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I cant figure out if I could have UARS from my sleep study results.
#1
I cant figure out if I could have UARS from my sleep study results.
Hi,

this was already asked a million times here and I went through some of the topics, also did a lot of googling. But I am having a bad day, feeling exhausted and I cant get my brain to understand what I am reading - so I am reaching out to some help.

I did my sleep test in Germany so the results are also in German and I think its missing some of the information that is needed for UARS diagnosis. So I think certain things were maybe not even checked. I will post both the original and the German version below, in case we maybe have someone who is from Germany to correct my translation . 


Results :

Number of apneas: obstructive 7; mixed 0; central 3; hypopneas 145
Oxygen saturation: continuous (average value) 97.0%; minimum during sleep 94.0%; ODI 4.9%; PLMS index 6.3 /h ;


Anzahl der Apnoen: obstruktive 7; gemischte 0; zentrale 3; Hypopnoen 145
Sauerstoffsättigung: kontinuierlich ( Mittelwert ) 97,0% ; minimal im Schlaf 94,0%; Entättigungsindex (ODI) 4,9% ; PLMS-Index 6,3 /h ;



I can not post Oscar results because my machine does not support it, I only get information about my AHI, pressure and leakage results. In the last 3 months I had one night where I had 6/h central apneas, on other nights its going from 0/h to max 4/h ( on most nights its 1/h or 0/h ).


Does the fact that I have 145 hypopneas mean that its not UARS ? Since the AHI is above 5 ? I dont see any info about RERA events and I cant figure out if the oxygen levels are good or not. 

I am currently on APAP with 7-14 pressure, usually the machine shows that I am somewhere around 8 to 12. But I still wake up feeling like crap so I am trying to fully understand whats happening. Any help is appreciated.
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#2
RE: I cant figure out if I could have UARS from my sleep study results.
(06-30-2020, 06:54 AM)vrapche031 Wrote: Hi,

this was already asked a million times here and I went through some of the topics, also did a lot of googling. But I am having a bad day, feeling exhausted and I cant get my brain to understand what I am reading - so I am reaching out to some help.

I did my sleep test in Germany so the results are also in German and I think its missing some of the information that is needed for UARS diagnosis. So I think certain things were maybe not even checked. I will post both the original and the German version below, in case we maybe have someone who is from Germany to correct my translation . 


Results :

Number of apneas: obstructive 7; mixed 0; central 3; hypopneas 145
Oxygen saturation: continuous (average value) 97.0%; minimum during sleep 94.0%; ODI 4.9%; PLMS index 6.3 /h ;


Anzahl der Apnoen: obstruktive 7; gemischte 0; zentrale 3; Hypopnoen 145
Sauerstoffsättigung: kontinuierlich ( Mittelwert ) 97,0% ; minimal im Schlaf 94,0%; Entättigungsindex (ODI) 4,9% ; PLMS-Index 6,3 /h ;



I can not post Oscar results because my machine does not support it, I only get information about my AHI, pressure and leakage results. In the last 3 months I had one night where I had 6/h central apneas, on other nights its going from 0/h to max 4/h ( on most nights its 1/h or 0/h ).


Does the fact that I have 145 hypopneas mean that its not UARS ? Since the AHI is above 5 ? I dont see any info about RERA events and I cant figure out if the oxygen levels are good or not. 

I am currently on APAP with 7-14 pressure, usually the machine shows that I am somewhere around 8 to 12. But I still wake up feeling like crap so I am trying to fully understand whats happening. Any help is appreciated.

Hello...

Healthcare in Germany and Austria sticks to the AHI definition and negates the existance of UARS as I myself have witnessed it, RERAs are not scored. 
Here is a nice interview of a man who defined the AHI and also defined the UARS: https://doctorstevenpark.com/guilleminaultencore



My case is much less sever than yours. I have around 8 hypopneas per hour and they mentioned nothing about RERAs. I did have around 64 arousals per hour and no one even cared to question what that was. I still don't understand it very well. 

Some of the arousals from the EEG are contributed to the hypopneas (namely 8 of them per hour) and the rest? I had around 1 periodic limb movements per hour so 1 arousal goes for that. What about the other 55? 

Here I found a study that says for people my age it is normal to have 10 arousals per hour:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564772/

So I deduct that as well. So what about the remaining 45?

I have 45 arousals left I do not know what to attribute it to.  So I guess I can assume they are RERAs or at least half of them.


To answer your question from what I was able to understand so far (I am myself a newbie)

HYPOPNEA AND RERA are the same sh*t. 

airflow reduction that causes EEG arousal and interupts your sleep.

Hypopnea however has higher airflow reduction and oxygen desaturates more or equal to 3%.

Now that is not the case with RERA. 

In RERA you are able to compensate that flow reduction by breathing stronger and deeper with more effort. That is why it is Respiratory EFFORT related AROUSAL.

So... obviously your brain knows you can not breath properly, how else would it get aroused and how else would you startd breathing with more effort? It is non sense to say it does not exist.

So.. before you develop these Hypopneas most likely you do have RERAs. Considering you had so littel obstructives, I guess, some logic tells me you most likely do have RERAs.

So, yes you officially do not have UARS because you have enough of hypopneas and have just touched the 3 % desaturation with each. But, forget about it... Drawing line between this is so stupid.

You can have someone who has RERAs all the time and yet still has 2 obstructives and 3 hypopneas per hour and then what? He has AHI of 5 and maybe 30 RERAs, then what? So had he shown AHI of 4 in that sleep study, you would consider it UARS but if he had 1 more hypopnea, then it is over and he does not count as UARS?
The goal is ideal breathing and just get a better machine, mandibular advacement device.

