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desiderata wrote:

mrbreezeet1 wrote:what kind of mask are YOU using? Is it discussed in your previous post(s)

Resmed Mirage Swift LT Nasal Pillow
The same as this (except I'm not as pale and have a better hairstyle):
https://1187b4d09c41350ddef3-8a2c38c894 ... T-side.jpg

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Nice, I wish I could wear one of those, I don't think it would seem so cumbersome. but I tend to breath through my mouth.
Have to have a way to keep it closed.

Yuck, your flow limitations are quite-quite horrible. Yet the RERA number shows mere 0.17. Either it's inaccurate or you don't have UARS. Our forum expert once suggested doing breath-by-breath review. You can either archive your data and send it to me or better examine every breath in the flow rate chart for irregularities. Also, I would try to minimize leaks even more. Sleep hygiene is important, too. Simple but not easy: do you wake up at the same time every day and immediately get out of the bed? If not, chances are that no matter what you do with your xPAP, you will have no relief just because your circadian is screwed up

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desiderata wrote:Who's the forum expert-- there's only one?

I think Tan is referring to a former forum member who also happened to actually run a sleep lab and knew his stuff when it came to evaluating individual breaths.
This forum member had a lot of aliases that he liked to use so it made for searching his words of wisdom a bit difficult.

One of his aliases was mollete
viewtopic/t88637/CPAP-Basics----Table-of-Contents.html
If you go to his first post and click on the Table of Contents link you get more reading.
He has done some FL discussion in the past...I just don't remember if it was under mollete or one of his other aliases.
His real name was Dave. Quirky guy but knew his sleep stuff backwards and forw ards.

I don't know for sure that you have UARS...you do have OSA and some doctors think that people with OSA also have UARS.
If you didn't have OSA it might be more important to evaluate for UARS but since the therapy is the same...cpap...it makes sense to do the cpap thing.
Only issue with cpap and UARS is that the data the machines gather isn't the greatest for evaluating therapy effectiveness in UARS patients. The data is more designed for the OSA side of things. UARS patients typically have to go more on how they feel than what they see on the machine's software reports. Makes it difficult since people want/need some kind of numerical value to help them determine therapy effectiveness. How they feel is hard to evaluate and do anything about.

desiderata wrote:

tan wrote:your flow limitations are quite-quite horrible. Yet the RERA number shows mere 0.17. Either it's inaccurate or you don't have UARS.

So, that means RERAs are a signifier for UARS, yes?

Google RERA UARS.

What else makes for a messy FL graph... Do I just have bad breathing habits?

Like smoking in your sleep??

Is the Airsense 10 For Her generally considered to be capable of accurately measuring RERAs? I'd have thought you'd need some of those sensors they use in sleep studies. But I don't understand how the machine gathers some of the data I see in Sleephead.

It could be that the machines cannot properly detect RERAs. As far as I know, scoring in the lab with EEG is still done manually. Though things may have changed lately.

I don't know how to do a breath-by-breath review; can someone who isn't an expert do a decent job of it, and is the process already spelled out somewhere around here?

Here is the idea:
1) You start here: the Flow Rate chart (second from the top)


2) keep left-clicking on that chart till you see breathing waveforms:


3) hold the mouse's right button and start continuously swiping left or right

4) post a few fragments here. Regular, proper wave forms are boring. You should be looking for periods of stopped breathing (almost a flatline) or impaired (waves with lesser amplitudes) followed by wild swings of resumed breathing. Those could be RERAs.

desiderata wrote:... because I don't always have a sense of tiredness, I may check the time...

Big F no. Don't check your time. Go to a chair and sit until you feel sleepy. Is your room where you sleep is absolutely dark? I suggest the No More Sleepless night book by Peter Hauri- it could be helpful in your case.

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desiderata wrote:I scrolled through the entire night. Not a single symmetrical sine curve.

normal sleep breathing doesn't look like a symmetrical sine wave.

Is there a specific reasons why:
- EPR == 1 (I would try 3, but even that wasn't enough for me to breathe comfortably);
- IPAP starts at 9;
- IPAP is limited at 13;
?

tan wrote:Is there a specific reasons why:
- EPR == 1 (I would try 3, but even that wasn't enough for me to breathe comfortably);

We didn't know what to try so I suggest try all settings and just choose one that was the most comfortable for her.

tan wrote: IPAP starts at 9;
- IPAP is limited at 13;

Lordy....don't let the guys over in the EPR "Is to be avoided or not" thread hear that you need/want/like some comfort. They will think you don't have any balls and haven't grown up.

To desiderata....
Do you have a screen shot handy of the Mar 25 night that isn't zoomed in? Just the overall detailed report without any zooming in on anything.. I was wondering where the pressure went to and stayed or not.
And yes...if you want to do snippets of the flow rate or flow limitation graph you don't need to include all that other stuff.

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once again, min 11, max 20.

Increasing the max to 20 (or in fact much more than 13) is unlikely to accomplish much if the machine only wants to kiss 13 on occasion but it wouldn't hurt anything to add a little more max. The machine will only go and responds as it feels the need to go and respond. Having the max higher doesn't really affect anything if it never goes there.
So PRs idea of 11 and 20...the max probably wouldn't really change much since it doesn't look like the machine wants to go there anyway.

I think now looking at the minimum is what we should look at.
Also at some point think about trying a fixed pressure but I don't have a good feel for what that would be just yet.

If you are comfortable with EPR at 1 then leave it there. The idea with EPR is mainly to make you feel comfortable breathing and remove any discomfort associated with the brain maybe getting hyper fixated on anything related to the breathing so that you can go to sleep easily and stay asleep as much as possible.

You don't need more minimum from the AHI stand point but the FLs...now they are still a concern and like we have talked about...we don't know for sure if they are responsible for your unwanted symptoms. They could be a factor though so I think it's worth at least investigating the FL response to a higher minimum pressure.

Remember science 101 when it comes to experiments...keep variables to a minimum unless something is causing an obvious problem that needs to be fixed immediately.

From all that I have read about UARS (and I know you aren't confirmed UARS) is that those patients often need more pressure beyond what gives them a good AHI, pointing to the OSA being well treated, to feel better. I think it is worth trying anyway. The main goal is to get you to feeling better and reducing any unwanted symptoms you have and not just targeting acceptable "numbers".

desiderata wrote: Min. 9: Pressure always goes immediately higher, so no need to have it lower. Am willing to try it out raised higher, if there's a suggestion for that.

Palerider has already suggested a minimum of 11 a number of times. What other suggestions do you need?

Max. 13: Pressure doesn't even get to 13 very often, and doesn't stay there a significant amount of time. Therefore it's not much of a factor in AHI or FLs. Am willing to try it out raised up a bit also.

In order to verify whether the suppression of FLs to be of benefit to you, you have to remove the upper limit

EPR at 1: I didn't like it at zero the first couple nights; 1 was better and still feels quite comfortable. I'm willing to try 2 or 3. Are there some people who have gotten a desired result by using higher exhale relief even when a lower one feels fine?

I have an EPR of 5, because with my IPAP of 13, I get aerophagia with EPAP 9 and above