Post Reply 
Flow Limitation/UARS and BiPAP
Author Message
zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #1
Flow Limitation/UARS and BiPAP
Flow Limitation/UARS and BiPAP
Barry Krakow MD
....................................................................
UARS: A Critical Link to Optimizing PAP Therapy Results

Having trained with the pioneer researcher Dr. Christian Guilleminault who discovered UARS, I wish to make a few comments that might help PAP therapy users optimize their responses to find high quality sleep.

A reminder that for all practical purposes, the following three terms are interchangeable:

· UARS (upper airway resistance)
· Flow limitation
· RERAs (respiratory effort-related arousals)

UARS as Mini-Suffocations

First and foremost, let's look at an analogy in cardiology to put to rest the nonsense that UARS does not exist or is somehow not important. We all know that asystole (heart stops) is bad, just as we know apnea (breathing stops) is bad. But, in cardiology, for decades we've known there are many other cardiac arrhythmias producing irregular heart rhythms, and we don't sit back and say, "well it's not asystole, so it must be OK." For decades, unfortunately, that practice is in fact what many physicians were taught or conditioned to believe, "it's not apnea, so it must be OK." Indeed, to this very day, I still see patients who have been to sleep doctors who told them their sleep study was OK because it didn't show apneas.

But, as we like to say, “a little choking is still choking,” therefore I think it is reasonable to state that each of the various forms of sleep-disordered breathing (apneas, hypopneas, UARS) reflects some degree of “suffocation.” Apnea is the most concrete form as the patient awakens choking or gasping, whereas UARS is probably equivalent to a “mini-suffocation,” which while asleep I imagine produces an unpleasant sensation but not choking.

UARS is not Mutually Exclusive of Hypopneas or Apneas

Please appreciate then that UARS is simply on the continuum of breathing events. To complete our analogy, UARS represents a more subtle form of breathing irregularity (or as some say pulmonary dysrhythmia). It is not mutually exclusive of apneas or hypopneas. You can have all three types of events when you are diagnosed with sleep-disordered breathing (SDB). In fact, the most common type of SDB shows all 3 components in varying proportions during the sleep study.

You would think though that apneas are more important than UARS events, right? Well, maybe. Don’t forget that UARS events, like apneas, are also frequently associated with sleep fragmentation and therefore unequivocally associated with daytime sleepiness and fatigue. We have seen patients with severe UARS (e.g. RDI > 40), who unequivocally have more sleepiness than say a patient with a moderate degree of apneas and hypopneas (AHI =20). That is why RDI (apneas + hypopneas + UARS) is more valuable when diagnosing and treating your condition than AHI.

To repeat, it is critical to realize that nearly all patients with OSA also have a UARS component on their diagnostic sleep studies, but if the sleep lab doesn’t use the proper respiratory sensors, they will not see it: "what you don't look for, you will not see!"

UARS Assessment and Treatment is Critical to Titration Success

Still more importantly, when a titration is conducted, UARS is invariably present, because the pressurized airflow doesn’t work like a magic wand to suddenly make apneas disappear. Apneas are often turned into hypopneas as the pressure is increased. Then hypopneas turn into UARS or as more commonly called in the lab nowadays “flow limitation.” Remarkably, many sleep lab techs do not push forward with the titration at this point, believing that their job is done. Even some proportion of sleep medicine physicians do not mandate that their sleep techs increase pressure for flow limitation.

“Consensus Medicine” Covered up The Science of UARS

How anyone would think UARS doesn't exist or isn\'t important probably relates to the sometimes misguided concepts of "conventional wisdom" and "consensus medicine" and how such processes frequently retard scientific discoveries from finding their way into community medical practices. In the early 1980s, papers were published about sleep apnea, then Medicare got on board to accept and cover the condition, after which a new CW was born that's taken quite awhile to revisit.

Once physicians and patients became accustomed to hearing the words "sleep apnea," it was only natural that people would block out any other pictures about the nature of a sleep breathing disorder. A consensus formed: either you stop breathing or you don't! Black and white, eliminate the gray! Which is why we always return to the heart rhythm analogy to help people understand the need to monitor different breathing irregularities, not just apneas.

I have treated thousands of patients with UARS who had either no apneas or hypopneas or an AHI less than 5. Nearly all these patients suffered sleepiness or fatigue from their conditions, and many suffered from insomnia and nocturia. Among those who were able to successfully use an appropriate SDB treatment (e.g PAP therapy, oral appliances, nasal strips, nasal surgery, nasal hygiene and so on.), virtually all achieved clear-cut improvements in their symptoms.

What’s in a Name?

