UARS and CPAP

palerider · Post by **palerider** » Fri Apr 19, 2019 12:55 pm

The first one is bad flow limitations leading to a respiratory related arousal and recovery breaths.

werther · Post by **werther** » Mon Apr 22, 2019 4:49 am

Thank you both for responding.

I'm so frustrated. I keep removing the mask. Sometimes I catch myself other times I'm not aware of it. I even tape the mask to my hair which hurts when removing it!

On the bright side, I begin to feel better after a night with 5 hours of sleep all with cpap compared to nights with 2 hours sleep with cpap and 6 hours without.

Sorry for ranting (guess what kind of night it was today).

werther · Post by **werther** » Tue May 07, 2019 2:00 am

So, not much to say, I'm still trying every night. One issue is my poor nasal breathing. Sometimes I have sinus headache when I have worn the mask the whole night. When I take the mask off but not the tape, I get VERY BAD headache the next morning. I wonder if I should get surgery for it. At least allergy season has ended now.

What's up with these shallow flow rates? The machine detects flow limitation, but much later than it should I think. And then it drastically raises the pressure (by 4cmH2o?!).

werther · Post by **werther** » Sun Feb 23, 2020 8:55 am

Hey, so over the last few months I tried out a bunch of different things (cpap and non cpap). And even though I would say I sleep a bit better, it is still far from perfect. I have attached one recent night, as well as a few close-ups. In my understanding, with UARS you want to round out the flow curves. But even though I increased my pressure to 12/15, my curves still often seem flat.

Is increasing the pressure until my curves are completely rounded out the right way to move on forward?

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slowriter · Post by **slowriter** » Sun Feb 23, 2020 9:34 am

werther wrote: ↑
Sun Feb 23, 2020 8:55 am
In my understanding, with UARS you want to round out the flow curves. But even though I increased my pressure to 12/15, my curves still often seem flat.

Is increasing the pressure until my curves are completely rounded out the right way to move on forward?

No.

You want to raise pressure support (PS) to address the FL.

Maybe try PS of 4 and report back?

werther · Post by **werther** » Sun Feb 23, 2020 9:42 am

slowriter wrote: ↑
Sun Feb 23, 2020 9:34 am
No.

You want to raise pressure support (PS) to address the FL.

Maybe try PS of 4 and report back?

Ok, I will try that. Thank you.

werther · Post by **werther** » Sat Mar 14, 2020 5:36 am

After trying the higher pressure support, I had issues with leaks (again) that I could not get resolved. I switched to a full face mask. My sleep quality has been a bit mixed, some nights were ok, others were not. Here are my two most recent nights and some very typical flow curves. Can i make any adjustments?

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slowriter · Post by **slowriter** » Sat Mar 14, 2020 11:10 am

Your pressure isn't changing during the night, and you're getting 0 OAs. This suggests to me you can lower your min EPAP; maybe to 9?

Notice that your FL has improved with the higher PS?

How does you sleep quality compare to before you made the PS changes?

werther · Post by **werther** » Sat Mar 14, 2020 11:58 am

Yes, I had 11 "flagged" obstructive apneas in the last 6 nights (about 1 every 4 hours). I don't think they seem to be an issue, and many nights I dont have any at all. I can try an EPAP of 9.

I'm not so sure about any FL improvements. I don't have "bad" flow limitations like I used to (like these) but to me it seems my curves often aren't rounded: either they are flat (e.g. 6:03:20 above) or they have this slight "M"-shape (starting around 5:44:00). The reason why I had increased my pressure in the first place were these types of limitations (maybe sometimes worse than that).

I don't feel any difference in my sleep quality.

Treatedandtired · Post by **Treatedandtired** » Sat Mar 14, 2020 1:41 pm

werther wrote: ↑
Sat Mar 14, 2020 11:58 am
Yes, I had 11 "flagged" obstructive apneas in the last 6 nights (about 1 every 4 hours). I don't think they seem to be an issue, and many nights I dont have any at all. I can try an EPAP of 9.

I'm not so sure about any FL improvements. I don't have "bad" flow limitations like I used to (like these) but to me it seems my curves often aren't rounded: either they are flat (e.g. 6:03:20 above) or they have this slight "M"-shape (starting around 5:44:00). The reason why I had increased my pressure in the first place were these types of limitations (maybe sometimes worse than that).

I don't feel any difference in my sleep quality.

I'm quite interested in where this goes as I find myself in a very similar situation. My AHI is low (typically <1), I don't feel well rested and my flow curves are nearly always flat topped or jagged, M shaped. Good luck to you.

slowriter · Post by **slowriter** » Sat Mar 14, 2020 5:33 pm

werther wrote: ↑
Sat Mar 14, 2020 11:58 am
Yes, I had 11 "flagged" obstructive apneas in the last 6 nights (about 1 every 4 hours).

Oh, I missed that.

In any case, adjust the EPAP for the OAs, and the PS for the FL and hypopneas.

werther · Post by **werther** » Tue Mar 17, 2020 12:22 pm

slowriter wrote: ↑
Sat Mar 14, 2020 5:33 pm
Oh, I missed that.

In any case, adjust the EPAP for the OAs, and the PS for the FL and hypopneas.

"
You didn't miss it. I should have mentioned it. I didnt want to "cherry-pick" "bad" nights. Here is one night with EPAP 9 where I did have obstructive apneas as well as one flagged hypopnea.

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slowriter wrote: ↑
Sat Mar 14, 2020 5:33 pm

In any case, adjust the EPAP for the OAs, and the PS for the FL and hypopneas.

Do you see my posted flow curves as flow limited? I would gladly further increase my PS to see if I might benefit from it.

slowriter · Post by **slowriter** » Tue Mar 17, 2020 2:31 pm

werther wrote: ↑
Tue Mar 17, 2020 12:22 pm
Do you see my posted flow curves as flow limited? I would gladly further increase my PS to see if I might benefit from it.

A little bit, in places.

You could try higher PS and see; can't hurt (unless it leads to higher centrals).

If you haven't already, you might try changing the trigger setting to high or very high. I and others have found that this setting can mitigate reported CAs.

werther · Post by **werther** » Mon Mar 23, 2020 6:23 am

slowriter wrote: ↑
Tue Mar 17, 2020 2:31 pm
You could try higher PS and see; can't hurt (unless it leads to higher centrals).

If you haven't already, you might try changing the trigger setting to high or very high. I and others have found that this setting can mitigate reported CAs.

Unfortunately, I had a night with much higher centrals. I didn't sleep bad though, and the night before that was even quite good. I'm trying out the very high trigger setting tonight.

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slowriter · Post by **slowriter** » Wed Mar 25, 2020 5:45 pm

werther wrote: ↑
Mon Mar 23, 2020 6:23 am
Unfortunately, I had a night with much higher centrals. I didn't sleep bad though, and the night before that was even quite good. I'm trying out the very high trigger setting tonight.

And maybe lower PS to 5.4 or 5.6?

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