me it looks like he has minimum pressure dialed in and especially if comfortable with that pressure no way I would lower it.

If his maximum never or rarely goes over 12 then maximum isn't an issue. Increasing a bit might help the odd time more pressure is needed but who knows maybe higher pressures or pressure variations wakes him up etc.

CPAP is proactive and the only downside to it is that you have to have a higher pressure when it is not required. APAP is reactive and requires you to have breathing issues in order for it to provide treatment. Ideal treatment is somewhere in between the two imo. Maybe one day they will make APAP machines that act before the breathing problem occurs, until then wide open ranges as are commonly implemented should be frowned upon for anything more than an aid when determining ideal settings.


Apneak, as for your flow charts posted I have the same and have been trying to figure it out myself. It looks like you have some flow limitation, higher pressure might help that but it might not make much of a difference. I've slowly been increasing mine but haven't noticed any obvious differences personally (started at min of 6, tried min of 12 last night). If you do what Pugsy says you may find that many/most of your central apneas are post arousal/sleep transition apneas or kind of like a deep breath in followed by deep breath out followed by the apnea. From what I can tell both of these kinds of CSA are normally occurring in small numbers.

[Julie]

Never suggested lowering min.

[palerider]

CPAP is proactive

You don't know what that word means, do you?

[jimbud]

Never suggested lowering min.

Geer1's reading comprehension is somewhat suspect.

He/she needs to stick to his/her redundant giving of advice.

Leave his/her critical comments out of his/her posts.

JPB

[zonker]

Folks....his minimum pressure is 10 cm....he's using the ramp feature which is why you all are seeing lower numbers in the statistics...
the statistics include the ramp usage.

So those of you telling him his minimum is god awful low.....please rethink your statements.

this is why i think it's important that someone stays in one thread and goes forward that way. true, the burden should be on me to read the previous threads. but i'm prolly not going to do that.

[Apneak]

THanks so much guys!

As for the questions/Points above:

1. I changed my equipment listing to be correct

2. The range is narrow because over many weeks of data, I have never seen a pressure above 11.5 being delivered even though it was possible. I have no issue with raising the max, but also so no reason to do so.

3. The numbers I've been playing with are the minimum pressure and the exhalation relief, with the goals of both treating the hypopneas as well as getting a nice rounded inhalation curve, which I generally get with lower pressures (7-9), but most reliably get at pressures of 10 cm on the inhalation. In an open range of 4-20, my 90% pressure was 7cm, with an epr relief of 3. Which is quite low! So I figured a 10 inhale, 7 exhale would be good....

4. Yes, I have an auto-ramp on so that's why it's lower in the beginning.

Here is an image of me with totally different settings,

[Jas_williams]

If your treating UARS I am out I know nothing about it sorry

[slowriter]

I'm trying to figure out, do I need a BiPap, or a "for her" algorithm, or even a servo ventilation? I'm pretty sure I've got UARS.

Just a few points:

• I doubt the "for her" algorithm would offer any benefit, so I would remove that from your list.
• If you have UARS, you have RERAs, which are effectively flow limitation-induced arousals.
• The closeup you posted shows inspiratory FL, but not arousal. You might do a little more exploring to see if you can identify and quantify those.
• To eliminate RERAs, you need to reduce FL as much as possible.
• To do that, you'd want EPR set at max. If, as appears likely, that doesn't work, then the next step would be a bilevel, which can give you more range to work with.

You might check my thread on UARS. I started on an APAP after UARS diagnosis, but failed that trial, and moved on to a bilevel after a titration study confirmed CPAP wasn't able to control the RERAs. The benefit of that titration study is it gave me and doc EEG-based documentation to confirm what the machine can't: the RERAs.