In most of my UARS cases, the patients would almost invariably start the discussion with, “so, you don’t mean I have sleep apnea do you?” Which is interesting, because if you follow the workings of the American Academy of Sleep Medicine, you’ll notice their strategy is to abandon the word UARS, and simply declare that UARS equals sleep apnea. In their lexicon, they would answer the UARS patient as follows, “yes, you have sleep apnea, oh but by the way, you don’t stop breathing.” See the problem? That’s why I continue to use the term UARS to make it clearer to the patient.

As an aside, I’ve seen cases where the UARS was ridiculously subtle (I was almost too embarrassed to call it UARS) or it only appeared in REM sleep. I had to inform these patients that I was skeptical about whether PAP therapy would make any difference. Although I still encouraged this particular subset of patients to give PAP therapy a chance, no more than 50% were willing to try it. Yet, in several cases, some of these patients reported dramatic and sustained (as in years) improvements in fatigue or sleepiness with PAP therapy. Undoubtedly, we find these events very perplexing, but the upshot appears to be that sleep assessment technology for measuring respiration and arousals has a long way to go….but then most of you knew that already!

Start Connecting Some Zzzzzots

Along these lines, let me mention a working theory we have developed about UARS and why bilevel might be the best option for its treatment.

The most salient factor during most titrations is how well the patient responds during expiration. Think about it: it sure feels a lot easier if not pleasurable to breathe in with pressurized airflow coming into your lungs. Many SDB patients are immediately hooked on PAP therapy because of this singular experience.

But breathing out against pressurized airflow is a completely different experience for a very large proportion of patients. After all, it’s downright weird to breathe out when pressurized air is coming in. And, that’s exactly how many people describe it and worse. It’s weird, anxiety-producing, claustrophobic, and triggers a sense of panic. Now, the biggest question is who are the types of UARS patients that would feel so negatively about exhaling on PAP therapy?

In our clinical and research experience, it would be someone who already has some degree of anxiety, a lot or a little, it may not matter, because once they try to use fixed CPAP in particular, they quickly report that it’s very uncomfortable or worse, they report feeling more anxious.

In a large proportion of these patients, we switch them to bilevel during the pre-sleep desensitization/adaptation period, and remarkably, we have found that 90% of these patients report immediate relief by virtue of the lower expiratory pressure.

Note: Bilevel combines IPAP (pressure on Inhalation) and EPAP (pressure dropping on Exhalation).

Can You Feel Anxiety in your Sleep?

Although we have more recently discovered that most patients want to switch to bilevel during the desensitization, that is, before the formal titration begins, we didn’t really figure out this point until we watched UARS patients while asleep. That’s when we saw that they did not like CPAP, that is, a fixed pressure on exhalation. That’s when we saw the ratty looking signal suggesting they were having some kind of anxiety or otherwise unpleasant response to air coming in while they were trying to breathe out.

In my opinion, which I don’t think is shared by the majority of sleep docs, anxiety is experienced while you sleep. If you can experience anxiety in dreams, I don’t see why you can’t experience anxiety to pressurized airflow in your sleep. So, in a nutshell, I think that’s why CPAP doesn’t work well in UARS patients and for that matter, I don’t think it works well in most SDB patients except for truly classic hypersomnolent, anxiety-free, sleep apnea cases.

I think anxiety is already present in the majority of SDB cases, because it is an anxiety-producing experience to breath abnormally all night long. That is, anxiety and breathing are intimately connected, so most SDB patients are more or less conditioned to be more nervous in general by having spent the night not breathing well. Now, introduce a foreign stimulus, CPAP, which then triggers or worsens anxiety by the introduction of an extremely foreign sensation: pressurized airflow forced inward during exhalation.

Is Bilevel the Answer?

Why bilevel works so well is still a puzzle. But, what’s so intriguing is that the subjective and objective findings match. That is, nearly all patients who switch from CPAP to bilevel state that it is easier (subjectively) to breathe out with bilevel. And, during their titrations, the ratty airflow signal disappears on expiration (objectively) and is replaced by a smooth and rounded curve indicating normal expiration.

Should you be able to produce the same results with CFLEX, APAP, etc? Presumably so, except for one “large” difference. You cannot generate the same gradient or gap between IPAP and EPAP with any of the other devices. And, in our clinical and research experience, we are using gaps of 4 to 12 cm of water in our patients. My personal bilevel settings are 21/12.5 for a gap of 8.5.

In our prescriptions for bilevel, I would venture that the average gap is in the 5 to 6 range with tremendous variation, including some with a gap of only 2 or 3. Those with a lower gap requirement would likely do as well on FLEX or APAP, but to repeat, the large majority of our patients have a gap of 4 or greater.

