UARS & CPAP

I'm still learning how to read these, so with that caveat:

Inspiration is top, expiration bottom.

With UARS, you often see inspiratory FL, which will be indicated by jagged curves.

Here, your's are rounded, which is what you want.

You can search for example graphs to look for this yourself. Here's an article that discusses, and gives some examples.

In your case, there's something funky going on with expiration on some of the breaths.

Not sure how common that is, but I guess what I'm thinking is you could use a bit more pressure. Your current setting of 4 is super low, and for a lot of people is actually uncomfortable.

slowriter wrote: ↑

Tue Dec 03, 2019 6:31 am

I'm still learning how to read these, so with that caveat:

Inspiration is top, expiration bottom.

With UARS, you often see inspiratory FL, which will be indicated by jagged curves.

Here, your's are rounded, which is what you want.

You can search for example graphs to look for this yourself. Here's an article that discusses, and gives some examples.

In your case, there's something funky going on with expiration on some of the breaths.

Not sure how common that is, but I guess what I'm thinking is you could use a bit more pressure. Your current setting of 4 is super low, and for a lot of people is actually uncomfortable.

Yes, it looks like I exhale rushed / all at once. and then slowly build up to inhaling. could be because my flex was set at 2. I will try 3, maybe bipap would be better.
At this point I will just focus on trying to get to sleep with the cpap on.

miner49er wrote: ↑

Wed Dec 04, 2019 11:20 am

slowriter wrote: ↑

Tue Dec 03, 2019 6:31 am

I'm still learning how to read these, so with that caveat:

Inspiration is top, expiration bottom.

With UARS, you often see inspiratory FL, which will be indicated by jagged curves.

Here, your's are rounded, which is what you want.

You can search for example graphs to look for this yourself. Here's an article that discusses, and gives some examples.

In your case, there's something funky going on with expiration on some of the breaths.

Not sure how common that is, but I guess what I'm thinking is you could use a bit more pressure. Your current setting of 4 is super low, and for a lot of people is actually uncomfortable.

Yes, it looks like I exhale rushed / all at once. and then slowly build up to inhaling. could be because my flex was set at 2. I will try 3, maybe bipap would be better.
At this point I will just focus on trying to get to sleep with the cpap on.

If you're at pressure 4, flex won't do anything, because nowhere to go but up.

I'd try min of 5 or 6.

Flex doesn't even normally engage at all unless the pressure is at least 6 cm on Respironics machines.

slowriter wrote: ↑

Wed Dec 04, 2019 12:18 pm

miner49er wrote: ↑

Wed Dec 04, 2019 11:20 am

slowriter wrote: ↑

Tue Dec 03, 2019 6:31 am

I'm still learning how to read these, so with that caveat:

Inspiration is top, expiration bottom.

With UARS, you often see inspiratory FL, which will be indicated by jagged curves.

Here, your's are rounded, which is what you want.

You can search for example graphs to look for this yourself. Here's an article that discusses, and gives some examples.

In your case, there's something funky going on with expiration on some of the breaths.

Not sure how common that is, but I guess what I'm thinking is you could use a bit more pressure. Your current setting of 4 is super low, and for a lot of people is actually uncomfortable.

Yes, it looks like I exhale rushed / all at once. and then slowly build up to inhaling. could be because my flex was set at 2. I will try 3, maybe bipap would be better.
At this point I will just focus on trying to get to sleep with the cpap on.

If you're at pressure 4, flex won't do anything, because nowhere to go but up.

I'd try min of 5 or 6.

what about gas? I am getting stomach pain especially when I lie on my side

miner49er wrote: ↑

Wed Dec 04, 2019 12:33 pm

what about gas? I am getting stomach pain especially when I lie on my side

Oh, I can't help with that; I've been blessed so far with never experiencing that symptom!

Maybe pugsy has some input?

slowriter wrote: ↑

Wed Dec 04, 2019 12:45 pm

Maybe pugsy has some input?

For aerophagia issues...the usual wiki/index.php/Aerophagia
and if pressures are needed that cause aerophagia issues then maybe a bilevel machine.

For UARS issues....I don't do flow rate evaluations for UARS. I could never find a good enough baseline to use as a guide and the machine's flow rate was never designed for the minute changes that might indicate UARS anyway. I am just not comfortable doing it.
I don't feel that I know enough definitive information about what UARS looks like in the flow rate...or even if it can be spotted at all.

Historically though it seems like UARS patients always seem to need a lot more pressure to alleviate their symptoms than what the machine will want or need to go to so more baseline is usually needed along with keeping meticulous sleep logs and symptom recording.
Auto mode and just allowing the machine to sort things out probably isn't of any great benefit. Just have to bite the bullet and use more minimum and hope it doesn't open the door for the aerophagia monster to come calling.
Flex isn't the best option for exhale relief when trying to create a bilevel situation though to help with aerophagia.
The absolute most Flex can give as a drop in pressure during exhale is 2 cm and that is at the setting of 3 and IF the person breathes forcefully enough to get the full drop. The actual amount of drop is flow based...and if someone is a shallow breather they might not even get 2 cm at the setting of 3.

Minimum pressure does have to be at least 6 cm though for Flex to engage at all.

Pugsy wrote: ↑

Wed Dec 04, 2019 1:11 pm

... it seems like UARS patients always seem to need a lot more pressure to alleviate their symptoms than what the machine will want or need to go to so more baseline is usually needed along with keeping meticulous sleep logs and symptom recording.
Auto mode and just allowing the machine to sort things out probably isn't of any great benefit. Just have to bite the bullet and use more minimum and hope it doesn't open the door for the aerophagia monster to come calling.

I have definitely found this to be so in my case.

