Flow Limitations, For Her, UARS, etc.

[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?

Where are you getting the idea of ASV for UARS?

Sorry (remember me saying I get a bit overwhelmed with all of this?): I meant auto ASV, the subject of much of this thread.

[Gideon]

ASV and Auto ASV are appropriate when centrals are present.

[slowriter]

FWIW, I just got confused by the different aircurve models. I meant to ask about the vauto, but now understand.

[alexp]

You use the bipap when you can't tolerate a higher pressure on a regular cpap  (developping pressure induced central, comfort, areophagia, ...)but need  that pressure to open up your airways during inhalation and suppress the remaining flow limitations.

With a bipap, you can increase the ipap pressure (inhalation) while leaving the epap pressure (exhalation) at a more reasonable level, therefore avoiding the unpleasant side effects associated with it.

[jomama]

I'm curious if the OP (WakeTired) is getting more restful/refreshing sleep?

[gcritchley]

I'm curious if the OP (WakeTired) is getting more restful/refreshing sleep?

I'm also on a similar path and wondering the same thing - WakeTired - you feeling better?

[WakeTired]

It's complicated...

The short answer is a little bit. I have tremendous room for improvement. 

Once I stablized the Bi-pap settings, I switched sleep medications and then tapered and stopped taking all sleep-related drugs.  This took 4 months. My body still has some residual effects from the sleep meds which should stop over time.

Regarding the Bi-pap, my numbers remain stellar, with the exception of being able to tolerate the machine more than 4-5 hours a night. The sleep meds caused me to wake up after 4 hours, and I found it easier to fall back asleep (if at all) without the machine. I also switched from a chin strap to the cervical collar, which worked really well for 2 months, but then I started having more leaks so I went back to the chin strap.

Which brings me to this week. I'm thrilled to report I've had nights that are much better than others. I've also had terrible nights too. Over time, I expect the good nights to dominate, and the bad nights to be the exception vs. the norm. 

My energy level has increased. This has manifested in my ability to swim longer in cold water. I'm an open water swimmer. Where I live, the water is in the low 60s (ºF) in the summers and around 50ºF in the winter. In past years, I've only been able to swim for about an hour in the summer. This summer, I'm able to swim for almost 3 hours. Winter will be another test. 

A few days a week, I have taken naps. In the past, I was only able to nap for 5-10 minutes. Now, I'm napping 45 minutes and feeling much better after the nap. (without the machine)

So there you have it. Things are better and I'm so very optimistic they will continue to improve.

[slowriter]

Did you ever experiment with higher PS?

I ask because I followed a similar path as you, but ended up at a PS of 6 after an in-lab titration study (not sure I would have tried it otherwise).

[WakeTired]

With a PS of 4.6, I eliminated my flow limitations and had no issues with aerophagia. 

What would be the advantage/reason to increase PS?

[slowriter]

With a PS of 4.6, I eliminated my flow limitations and had no issues with aerophagia. 

What would be the advantage/reason to increase PS?

First, caveats.

1. I'm still learning, and the learning curve steep.
   
2. I'm making no specific recommendation.
   
3. I don't really know the significance of the FL max number in relation to the FL graph in relation to outcomes, and I'm certain it varies by individual.
   

It looks to me based on your latest data at PS 4.6 that you dramatically reduced FL, but not entirely eliminated it. 

Whether entirely eliminating it is possible or wise is another question, and key seems really how much FL is too much to impact your sleep.

Your FL data was similar to, and maybe even a bit higher than, mine at a similar PS.

But the sleep tech that did my titration study (and of course, we're all different) found that only at PS 6 were my RERAs eliminated. So it seems likely that in my case, at least, I'm highly sensitive to FL.

So I'm just wondering if it's possible you might still benefit from experimentation there; not to chase numbers, but just to see if any changes there have a positive impact on your outcomes.