Still, it would be nice to have a respiratory physiologist explain to us why the larger gap is so effective. As an internist and sleep medicine physician, there are only two obvious theories that stand out. First, what if we’ve always assumed, mistakenly, that airway pressure had to be constant for both inspiration and expiration? I think it has already been proven by other researchers that you actually need higher pressure to keep the airway pinned open on inspiration and a lower pressure on expiration. If that’s so, then is bilevel the best system because it provides the exact pressure you need (not too much and not too little) during expiration.

The second idea relates more to the psychophysiological response to PAP therapy. Maybe the larger gradient simply gives the patient a distinctly more comfortable feeling, because the lower pressure creates a feeling so much closer to breathing normally (without PAP). If this theory were accurate, though, it would imply that over time as you get used to any sort of PAP therapy, then perhaps the gap would narrow and eventually you could use fixed CPAP again. If this were true, I would expect more people to eventually adapt to fixed CPAP pressure, and I don’t believe that’s occurring.

UARS Diagnosis and Medicare

Last, insurance coverage for UARS is always a hot topic. This section is not relevant to titrations, because nearly everyone manifests UARS on the titration. Insurance questions revolve around the diagnostic study: does the patient “only” have UARS?

In Albuquerque, I have pushed back on this issue for more than a decade, and the results have been tangible and somewhat satisfying. At this point, there are only 3 insurance carriers in New Mexico who do not cover treatment (specifically, PAP therapy or oral appliances) for UARS. Even among these 3 carriers, we can always make an appeal on very specific comorbidities (e.g. a UARS patient who has had 2 car accidents in the last year), then Medicare might decide to cover such a UARS patient.

In the beginning of this particular journey, I found it frustrating at first, but it was also an opportunity to educate medical directors at insurance companies. We would routinely call these individuals, send them research publications, and explain how UARS was going to cost them more money in the long-run if they didn't cover it.

As an aside, I have to mention how frustrating and disappointing it is to hear about sleep physicians who might make their decisions about UARS based on insurance considerations. I was never trained to think that way in medical school, and it approaches unethical behavior in my opinion. If a patient is diagnosed with UARS, that's the diagnosis whether it's covered by insurance or not. Insurance companies don't tell me what I can diagnose and they don't tell me how to treat my patients!

Financial considerations are relevant and important, but they have nothing to do with my patient advocacy and my duty to inform the sleep patient of the diagnosis and treatment plan we recommend.

I am deeply perplexed by the notion that a sleep physician would withhold this information from a UARS patient because the insurance company wasn't going to cover it. As before, it borders on unethical behavior, in my opinion.

Summing Up

Last and not least, UARS is one of the primary reasons that many SDB patients do not achieve an optimal response. As I describe at length in my book, it is a human tendency to "normalize" behaviors, which over time prevents us from obtaining the best possible response to PAP Therapy. If you are so used to fatigue and sleepiness, having suffered for so many years, then how could you possibly discern what a normal level of sleepiness and fatigue should be? Instead, (and I know this from my own trials from CPAP to APAP and finally bilevel), when you experience some improvement, the tendency is to create a new "normal" and wrongly assume that this is "as good as it gets."

Well, it's not as good as it gets if the UARS component of the SDB hasn't been treated, because there is still more to treat. Undoubtedly, most of the members of this forum recognize the fine-tuning and tweaking that's needed to manage mask leaks, mask comfort, mouth breathing, humidifier settings, and nasal congestion, just to name a few of the issues that must be regularly attended to enhance the PAP response.

Notwithstanding, in my clinical experience, I have found that resolving the UARS component of SDB is in the top tier of factors that frequently must be addressed to achieve optimal results, especially so among patients whose regular use of PAP therapy has not yielded the desired effects.

I\'ve lived through this problem and I've breathed through it, and no other single factor enhanced my sleep quality to the level I currently enjoy and am eternally grateful for experiencing.

Surely, this is something to sleep on. I do, night after night.
(This post was last modified: 04-06-2012 03:04 PM by zonk.)
04-06-2012 02:55 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Sleepster Offline
Wiki Editor
Moderators

Posts: 4,994
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #2
RE: Flow Limitation/UARS and BiPAP
Quote:I think anxiety is already present in the majority of SDB cases, because it is an anxiety-producing experience to breath abnormally all night long. That is, anxiety and breathing are intimately connected, so most SDB patients are more or less conditioned to be more nervous in general by having spent the night not breathing well.

I think this is the story of my life!

