Flow Limitation and UARS?

[tan]

There is a member that went to him for URAS but I do not think he has gotten any relief....

he had his wallet relieved of quite a load of heavy cash.

yeah... some people suffer so much they'll try just about anything to get some rest.

Exactly. I don't suffer too much, but I stopped getting a refreshing sleep -- I would pay anyway.

I guess BIPAP for URAS's is not approved by insurances.....

and, hell, I would pay for BiPAP, if I knew, it would help. Thoughts? Rental?

[jwuzy]

I really need more information here...I don't know what mask is being used.
Is it a full face or nasal?
Would the FLs be better addressed with simply a little more minimum to prevent them in the first place?
There's obviously plenty of room to do either...open up the max or just simply add more minimum and I am wondering if more minimum might benefit a person with UARS better than more maximum would.
Better prevent the collapse in the first place type of thing so not as much need to fix it after it happened.

Thanks for all the responses guys. I'm dying for a good night sleep. I'm currently using a Resmed Nasal Pillow.

I actually wasn't prescribed the 4-6 range but set it myself. I actually remember talking to you before to use a tight range so I set it manually.

When I was given my CPAP, it was set on auto for 4-20. I'm not sure what to do. Do I even continue using the CPAP? Do people have success with UARS using this?

[jwuzy]

Do we know if UARS is dangerous to your health like sleep apnea is advertised as?

[tan]

I really need more information here...I don't know what mask is being used.
Is it a full face or nasal?
Would the FLs be better addressed with simply a little more minimum to prevent them in the first place?
There's obviously plenty of room to do either...open up the max or just simply add more minimum and I am wondering if more minimum might benefit a person with UARS better than more maximum would.
Better prevent the collapse in the first place type of thing so not as much need to fix it after it happened.

Thanks for all the responses guys. I'm dying for a good night sleep. I'm currently using a Resmed Nasal Pillow.

I actually wasn't prescribed the 4-6 range but set it myself. I actually remember talking to you before to use a tight range so I set it manually.

When I was given my CPAP, it was set on auto for 4-20. I'm not sure what to do. Do I even continue using the CPAP? Do people have success with UARS using this?

No success yet, but I am determined to achieve my successful resolution... or die trying

4-6 range is not effective in your case. You have to reset it back to 4-20 and see how high the pressure goes. How does your flow limitation chart look like?

Updated:
...and your leaks are too high, if I read your diagram properly.

[palerider]

...and your leaks are too high, if I read your diagram properly.

that is a *lot* of leak for such a low pressure.

[tan]

Do we know if UARS is dangerous to your health like sleep apnea is advertised as?

It is. Basically the same, but considerably more subtle and hard to be acknowledged even by some, if not many, medical professionals, which makes UARS even more dangerous.

[jwuzy]

I'm not sure how to control my leaks. I taped my mouth last night and I don't hear any air coming out other than the pillows. I was having large leak events before taping my mouth and that doesn't seem to show up on the report now that I've started taping my mouth.

[Pugsy]

Actually the leak line is stable and you all with Resmed machines have to remember that the top line on this report includes the vent rate. If you want to compare apples to apples (sort of within SleepyHead's ability to figure excess only leaks) take a look at the bottom leak line. There's not much excess leak going on and any that is going on is well below large leak threshold.
Leaks are not excessive though.
It does seem a bit high for a nasal pillow mask at such low pressures though...but it is stable. Wonder which nasal pillow mask.
So unless leaks are waking a person up...I doubt these are impacting the pressure therapy aspect of things.

Do we know if UARS is dangerous to your health like sleep apnea is advertised as?

Probably not in terms of O2 levels if that is what you are thinking unless your oxygen levels are taking a nose dive which most of the time with UARS it doesn't. I don't know about the stress hormone aspect though.
Like at what point does the stress actually cause a physical reaction or are we dealing with mainly poor sleep quality in general issues. UARS used to be a catch all for what got blamed when nothing seemed to work but now it is just now getting some attention devoted to it specifically. UARS therapy is sort of in its infancy in that regard.
Not to mention poor sleep in general and its long term effects on the body.

I actually wasn't prescribed the 4-6 range but set it myself. I actually remember talking to you before to use a tight range so I set it manually.

