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[Diagnosis] Cant get a concrete diagnosis
#1
Cant get a concrete diagnosis
Hi All,

Getting very desperate now. Been suffering with constant fatigue now for the last 18 months. Had everything checked, Bloods, Thyroid ECT. Any I've had 3 sleep studies now, one said I had mild sleep apnea and the other two said I was ok. I've been given a trial CPAP due to potential "UARS". So far the CPAP hasn't made one bit of difference and I manage to sleep with it every night. I've downloaded OSCAR but I dont know what im looking for. Here is the attached file of my afternoon nap yesterday plus sleeping last night. 

Please Help!!!


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#2
RE: Cant get a concrete diagnosis
Be thankful you can tolerate the machine.  There are many that can't.  I'm far from an expert, but it seems that your pressure setting is 'baseline', meaning that it really hasn't been set for you.  A pressure setting of 4 is very low for an adult, usually it is set to minimum of 6 or 7.  Your flow limit graph has a lot of activity.  A higher base pressure might be beneficial.  Another thing you could try is increasing the EPR to 3, this may make breathing more comfortable for you.  If you increase the EPR, please also increase the minimum pressure.  As an example use: EPR=3, Pressure = 9 to 14.  Your exhalation pressure relief with be 9-3 = 6.  You may find this setting more comfortable, and hopefully more effective. 

As a fellow UARS sufferer, I'd say it is par for the course to get a non-definitive diagnosis.  After years of mis-diagnoses, I ended up getting a ResMed 10 Aircurve VAuto bi-level machine.  It has treated my UARS pretty effectively now.  A bi-level machine has higher level of pressure support than a standard APAP machine.  However, if you make the EPR = 3, it is equivalent to a pressure support of 3 cm H20.  Increased pressure support has helped many UARS patients.

Hopefully someone more qualified than myself will be along shortly to help you further.
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#3
RE: Cant get a concrete diagnosis
You are using an Airsense 10 Autoset with a minimum pressure of 4.0, maximum pressure of 20.0 and EPR set to 2. Your Median pressure is over 7.0, so my first suggestion is to increase the minimum pressure to that level. You clearly have a persistent flow limitation that is driving the pressure increases, and that flow limitation is what is disrupting your sleep. Although most sleep studies do not even report this, flow limitation is what gives rise to respiratory effort related arousals (RERA) and hypopnea. We can see frequent larger breaths being taken, as evidenced by the spikes in flow rate. If you would like to learn more about this, post a zoomed image of about a 2 to 3 minute segment of your therapy at about 5:30. We want to be able to visualize the individual respiratory flow waves to see the extent of flow limitation and arousal that might be present. Based on what can be seen already, I think you would do better with a minimum pressure of 7.0 and EPR at 3.
Sleeprider
Apnea Board Moderator
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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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#4
RE: Cant get a concrete diagnosis
Hi,

The hospital just sent me the machine without me every going into to see anybody due to covid. Sleep studies dont seem to be very common in the UK and its taken me ages to even get a machine! i'm not sure if i can alter the pressures myself

(12-19-2020, 12:23 PM)Sleeprider Wrote: You are using an Airsense 10 Autoset with a minimum pressure of 4.0, maximum pressure of 20.0 and EPR set to 2. Your Median pressure is over 7.0, so my first suggestion is to increase the minimum pressure to that level.  You clearly have a persistent flow limitation that is driving the pressure increases, and that flow limitation is what is disrupting your sleep.  Although most sleep studies do not even report this, flow limitation is what gives rise to respiratory effort related arousals (RERA) and hypopnea.  We can see frequent larger breaths being taken, as evidenced by the spikes in flow rate.  If you would like to learn more about this, post a zoomed image of about a 2 to 3 minute segment of your therapy at about 5:30. We want to be able to visualize the individual respiratory flow waves to see the extent of flow limitation and arousal that might be present. Based on what can be seen already, I think you would do better with a minimum pressure of 7.0 and EPR at 3.

I've been told i definitely dont have sleep apnea, but i've been given a CPAP due to suspected UARS, what do you think?