Quote:In our prescriptions for bilevel, I would venture that the average gap is in the 5 to 6 range with tremendous variation, including some with a gap of only 2 or 3. Those with a lower gap requirement would likely do as well on FLEX or APAP, but to repeat, the large majority of our patients have a gap of 4 or greater.

My machine has both! The PRS1 BiBAP Pro with Bi-Flex esentially gives me three levels of pressure. My gap is 3, but with Bi-Flex set at 2, that gives me a total of 5.

I just want to point out here that it's not a question of one or the other (bilevel or exhalation relief). You can have both! With exhalation relief the pressure goes back up when you stop exhaling, but with bilevel the pressure doesn't go back up all the way until you start inhaling.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
04-06-2012 03:33 PM
Find all posts by this user Post Reply Quote this message in a reply
Sleepster Offline
Wiki Editor
Moderators

Posts: 4,994
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #3
RE: Flow Limitation/UARS and BiPAP
Strangely enough, I don't see the smoothing out the exhalation that he talks about in the article when I switched from CPAP to BiPAP. But I do see a smoothing out of the inhalation!

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
04-06-2012 03:42 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Chuck Offline

Preferred Members

Posts: 21
Joined: Mar 2012

Machine: ResMed VPAP Auto 25 (S8)
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro
Humidifier: ResMed (not used)
CPAP Pressure: I = 12; E = 8
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Arizona

Post: #4
RE: Flow Limitation/UARS and BiPAP
Wow thanks for this article. This explains a lot of my recent experience. I have few "real" measured AHIs, but plenty of arousals and pronounced SA sx including chest pains, rapid heartbeat, HBP and daytime sleepiness. I was doing alright with my CPAP for some time, but suddenly had a decline in therapy and an increase in events.

Also like you said, I suspect that I will have a struggle with insurance and my PCP, who isn't much into sleep medicine anyway. Good thing I'm a DIY-er!

Best regards, --Chuck
04-06-2012 03:56 PM
Find all posts by this user Post Reply Quote this message in a reply
Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #5
RE: Flow Limitation/UARS and BiPAP
What does UARS look like in the CPAP flow data? Can you tell from a nightly flow diagram if you have UARS vs. sleep apnea?

The article suggests that UARS patients have a "ratty" looking signal, indicating that they experience some kind of discomfort or anxiety during exhalation. I'd love to know what this looks like.
07-14-2013 05:58 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
MAPnea Offline

Advisory Members

Posts: 182
Joined: May 2013

Machine: ResMed S9 AutoSet - currently "set" on CPAP mode
Mask Type: Other
Mask Make & Model: ResMed AirFit F10 and P10 - varies
Humidifier: ResMed H5i
CPAP Pressure: 8
CPAP Software: SleepyHead

Other Comments: New Sleep Doc + New DME = Trying new approach to PAP therapy.

Sex: Female
Location: near Great Basin National Park, Nevada

Post: #6
RE: Flow Limitation/UARS and BiPAP
This article was so exciting to read. I kept thinking "That's ME!", "That's MY experience!", "WOW!" I wonder if I have UARS??? This could explain everything!

My cardiologist suggested I have a sleep study because of increasing episodes of tachycardia, anxiety about not being able to breathe when I went to bed (my PCP prescribed Lorazepam prn at bed time which, in retrospect probably wasn't such a good "fix"), an inability to "sleep" longer than 90 minutes... and the resulting dead-tired feeling I had all day long. The initial sleep study came back without ANY AHIs. Not even one which mystified my cardiologist, so he sent me to a different sleep doctor and that sleep study showed some AHIs in the "normal range", but what seemed unusual to the "sleep tech" was that I never entered REM sleep.

My second sleep doctor prescribed a CPAP (I've never had a titration study) because of my escalating episodes of tachycardia and worsening high blood pressure (neither of which were helped with higher doses of blood pressure meds and digoxin). First night at home with my new ResMed S9 Auto Set with EPR I slept 9.1 hours. I woke up and thought... that's weird, it's light outside. Where am I? That was nine months ago.

Now I'm having dreams. Maybe get up once or twice in a night. Have more energy than I've had in years and years. I'm not only much happier, but I'm getting healthier! My cardiologist has already started reducing my blood pressure meds and says - maybe - we can start to reduce the digoxin in a few more months. I stopped taking the anti-anxiety medication the second night I slept with my ResMed S9. And now I don't have to feel like the sleep doctor gave me a placebo CPAP machine.

