UARS CPAP setting? Help me interpret OSCAR data

I've slept a couple nights with my CPAP now, but I feel I'm still doing worse than just sleeping on the side without the CPAP.

Here's my sleep studies for reference:

Here are the results from my earlier in-lab study:

AHI: 10, RDI: not scored
https://imgur.com/a/5jHyNvu
https://imgur.com/a/ChqAO3F

New results from Watchpat while sleeping on the side:

AHI: 1.1, RDI: 16.2
https://imgur.com/a/mknxORS
https://imgur.com/a/Ec3rtLA

I'm using a nasal mask (Philips Dreamwear), and the CPAP came with settings 5-15, EPR: 2. I noticed air leaking out of my mouth, so I'm using mouth tape every night.

I also noticed a feeling of not getting enough air, so I raised the min pressure to 7 and turned off EPR (I felt like it set in before I was done inhaling, again leading to feeling of insufficient air).

The AHI is low, but I still felt terrible in the morning and woke up after just 6 hours of sleep, in addition to multiple wakeups during the night. After waking up my nose felt congested.

Any ideas what's going on? Setting changes?

OSCAR data (I was going to bed at 23:45, before I was wearing the mask while watching TV):

You might try raising your min pressure a bit, but with EPR of 3, and see how you do.

The idea is EPR can help with the flow limitations that can lead to the RERAs characteristic of UARS.

And you'll have to be patient; it can take weeks or months to adjust.

And check the instructions again - you don't need all those graphs - only 4-5 I believe.

Here's another night: I raised both min pressure and EPR by 1 and I think I feel slightly better.

However, I noticed I'm still getting mouth leeks even though I'm wearing both chin strap and mouth tape right now.

Also I noticed the lower part of my nose is irritated in the morning (feels like when you have a sunburn).

Any ideas about this?




Other info: https://i.imgur.com/tDBdRTZ.png

throwaway08150 wrote: ↑

Fri Jul 24, 2020 10:22 am

Any ideas about this?

two things-

1. please post charts in this order-
Suggested Support Order for your charts
Event Flags
Flow Rate
Pressure
Leak Rate
Flow Limit (Only for Resmed machines, not on Respironics)

it may sound like i'm being picky, but i'm not. the less events charts you show, the easier it is to see what is important. that way, you can get good advice.

2. please, when you have time, go to your user profile and fill in your equipment. that way it shows up at the bottom of each and every one of your posts.

thank you and good luck!!

1. please post charts in this order-
Suggested Support Order for your charts
Event Flags
Flow Rate
Pressure
Leak Rate
Flow Limit (Only for Resmed machines, not on Respironics)

Seems like I just need to remove my second screenshot? Which I just did.

2. please, when you have time, go to your user profile and fill in your equipment. that way it shows up at the bottom of each and every one of your posts.

Thanks I just added my equipment.

Get some Lansinoh lanolin ointment/cream and use it liberally during the day and sparingly at night. It will help the soreness at the nostrils. Found in the baby aisle of most stores as nursing mom's use it for nipple chaffing when breast feeding. Won't hurt you or the mask and it helps heal faster.

If you do have UARS you are going to have to go more by how you feel than what the data is going to show you.
The data the machine collects is more along the lines of OSA data which isn't the same as UARS data. It really can't detect the more minor changes that are known to be associated with UARS and disturb sleep.
Your AHI and other data won't ever be all that remarkable if all you have is UARS.

Play with the minimum pressure....keep a setting for a week or two and keep a detailed log as to how you feel.
Then try another setting for a week or two.

Historically people with UARS tend to need a more higher minimum pressure to feel better well past where the data looks good because the data wasn't bad to start with. So the software isn't all that much help....you will have to rely more on subjective feelings.

Oh...unless minor mouth leaks are waking you up...they are no where near the level where they will be a negative impact on the therapy itself.
Now if they are causing wake ups...then that means disturbing sleep and of course that is unwanted.