3 minute window


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#5
RE: Cant get a concrete diagnosis
Welcome to Apnea Board,

Let them have Defaults. I hope you convey your sincere whole-hearted appreciation for the intense thought, time, and effort that went into the selection of default settings. I do hope the duck or tech duck didn't sprain a pinky or suffer from paper cuts burning the midnight oil to come up with default settings.
Quack Quack Quack Quack

PS blind squirrels can find nuts sometimes but quack doctors almost never get PAP settings right.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Cant get a concrete diagnosis
@Benjy505, you most certainly can change your own settings. You need to get into the clinicians mode to change the pressure. Typically this is done by pressing both the rotary knob and the button under the display simultaneously for about 3-5 seconds. You can download the Clinicians Manual by going to the top of this webpage and clicking "CPAP Setup Manuals".
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#7
RE: Cant get a concrete diagnosis
(12-19-2020, 01:19 PM)happydreams Wrote: @Benjy505, you most certainly can change your own settings.  You need to get into the clinicians mode to change the pressure.  Typically this is done by pressing both the rotary knob and the button under the display simultaneously for about 3-5 seconds.  You can download the Clinicians Manual by going to the top of this webpage and clicking "CPAP Setup Manuals".

Thank you, The hospital said they would monitor me so im not sure i should change it just yet. Do you reckon im suffering with UARS? i dont know what im looking at data wise
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#8
RE: Cant get a concrete diagnosis
The Resmed Airsense 10 Autoset is a very good CPAP machine and can actually produce bilevel pressure with pressure support (difference between inhale and exhale) up to 3-cm.  Your machine is set to the full range of the machine, and that is rarely ideal.  Your 3-minute window is actually closer to 5, and half of the screen on the right has some artifact I have not seen before.  Looking at the flow rate I see quite a bit of unevenly paced breathing with flattened inspiratory peaks. at 05:26:00 breathing becomes even more flow limited and the machine increases pressure to 8.0/6.0 (inhale/exhale). This appears to stabilize the breathing rate, however flow limitation increases as pressure drops by about 0.2 cm. At 05:30:20  the machine again increases pressure, and we see some higher amplitude flow. This is an arousal (RERA). Breathing stabilizes and pressure starts to slowly drop, and as it does, flow limitation starts to increase.

This tells us the machine is doing a good job of addressing obstruction before it triggers an event, but because the minimum pressure is too low, the pressure drops below the level needed to prevent arousals. If it were to drop further, you might actually have apnea or hypopnea. What we want to do is to force the machine to maintain a minimum pressure that will prevent this cycle of dropping into the range where your airway destabilizes.  I actually think after seeing this, you need a minimum pressure of 8.0 with EPR 3 to resolve that.  Here is a quick tutorial on how to access your settings. You can also get a clinical manual from the Setup Manuals link at the top of this page. https://www.apneaboard.com/resmed-airsen...setup-info

[Image: attachment.php?aid=28769]
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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#9
RE: Cant get a concrete diagnosis
Sorry the black part of the screenshot is because im using a dual monitor and thats the second screen, my apologies. I will definitely increase it myself tonight then and post the difference. What do you think im suffering from, sleep apnea or uars?


thanks
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#10
RE: Cant get a concrete diagnosis
@Benjy505, in the end it doesn't matter if it is either.  What matters is that you are feeling better.  Follow Sleeprider's instructions.  He's really good at this!  

I've been able to feel a lot better from following guidance here on Apnea Board (AB).  I suffered a long time - and then came here.  Within a few months, I feel like a new person.  Energetic, perky, and no headaches.  That's quite a change from before.  

Seriously, follow Sleeprider's instructions.  Change your settings to what he says.  Do you want to get better sooner?  If you make changes, you will get better sooner.  If not, well, you just won't get better.  Don't assume that the hospital, or doctor are super knowledgeable about this area.  Most likely they aren't.  My doctors weren't knowledgeable.  Some even mislead me.

That's why AB exists.  AB helps apnea sufferers to get better more quickly.  Follow Sleeprider's guidance.
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