Can someone explain my sleepy head chart?

Long story short - I have had two sleep studies confirming a UARS diagnosis. I do not have any apnea, my AHI on studies was <5. The first study used a Pes to determine the diagnosis and while the second did not, it showed multiple stage shifts, increased EEG arousals, reduced NREM sleep and snoring. My titration was based off snoring in the supine position, and not FL or EEG arousals, so I'm not sure it is accurate. Anyway, they told me to use a pressure of 7 or 8. I got my hands on a data capable machine and ran auto for one night with settings at 6.5 - 12... see the pic below. Why are the pressures rising and falling like that?

I've been running straight PAP of 7 since then with no improvement in my day time fatigue, awakenings or nocturia.


http://imgur.com/gallery/vqbg3

You are using a Respironics machine in apap mode and the bulk of those pressure changes are simply test pressure probes.
The spikey sawtooth looking increases are just Respironics testing the waters. As to why....beats me but it is just something they do in apap mode.
The pressure changes aren't nearly as quick as they look like on the graph. It's a scale thing. If you zoom in real close you see it goes up gradually and comes back down gradually.

The SleepyHead data isn't going to help you much since you have UARS.
You are going to have to rely on how you feel more than what the reports show.
Using snores as a guide for determining pressures isn't particularly useful for UARS but it's about all they have to get you a starting point.

If it were me I would systematically increase the pressure up to around 10 to 12...give each setting a week...keep a diary as to how you feel and how you felt your sleep.
Seems like every UARS patient I know of seems to need 2 to 3 cm more pressure than what looks good on the SH report before they actually start feeling better.
The machine isn't really designed to measure UARS type of data...mainly it's OSA data and you don't have OSA.
I am not even sure that the Flow limitation flagging is all that helpful.

We like numbers to base effectiveness on...but with UARS and the limitations of the data the machines give us...we don't have numbers for validation.

Thanks pugsy. that's more or less what i thought. i'll slowly start increasing the pressure i guess.

I also suggest you try a soft cervical collar - it'll help keep your airway open, head up and jaw (if not lips) closed. Maybe your 'flow rate' will improve with a consistently more open airway.

Thanks Julie. I do wear a cervical collar thanks to the advice on this board and it has helped.

xxyzx wrote:

mangos21 wrote:Long story short - I have had two sleep studies confirming a UARS diagnosis. I do not have any apnea, my AHI on studies was <5. The first study used a Pes to determine the diagnosis and while the second did not, it showed multiple stage shifts, increased EEG arousals, reduced NREM sleep and snoring. My titration was based off snoring in the supine position, and not FL or EEG arousals, so I'm not sure it is accurate. Anyway, they told me to use a pressure of 7 or 8. I got my hands on a data capable machine and ran auto for one night with settings at 6.5 - 12... see the pic below. Why are the pressures rising and falling like that?

I've been running straight PAP of 7 since then with no improvement in my day time fatigue, awakenings or nocturia.
http://imgur.com/gallery/vqbg3

============

if your AHI is low then something else is the problem

higher pressure may help or cause other problems
and what is disturbing your sleep is something other than what causes AHI
you need to find the real problem and address it

thanks xxyzx. the real problem is UARS, as is stated in my initial post.

you have to keep an eye on the flowlimits and the snoring! increase the pressure until both are gone - at least the flowlimits.

CPAP is a good choice ... if you sleep in one position. I don't know respironics - Airsense 10 in the "for her" mode (well dialed in) might be the obvious choice.

UARS is basically: your body reacts to obstructions or changes in your flowrate long before it gets scored as hypopnea or apnea - long before that. If you see RERAs (assuming your machine is capapble of scoring them) - that is the worst of your problems.
If I had to translate the events from sleep apnea to UARS it would be as follows:
apnea --> RERA
hypopnea --> flowlimit (maybe even (severe) snoring)

you might see some apneas or hypopneas - ignore them! most likely SWJ or from STS. Your problem are indeed real RERAs!
remember: the machines are not able to detect an arousal - they can only detect the change in the breathing pattern which is usually related to an RERA - not every RERA will be a realy arousal. If there were no flowlimits or obstructions around it was most likely a change in position.

If you are keen for a resmed device make sure, that it has the for-her mode! the normal autoset mode will most likely wake you up and make it worse or don't improve it at all.

and ignore xxyzx! he is not always wrong, but as you can see: he just googled UARS and is already giving out advice about how to treat the (newly found - for him) problem!

He just started CPAP and failed already on some machines and is in the process of failing his new machine - there really is not much advice he can give, as he simply lacks (first hand) experience. His capabilities of understanding a scientific paper and making the proper conclusions to the case at hand are very limited!

this does NOT mean, that you should take my advice and go for it! - I'm just some random guy in a completely unmoderated board that was in the mood of spamming or sharing - depends on the view^^

I have to admit, that I did not read your post - usually it is just some random spam from a googlesearch on the topic. so, why bother? (I do not say, that you are always wrong - but you are very often wrong. The germans have a very nice saying about a blind chicken)

as far as I can tell, the doctors do say the same. Indeed oral appliances (and other things) do work for UARS - as does CPAP! As with OSA: CPAP works always, where the other things only sometimes work.
Not every machine works for UARS in peticular - not every manufacturer is paying attention to UARS. But it is a growing market and the doctors start (albeit slowly) to diagnose that.