If you look at my thread, I started out with CPAP with pretty low pressures; we're talking in the range of 6 or 7.

When I had a subsequent titration study, it confirmed I needed much more pressure, and pressure support, to eliminate the RERAs.

I've read this is a pretty common thing with UARS.

slowriter wrote: ↑

Wed Dec 04, 2019 1:16 pm

Pugsy wrote: ↑

Wed Dec 04, 2019 1:11 pm

... it seems like UARS patients always seem to need a lot more pressure to alleviate their symptoms than what the machine will want or need to go to so more baseline is usually needed along with keeping meticulous sleep logs and symptom recording.
Auto mode and just allowing the machine to sort things out probably isn't of any great benefit. Just have to bite the bullet and use more minimum and hope it doesn't open the door for the aerophagia monster to come calling.

I have definitely found this to be so in my case.

If you look at my thread, I started out with CPAP with pretty low pressures; we're talking in the range of 6 or 7.

When I had a subsequent titration study, it confirmed I needed much more pressure, and pressure support, to eliminate the RERAs.

I've read this is a pretty common thing with UARS.

does your machine sometimes try to "breath for you". I noticed that sometimes the breath will start before I inhale and end before I'm done inhaling.

miner49er wrote: ↑

Thu Dec 05, 2019 3:00 pm

does your machine sometimes try to "breath for you". I noticed that sometimes the breath will start before I inhale and end before I'm done inhaling.

Your machine doesn't 'breathe for you' *at all*. Aflex drops the pressure so you can exhale a little easier, then it raises the pressure back up to normal in preparation for your next breath.

This does tend to confuse many people though.

palerider wrote: ↑

Thu Dec 05, 2019 3:05 pm

miner49er wrote: ↑

Thu Dec 05, 2019 3:00 pm

does your machine sometimes try to "breath for you". I noticed that sometimes the breath will start before I inhale and end before I'm done inhaling.

Your machine doesn't 'breathe for you' *at all*. Aflex drops the pressure so you can exhale a little easier, then it raises the pressure back up to normal in preparation for your next breath.

This does tend to confuse many people though.

thats why I put it in quotes.

miner49er wrote: ↑

Thu Dec 05, 2019 3:00 pm

does your machine sometimes try to "breath for you". I noticed that sometimes the breath will start before I inhale and end before I'm done inhaling.

The only experience I have with a respironics machine was during my titration study. I struggled with it in a way I don't with the resmed machine I've tried, but I think part of that was some setting the tech had not turned on for part of the night.

miner49er wrote: ↑

Thu Dec 05, 2019 3:46 pm

palerider wrote: ↑

Thu Dec 05, 2019 3:05 pm

miner49er wrote: ↑

Thu Dec 05, 2019 3:00 pm

does your machine sometimes try to "breath for you". I noticed that sometimes the breath will start before I inhale and end before I'm done inhaling.

Your machine doesn't 'breathe for you' *at all*. Aflex drops the pressure so you can exhale a little easier, then it raises the pressure back up to normal in preparation for your next breath.

This does tend to confuse many people though.

thats why I put it in quotes.

You said that "the breath will start"... but, it *doesn't* it just raises the pressure back up to your set pressure in preparation for you to take another breath.

And no, Slowwriter's machine doesn't do that.

Update: I think I have a problem with the flex function. to quote another site:
"I'll be out front with, I don't like Flex of any kind. I think Philips really missed the boat compared to Resmed's EPR. Flex predicts the timing of inhale and exhale in AFlex and exhale in CFlex, while EPR follows the respiration lead with changes in pressure that last through the entire inhale or exhale, just like bilevel. This anticipation by the Philips machines results in many people with much higher events, especially hypopnea, and a common inhale time that is longer than exhale time. That is not natural, and it doesn't match up with the flow rates on these individual's charts. I think this mis-timing of respiratory trigger and cycle is responsible for a lot of problems and sleep disruptions in more sensitive people. JMHO.

Cflex only reduces pressure for expiration, and returns pressure to the CPAP setting before exhale ends. In many people it returns that pressure to CPAP long before exhale is complete, and the machine records that moment as the start of inhale. (note CPAP pressure is the same as IPAP pressure in bilevel terms). This increase in pressure before exhale is over means many people feel like exhale has been cut-off and it reduces the volume of the subsequent breath. AFlex just doubles up on the errors since it provides pressure changes at both inhale and exhale transitions.

CFlex and AFlex works best for people with normal strong respiration that does not include a period of zero or near-zero flow near the end of expiration. For these people, Flex is comfortable and effective. For those with a longer zero flow at the end of expiration, before inspiration begins, Flex is a problem. This is based on many many observations, and I can predict who will have problems with Flex vs EPR based on the flow rate wave-form. "

This definately describe smy bereathing as I have a slowdown in intake at the top of my breath followed by a short pause before exhale. The flex is really messing up my breathing cycle and making me feel suffocated and out of breath.
I tried turning flex off but at a min of 7 it feels hard to exhale against the pressure. I think my best bet is to try to get used to no flex, or to buy a used ResMed bilevel as slowrider suggested.

I am going to jump the gun and just order the used Resmed. I don't think I'll be able to get meaningful sleep with any type of flex and without flex I haven't tried but I also don't feel capable of spending another week getting terrible sleep with work. I was holding out because I was weighing to option of switching to a mouth brace approach. I still think Cpap is the most effective so I'm going to take the risk that I can sleep with the bilevel resmed machine.

miner49er wrote: ↑

Mon Dec 09, 2019 8:51 am

I tried turning flex off but at a min of 7 it feels hard to exhale against the pressure.

What kind of physical shape or what kind of health problem do you have that you can't exhale easily against 7.0?