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Bipap Titration for Preliminary UARS Diagnosis
#1
Bipap Titration for Preliminary UARS Diagnosis
I would like some help for Bipap titration for my breathing related sleep disorder. My preliminary diagnosis is UARS with WatchPAT. However, will get full PSG very soon to confirm. 

Some Questions

1) I am not getting enough sleep on CPAP. How to find a best mask? I am using N30 nasal pillows. I am a stomach sleeper ( I am not able to fall asleep side or supine). My problem with nasal pillow is I need to adjust it constantly at night as it gets squeezed between my face and pillow. Is there any mask recommendation?

2) I am not too much obsessed with numbers. The most important predictor of response for me is how I feel when I wake up. If I can sleep with the mask on minimum 7 hours (happens very rare), I feel better. What are the tips for getting used to a mask? 

3) I attached some flow rates. Are you seeing any gross abnormality there? As per WatchPAT my RDI is 18 while AHI is 1.2 so I am very likely experiencing RERAs. 

I really appreciate any feedback and advice. Thanks


Attached Files
.pdf   Screen Shot 2021-02-21 at 2.23.15 PM.pdf (Size: 870.9 KB / Downloads: 19)
.pdf   Screen Shot 2021-02-21 at 2.24.45 PM.pdf (Size: 838.28 KB / Downloads: 12)
.pdf   Screen Shot 2021-02-21 at 2.25.20 PM.pdf (Size: 831.31 KB / Downloads: 13)
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#2
RE: Bipap Titration for Preliminary UARS Diagnosis
Your profile need to be modified to show that you're using a Resmed Aircurve 10 Vauto, same as me. Seeing ASV on the profile, I was expecting something else. In Vauto mode you are using EPAP min 6.0, max pressure 11.0 and PS 4.0, so your settings prevent pressure from changing more than 1-cm. Your first zoomed screenshot shows some variation in respiratory volume, but no flow limitation or issues that should be affecting sleep. The second screenshot you're awake. The full night screenshot has about 2-hours cropped out of it, and the monthly calendar needs to go so additional information is apparent on the left column statistics and settings, and most importantly you did not include flow limitations. You are asking to optimize for UARS and that means the flow limit graph is most important.

The complete lack of flow limitations in statistics suggests to me the PS 4 is dealing with that pretty effectively. You have over 7 hours of therapy time, but that is fragmented into two sessions separated by a 1-hour break. I am sure that if my sleep pattern looked like that, I would feel equally dissatisfied with how I feel. The therapy itself looks pretty good, what I can see of it. I think it's going to take a bit more information to form a working opinion or recommendation.
Sleeprider
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#3
RE: Bipap Titration for Preliminary UARS Diagnosis
(02-21-2021, 04:22 PM)Sleeprider Wrote: Your profile need to be modified to show that you're using a Resmed Aircurve 10 Vauto, same as me. Seeing ASV on the profile, I was expecting something else.  In Vauto mode you are using EPAP min 6.0, max pressure 11.0 and PS 4.0, so your settings prevent pressure from changing more than 1-cm.  Your first zoomed screenshot shows some variation in respiratory volume, but no flow limitation or issues that should be affecting sleep. The second screenshot you're awake. The full night screenshot has about 2-hours cropped out of it, and the monthly calendar needs to go so additional information is apparent on the left column statistics and settings, and most importantly you did not include flow limitations. You are asking to optimize for UARS and that means the flow limit graph is most important.

The complete lack of flow limitations in statistics suggests to me the PS 4 is dealing with that pretty effectively. You have over 7 hours of therapy time, but that is fragmented into two sessions separated by a 1-hour break. I am sure that if my sleep pattern looked like that, I would feel equally dissatisfied with how I feel. The therapy itself looks pretty good, what I can see of it. I think it's going to take a bit more information to form a working opinion or recommendation.



Thank you for the guidance. Could you please check out the numbers. I have multiple awakenings at night and do not feel rested well in the morning. I am suspecting that flow limitations are not calculated accurately for some reason. Attached is the full night screen with 2 minutes zoom where I see some level of flow limitations that are not calculated.


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#4
RE: Bipap Titration for Preliminary UARS Diagnosis
Try a small increase in PS to 4.0 and use Trigger sensitivity on high. This may reduce the small amount of flow limitation and reduce the CA events. Try to include pressure on your charts. I thought we had discussed PS at 4.0 last time?
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Bipap Titration for Preliminary UARS Diagnosis
I see your declared (profile) PS of 4, and a PS of 3 on your charts both of which on the absolute low end of what is needed by most to treat UARS. You need to increase PS, possibly significantly, I don't know ho much at this stage. The PS of 4 SR mentioned is a good start.
What is your Trigger sensitivity? Setting it to high could help with your CA levels. We will not know until you try.

Your sleep pattern does indicate that implementing a good sleep hygiene could help you quite a bit.
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#6
RE: Bipap Titration for Preliminary UARS Diagnosis
(04-04-2021, 10:56 AM)Sleeprider Wrote: Try a small increase in PS to 4.0 and use Trigger sensitivity on high. This may reduce the small amount of flow limitation and reduce the CA events.  Try to include pressure on your charts. I thought we had discussed PS at 4.0 last time?

Feeling slightly better today with better numbers in OSCAR. I am planning to go up to 4 tonight as 3.4 did not give me any centrals. I went down from IPAP 12 to 11 because of aerophagia and increased mouth leaks with higher pressure. The leaks are problem even with 11. All these leaks in the chart are mouth leaks, air blurting out from relaxed lips.

Also flow limitations are significant. I am also suspecting that I have significant sensitivity to flow limitations as i I immediately wake up before they turn into OA or HA

So the next step is PS 4. Any recommendation regarding taping the mouth to control leaks?


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#7
RE: Bipap Titration for Preliminary UARS Diagnosis
Is this a real obstructive apnea ? I am assuming that is a miscalculation. 8 minutes of OA sounds excessive. I would appreciate if anybody reassure me


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#8
RE: Bipap Titration for Preliminary UARS Diagnosis
I would say that is unlikely to be obstructive apnea but definitely RERA. Respiration is present and at very low volume which is more typical of hypopnea. We can see that there may be a brief apnea at the beginning of that event, then respiration continues with a tidal volume of about 250 mL. The event begins and ends with large spikes of flow that may be arousal or movement. You may have just gotten yourself into a chin tuck or some other place where airflow was restricted.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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