I wish my leak line looked as good as yours. I always open my mouth at some time during the night but it's rare, never prolonged and I sleep through it so I don't care. 5 minutes of mouth breathing leak isn't the end of the world if you sleep through it.

Nasal soreness ... I used to have that from time to time with the Tap Pap. It usually meant I had the part that goes in the nose at the wrong angle.

I realize that not all nasal masks let you tweak that...

If you are able, I strong urge trying the Bleep Dreamport mask. Yes, its something new to get used to but once you do the seal is PERFECT and the comfort is unparalleled. The only issue could be if you are a mouth breather, but I think you'd already know that...

Thanks for all of your replies!

If you do have UARS you are going to have to go more by how you feel than what the data is going to show you.
The data the machine collects is more along the lines of OSA data which isn't the same as UARS data. It really can't detect the more minor changes that are known to be associated with UARS and disturb sleep.
Your AHI and other data won't ever be all that remarkable if all you have is UARS.

If the CPAP doesn't measure my UARS correctly, then why does it raise the pressure through the night? Is there something else it measures?

I think someone mentioned the flow limitations graph to me. Is that something I should monitor?

CPAP was never designed for UARS. It was designed for OSA. The bulk of the data points are related to OSA and not UARS. UARS changes that cause arousals are or can be much more subtle and these machines were never designed with UARS criteria in mind.
For many, many years UARS wasn't really considered a viable diagnosis. Now the medical community has sort of done an about face and to really for sure diagnose UARS a person needs a sleep study with a Pes device. Not a lot of sleep labs do it and since the gold standard treatment for UARS is the same as OSA...the cpap machine people will usually get a cpap machine but there isn't anything that the cpap machine can give us to help figure out what pressure a person needs to prevent UARS events from happening...Again...a sleep study using cpap and the Pes device is needed. I know people who have had it done though...so it can be done.
One person comes to mind...her cpap machine only wanted to give her 8 cm pressure and that's all it would do with her flow limitations..and her AHI was already non existent. She had the sleep study with cpap and the Pes device and guess what...she need 13 cm pressure all night long to prevent her UARS events from happening. It was at that point she finally started feeling improvement.

Big difference between what the machine wanted to give and what was actually needed. I hear this time and time again when people suspect UARS and their reports from their machines aren't greatly exciting.

Your machine wants to increase the pressure in response to flow limitations. They may or may not be related to UARS.
Flow limitations can disturb sleep though and they are thought of as an early pre-cursor to OSA which is why the machines will increase the pressure in an effort to reduce/prevent them. Not all Flow limitations mean UARS but there is always the possibility that they go hand in hand. We just don't have any reliable data point to reference.

Now if you are experiencing any nasal congestion issues...we have a different discussion about the FLs shown on your reports but for now I am going to assume you aren't having nasal congestion.

You essentially just have to self titrate using higher minimums despite what the machine wants to do or shows...and go more on how you feel. Keep a detailed log and then look back to see at what point you started actually feeling better. It's not a quick fix by any means because even if you did have an in lab sleep study with cpap and Pes device to find optimal pressures...it takes a while for the body to heal and get back to any type of half way normal feel.

We tell people with documented OSA that we can't get in a hurry and expect overnight miracles...it takes time. We didn't get in this shape overnight and we can't fix it overnight either.
We tell people with UARS...expect it to take even longer. It's just not as easy to fix because we can't go by the AHI or leak or pressures or even the FL graph. The FL graph is a pointer but it isn't the end all data point. It is at least a starting point (assuming no nasal congestion which really messes with the FL graph) so we start there.

You just keep raising the minimum pressure and watch the FL graph and see if it levels out or not so it isn't so active AND you monitor how you feel in general because that is actually the end goal...sleep better and feel better no matter what the software reports show.

Side note..your machine will flag RERA which are Respiratory Event Related Arousals. When we see a lot of RERA flagging we think UARS.
Those flags mean your breathing pattern looks like the breathing pattern of known arousals from known respiratory event causing arousals and they probably don't meet criteria for OA or hyponea event. Very minor changes in the airway that cause arousals but don't meet the criteria for apnea event of some sort. Doesn't mean they don't mess with your sleep though.

