Flow Limitations, For Her, UARS, etc.

[WakeTired]

[attachment=10861][attachment=10862][attachment=10863]

With much excitement, I moved my Airsense for Her to my CPAP graveyard and welcomed the Vauto 10 into my life.

First night with the Vauto 10 was a mixed bag. Having just returned from a +16 hour time zone shift, I had restless sleep, woke frequently, and feel a bit off. From looking at the SleepyHead data, I'm extremely encouraged as it appears the flow limitations have been mostly eliminated - yipee!


I expect to establish regular sleep patterns as the jet lag subsides.

With only one night of data, I'm not sure I would change any of the machine settings just yet

The attached images represent the summary data as well as two random 2-minute highlights from last night

[Sleeprider]

Flow limitation is nearly resolved...your use of the monthly calendar, not so much

Looks pretty good, and we can let this settle in. I expect we might try small 0.2 increments in the pressure support to clear up the rest of the FL.

[WakeTired]

[attachment=10889][attachment=10888]

I now have 2 more nights of data and increased PS to 4.2 with IPAP/EPAP @ 16/5.

The results are very similar to the first night, showing some, but not as many flow limitations and a couple of centrals.

As part of the strategy for driving out FLs, Sleeprider suggested increasing PS by .2

So here's my question:  How do I determine optimal EPAP min as I continue to increase PS?   For example, should I decrease EPAP min by .2 each time in increase PS by .2 (until I get to 4)? My hope would be to keep IPAP as low as possible as to not induce aerophagia.

Thanks in advance!

Note in the graphs, it took me a really long time to fall asleep on both nights.  The first few hours for each night represent me mostly awake in bed.

[Sleeprider]

EPAP min is normally set to prevent obstructive apnea, and the minimum the machine can be set to is 4 cm. If you are comfortable with the current pressure I don't see any need, nor harm in decreasing EPAP. If you are experiencing aerophagia, then try the lower EPAP. Your event rate is very very low and flow limitation is practically nonexistent.

[WakeTired]

Update:

I'm about 6 weeks into the Vauto and the FLs have been mostly eliminated. Every night, my charts and data are pretty much the same - boring and solid numbers!

While the data looks great, I still don't feel all that great. Some nights I can manage 6-7 hours on the machine, and others I only get 4-5. Once I wake up, I'm pretty much done sleeping, whether it's 4, 5, 6, or 7 hours. Once in a while, I get an 8 hour night, and on those nights, I wake even more tired - go figure!

My CBTI practices remain very consistent and good.

My plan is to keep on using the machine as is unless there's a good reason to change the settings. 

Since I've struggled with SBD for a couple of decades, it's likely to take some time for sleep to improve. 

I'm in no rush, but optimistic about what will be!

Any suggestions and ideas are always welcome!

Thanks in advance

[Sleeprider]

From a therapeutic point of view, your use of bilevel is nearly ideal with excellent respiration statistics and very low occurrence of events. The pressure is nearly constant, and should not be a disruptive factor in your sleep. I think your conclusions are correct and that it may take time to recover, or you may need to look elsewhere to deal with sleep disruption. You can be assured that UARS and sleep disordered breathing are not significant factors at this point. Well done!

[WakeTired]

Thanks, Sleeprider!

I really appreciate your great advice, suggestions, and responses.

[slowriter]

.... Your settings are currently at 8 to 15 pressure with EPR 3, and many UARS sufferers do achieve good results with these settings.  The fact that you are already on EPR 3, means the pressure support capabilities of your machine are maxed out, and the next step is a true bilevel like the Aircurve 10 Vauto.  I wish I had a better recommendation for you, but if you want to resolve the flow limitations and RERA, you will need the bilevel. Increasing pressure is not likely to yield the results and comfort you seek. What you need is low EPAP pressure and enough pressure support to mitigate flow limits ....

I wonder if someone can explain the above to me (newly diagnosed with UARS), as simply as possible, as I'm getting a bit overwhelmed with detail.

And are there some general guidelines for UARS treatment about when to look into ASV, and when APAP alone ought to be sufficient?

Is it the case, for example, that APAP is likely sufficient where low pressure values are effective in minimizing flow limitation, and that ASV may be needed (or at least recommended) where higher pressure (I dunno; above 10?) are needed?

[Gideon]

.... Your settings are currently at 8 to 15 pressure with EPR 3, and many UARS sufferers do achieve good results with these settings.  The fact that you are already on EPR 3, means the pressure support capabilities of your machine are maxed out, and the next step is a true bilevel like the Aircurve 10 Vauto.  I wish I had a better recommendation for you, but if you want to resolve the flow limitations and RERA, you will need the bilevel. Increasing pressure is not likely to yield the results and comfort you seek. What you need is low EPAP pressure and enough pressure support to mitigate flow limits ....

I wonder if someone can explain the above to me (newly diagnosed with UARS), as simply as possible, as I'm getting a bit overwhelmed with detail.

And are there some general guidelines for UARS treatment about when to look into ASV, and when APAP alone ought to be sufficient?

Is it the case, for example, that APAP is likely sufficient where low pressure values are effective in minimizing flow limitation, and that ASV may be needed (or at least recommended) where higher pressure (I dunno; above 10?) are needed?

Where are you getting the idea of ASV for UARS?
CPAP, APAP, and BiLivel I can see, but NOT ASV.

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

[Sleeprider]

Here is a good article on UARS an why bilevel is recommended. http://www.apneaboard.com/wiki/index.php...ome_(UARS)

WakeTired has good results and low flow limitation with the Resmed Autoset and EPR 3. The purpose of pressure support or EPR is to provide increased pressure support during inhale to overcome the increasing resistance during inhale that is common with UARS.