Good idea but just need maybe a different minimum and maximum and we have to go on how you feel more than what the numbers might show. You can try 4 to 20 range and let's just see where it wants to go and then decide but we can't pull all our eggs in the "where it wants to go basket". I actually doubt if it will go very far above that 6 maximum you have started with. I don't see it going a bunch higher because the FLs that are making it through aren't horribly numerous.

I was wondering how a 6 to 8 range might work out. Though you won't be able to judge much by the software reports and you probably are going to need a more constant baseline pressure past what those of us with plain OSA might use.
Don't know where that might be though. See where it wants to go...and maybe try that as a baseline (or in that area).

[Pugsy]

Which nasal pillow mask are you using?
You total leak number (while it is stable) is still a bit higher than we would normally expect from a nasal pillow mask at your low pressures.

[jwuzy]

Which nasal pillow mask are you using?
You total leak number (while it is stable) is still a bit higher than we would normally expect from a nasal pillow mask at your low pressures.

Resmed Swift FX...

What does Flow Limitation mean anyways?

[Pugsy]

Flow limitations are a reduction in air flow in terms of air flow through the airway.
They don't necessarily meet criteria for a hyponea or OA flag..maybe because of duration of the reduction or maybe the amount of reduction isn't quite enough...like for a hyponea the reduction has to be 40% reduction (Respironics machine definition) and maybe the reduction in flow is only 35%..or maybe it's 8 seconds instead of the 10 seconds it needs to get a flag.

If you have the clinician's manual it explains the various definitions for what it flags.
If you don't have it you can request it here.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

The idea behind UARS is that if a person has enough of these flow limitations that don't grow up to earn an OA or hyponea flag they can be just as harmful or bad for you and your sleep as those grown up OAs and hyponeas.
They can cause arousals from sleep, which we may or may not remember, but totally mess up the sleep architecture that we need for the restorative powers of sleep to work its magic.

[tan]

Just out of curiousity, the following settings, which according to Dr Krakow are disturbing sleep:
User flagging:
UF1 10% - 4 s
UF2 20% - 2 s

The values are arbitrary but the picture is different from my almost ideal (with AHI below 1.0), -- and I would appreciate if any one could please point out the real threshold values of flow limitations that disrupts sleep:

[jwuzy]

Here's mine from last night as well. Quite a bit of Flow Limitation. http://imgur.com/sADEt11

I raised my pressure from 4-20 last night. Anyone have any input?

[Pugsy]

Increasing the maximum did just what I expected...nothing.
Flow limitations and snores are the primary driving force behind pressure increases and yours aren't bad enough (per the machine's sensing) to drive the pressure up.
This is why I say that we can't go by what we see on these reports as a guideline for pressure needs when it comes to UARS. The flow limitations aren't "bad" enough to drive the pressures up...that's not saying they aren't bad enough to cause a problem with your sleep...just that these machines are designed to help out with bigger (worse) flow limitations per the algorithm that it was written for.

You are going to have to look at things from the minimum pressure stand point and forget the maximum because the machine isn't going to try to fix something that it doesn't think needs fixing.

You are going to have to use more minimum pressure to help hold the airway open better and prevent pretty much any collapse of the airway and you aren't going to be able to accurately judge the effectiveness of what you are using by these reports. You can get close but short of changing the SH flow limitations so you can flag flow reductions that the machine normally wouldn't care about, you have to go more on how you feel.
I am not sure that changing the user flags will help out that much but it might give you some sort of guideline or feel for what is happening.

The problem with doing the user defined flagging...we don't know at what point whatever flow reduction you are having that might be creating the problem, is going to be...is it at 20 % reduction? Is it at 10% reduction?
Is it at 30%? Heck, is it at 5%.
And what do we do about flow reductions that are a normal thing and don't always cause problems.
We could fix it so you could see a truck load of user defined flow reductions but they may or may not mean much other than we made them show up.

For now...if it were me....I think I would just address the flow limitations that are showing up now and see what happens...
That means more minimum pressure because they sure aren't driving the machine to want to do anything about it.
I normally would go up slowly but in your situation since you are already at the minimum pressure and the machine doesn't really want to do much...I would use 7 cm keep the max at 20 if you wish because it isn't ever going to go there and in fact at 7 cm I doubt it does much of anything at all.
If 7 isn't comfortable..try 6 for a little while and see what happens.

[jwuzy]

Thanks, I think we discussed this before. I don't want to go too high because my machine doesn't have a humidifier but I was starting to get bloody noses because I was drying up. I don't think my insurance would cover a humidifier... Any cheap alternatives?