Thank you so much, zonk, for posting this article! And thank you everyone who shares information, support and caring on Apnea Board.
07-14-2013 07:24 PM
Find all posts by this user Post Reply Quote this message in a reply
vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #7
RE: Flow Limitation/UARS and BiPAP
(04-06-2012 03:33 PM)Sleepster Wrote:  
Quote:In our prescriptions for bilevel, I would venture that the average gap is in the 5 to 6 range with tremendous variation, including some with a gap of only 2 or 3. Those with a lower gap requirement would likely do as well on FLEX or APAP, but to repeat, the large majority of our patients have a gap of 4 or greater.

My machine has both! The PRS1 BiBAP Pro with Bi-Flex esentially gives me three levels of pressure. My gap is 3, but with Bi-Flex set at 2, that gives me a total of 5.

Hi Sleepster,

Unlike C-Flex or A-Flex, I thought Bi-Flex affects only the shape (steepness/gradualness) of the pressure transitions, and not the size of the gap, which in a bi-level machine is set by the amount of "Pressure Support".

When you look at your high rate pressure plot, does the difference between the inhale pressure and exhale pressure actually change when you set Bi-Flex to zero versus 3, or does only the abruptness of the transition change?

Thanks,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 07-15-2013 02:36 AM by vsheline.)
07-15-2013 02:33 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
RonWessels Offline

Preferred Members-2

Posts: 465
Joined: Jun 2013

Machine: REMstar Auto AFlex DS560TS
Mask Type: Nasal mask
Mask Make & Model: ComfortGel Blue
Humidifier: REMstar Heated Tube DS6T
CPAP Pressure: 11 - 20
CPAP Software: SleepyHead

Other Comments: CMS50F Pulse Oximeter

Sex: Male
Location: Ontario, Canada

Post: #8
RE: Flow Limitation/UARS and BiPAP
The article does not mention whether the patients studied are existing CPAP patients or new patients as-yet unused to CPAP.

While I fully admit my experience may not be universal (or even the norm), I find that in the 2 months that I have been on CPAP, I have become accustomed to the exhalation pressure. In fact, so much so that, for reasons I won't get into here, I am reducing my CFlex/AFlex settings with the goal of zeroing them. I started on 3, spent about 3 days on 2, and am now on 1. I don't even notice the difference. Seriously - when I wake up, I have to concentrate to figure out if the machine is still on or not. [ Or just lift the mask, but that's cheating. Smile ].
07-15-2013 11:01 AM
Find all posts by this user Post Reply Quote this message in a reply
Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #9
RE: Flow Limitation/UARS and BiPAP
True or False:

1) SpO2 % is the source of truth for whether or not there are sleep disordered breathing problems of any kind present, including UARS.

2) A good, healthy SpO2 % that stays consistent throughout the night is the best single indicator for sleep quality and non-fragmented sleep architecture.

?


(It's not a test; I don't know the right answers!)
(This post was last modified: 07-15-2013 09:45 PM by Paptillian.)
07-15-2013 09:44 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
digitrax2 Offline

New Members

Posts: 1
Joined: May 2013

Machine: resmed S9 elite
Mask Type: Full face mask
Mask Make & Model: fisher & paykel simplus
Humidifier: resmed h5
CPAP Pressure: 11
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: British Columbia ,Canada

Post: #10
RE: Flow Limitation/UARS and BiPAP
(07-14-2013 05:58 PM)Paptillian Wrote:  What does UARS look like in the CPAP flow data? Can you tell from a nightly flow diagram if you have UARS vs. sleep apnea?

The article suggests that UARS patients have a "ratty" looking signal, indicating that they experience some kind of discomfort or anxiety during exhalation. I'd love to know what this looks like.

Could some one post a "RATTY" graph
I'd also like to see it
07-16-2013 05:30 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  [Equipment] respironics bipap error code hanasdaddy 6 98 Today 01:48 AM
Last Post: hanasdaddy
  Source of Resmed S9 EPR reverse flow whistle! neal 5 235 12-01-2016 07:22 PM
Last Post: klv329
  New User Problem with BiPAP AVAPS - Part 1 jmayer180 35 1,301 11-27-2016 09:50 AM
Last Post: jmayer180
  First time Bipap User, years of suffering SleepyMersim 18 653 11-16-2016 11:46 PM
Last Post: Galactus
Question BiPAP vs EPR/Flex etc? SleepyBee 7 266 11-13-2016 08:52 PM
Last Post: Galactus
  Flow Rate Interpretation nadprok 2 218 11-13-2016 06:08 PM
Last Post: nadprok
  [Equipment] Annoying on/off beep on Respironics BIPAP S/T C series rcattell 8 344 11-06-2016 12:07 PM
Last Post: rcattell

Forum Jump:

Who's Online (Complete List)