RERAs... may or may not be all that helpful for people with UARS as a data point to watch. The fact you aren't having many (if any) RERA flags doesn't really mean much. I tend to put that data point in a teaspoon along with a grain of salt because it is sort of an educated guess anyway and I haven't seen any documentation proving it one way or the other as to reliability in pointing to UARS. To know for sure if any arousal is respiratory related or not we first have to know if we were asleep first and the machine has zero way to monitor or know if we are asleep or not.
So how can it know for sure if an arousal from sleep is related to anything if it can't know if we are asleep or not.

Now when I see a lot of RERAs flagged...we at least know crappy sleep and the first culprit that comes to mind is potential airway issues so we go with either more minimum or more maximum if a person is limiting the max. Never hurts to try more pressure unless the more pressure ends up creating a problem...like aerophagia (fairly common) or triggering centrals (rare). Should more pressure create a problem then we sit back an re-evaluate things.

Thanks Pugsy those are great replies! This is great help!

I have some more questions:

needs a sleep study with a Pes device

Can you give me some pointer to this Pes device? I never heard of it and couldn't find it on Google.

I know there are Watchpat home sleep tests which are designed to measure UARS/RERAs. Would it make sense to wear one of those together with my CPAP?

She had the sleep study with cpap and the Pes device and guess what...she need 13 cm pressure all night long to prevent her UARS events from happening.

I wish they would have done that during my sleep study. I didn't even wear the CPAP during the study; they just handed it to me, preset to 5-15.

Now if you are experiencing any nasal congestion issues...we have a different discussion about the FLs shown on your reports but for now I am going to assume you aren't having nasal congestion.

I'm sorry I should have mentioned that earlier: I do indeed have nasal polyps and chronic sinusitis. I'm using nasal steroid to treat those, but I definitely have more nasal congestion than the average person.

Given that, what do the flow limitations mean?

Oh...unless minor mouth leaks are waking you up...they are no where near the level where they will be a negative impact on the therapy itself.
Now if they are causing wake ups...then that means disturbing sleep and of course that is unwanted.

Indeed some of the mouth leaks are waking me up. Otherwise, how would I know it's a mouth leak and not some other leak? Will try out a full-face mask and see if it's better.

You just keep raising the minimum pressure and watch the FL graph and see if it levels out or not so it isn't so active AND you monitor how you feel in general because that is actually the end goal...sleep better and feel better no matter what the software reports show.

Thanks, I will do that!

I don't know much about the Pes device.
https://en.wikipedia.org/wiki/Upper_air ... e_syndrome

https://www.breathesleepandbewell.com/a ... rome-2.pdf

The Pes device is an esophageal monitoring catheter.

I had a link that explained how the Pes device was used to help diagnose UARS but I can't seem to find it at the moment.

There is no way in hell the WatchPat can be used do for sure diagnose UARS. Now it might measure RDI and all that but it's not a for sure diagnostic tool. It's good but not that good. Would it be useful for figuring out pressure requirements when using a cpap...all you have to go on is the RDI....I have no idea but I don't see it myself and you would have to use it many nights in a row to test pressures.

UARS has been more of a "rule out" diagnosis in the past...when nothing else fits or explains things then they blamed UARS. It's not an easy diagnosis to make sometimes. The medical community is just more recently in the last few years starting to address it as a separate diagnosis in its own class and not a catch all basket for people who didn't meet OSA criteria.

Given a choice of the 2....I much prefer my OSA diagnosis. It's much easier treated and stands a greater chance for seeing improvement faster.

Here's another night. I raised the pressure by 1 and was only using mouth tape, not the chin strap. The results show some more mouth leaks.

I tried raising the EPR, but I always feel it kicks in before I'm done inhaling, which makes it harder for me to fall asleep.

I also got the feeling of getting more air into my stomach, so maybe I'll lower the min_pressure a bit again.