Whether they are RERAs or Hypopneas or Apneas, they all deserve to be ZERO and gone. 

Drawing a line of AHI 5 was just a thing of procedure,

The answer is I do not know if you have UARS or dont because your AHI is high already, at the same time so you may have it and maybe not. 

IF you stick to the definition, then no, you do not have it because definition requires AHI to be low. HAHA but definition is stupid. 

One could have typical UARS with only RERAs for 4 hours and then turn on his back and get obstructives in REM sleep for 1 hour and end up having what then? High AHI while his sleep was constantly full of RERAs and thus breathing was UARS type of breathing most of the night. 

As you can see, biology does not follow the number and line drawned by an insurance company.

What we do not for sure:

Air CAN NOT flow good and is limited> It MUST flow good with therapy.

Period. 

The goal is always the same, have good inspiration and expiration curves, and as less arousals as possible.



TIPS:
For proper sleep study with manometry and nasal cannula contact this guy: Hofklinik Prof. Dr. Med ARto Nirkko,
For diagnostics of anatomy of your airways CT scan, MRI scan, sleep endoscopy and MRI while sleeping contact: PD Dr.med. Dr.med.dent. - CHRISTINE JACOBSEN

Keep in mind everything I said might be wrong because I am a noob. If others say soemthing else then listen to them. 


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#3
RE: I cant figure out if I could have UARS from my sleep study results.
UARS is likely, but we don't need a specific diagnosis to advise that you would clearly do better with pressure support. While obstructive apnea will respond to fairly low levels of pressure to prevent airway occlusion, the continued flow limitation and associated respiratory effort related arousals and hypopnea, are much better treated by a bilevel therapy (i.e. Resmed Aircurve 10 Vauto) than with CPAP.

fejsbukpejdz who responded above, went through much the same thing, and eventually binned his CPAP and bought the Resmed Aircurve 10 Vauto. His experience moved from frustration and discomfort to very effective therapy and a high level of comfort using the pressure support from his new machine. http://www.apneaboard.com/forums/Thread-...n-to-Vauto

We are very limited in the help we can provide with the Prisma, but things you can try is to use the full exhale pressure relief available on the machine, and try increasing pressure slightly. These actions can help to reduce airway resistance and make breathing easier with fewer disruptions.
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#4
RE: I cant figure out if I could have UARS from my sleep study results.
Thank you both for the detailed answers. I was supposed to have a sleep study in a month with a over the counter MAD device but I couldnt get used to it, so I am trying to change that for a follow up sleep study with my CPAP. Its not in the same sleep lab where my initial one was , so I will ask them to check for UARS and push for more information after.

I also need to push for another CPAP machine which is supported by Oscar because its driving me insane that I dont have access to almost any data.

Could anyone maybe suggest other BiPAP machines that are good and supported by Oscar? I would like to check if they are available in Germany because the Resmed Aircurve 10 Vauto can only be bought from one shop. So I dont think that I will be able to get it from the company thats given me my CPAP.

Also, Sleeprider - when you say that I should make my pressure a bit higher, what exactly do you mean? I have APAP on 7 to 14 currently and on most nights the average is somewhere between 8 to 12. To what do you suggest to raise it?
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#5
RE: I cant figure out if I could have UARS from my sleep study results.
If they do not do RERAs scoring with proper cannula and device and of course EEG monitoring, do not bother. 
Do not do the study, it's a waste of money if they will again do the same and tell you you have hypopneas.


Either way you need ResMed Aircurve 10 Vauto so I advise you to buy it out of your own pocket because insurance will not cover it.
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#6
RE: I cant figure out if I could have UARS from my sleep study results.
I agree in that you do not NEED another sleep study. What you have reported is much better resolved by a BiLevel. ResMed's algorithms aggressively treat flow limits. Thus the strong suggestion for ResMed VAuto. The question is will the sleep study help you to get a ResMed VAuto?
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#7
RE: I cant figure out if I could have UARS from my sleep study results.
(06-30-2020, 02:11 PM)vrapche031 Wrote: Thank you both for the detailed answers. I was supposed to have a sleep study in a month with a over the counter MAD device but I couldnt get used to it, so I am trying to change that for a follow up sleep study with my CPAP. Its not in the same sleep lab where my initial one was , so I will ask them to check for UARS and push for more information after.

I also need to push for another CPAP machine which is supported by Oscar because its driving me insane that I dont have access to almost any data.

Could anyone maybe suggest other BiPAP machines that are good and supported by Oscar? I would like to check if they are available in Germany because the Resmed Aircurve 10 Vauto can only be bought from one shop. So I dont think that I will be able to get it from the company thats given me my CPAP.

Also, Sleeprider - when you say that I should make my pressure a bit higher, what exactly do you mean? I have APAP on 7 to 14 currently and on most nights the average is somewhere between 8 to 12. To what do you suggest to raise it?

My disadvantage is I don't know your full range of settings.  You seem to be using pressure that is within the range the machine provides with its auto pressure, but I don't know if you're using a pressure relief feature and at what setting.  If your machine likes being at 8 to 12, I would certainly change the minimum to 8.0 or perhaps 9.0 to make sure you're starting in the sweet spot, and as I said, maximize the use of exhale pressure relief.
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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#8
RE: I cant figure out if I could have UARS from my sleep study results.
you can buy Aircurve 10 Vauto in GErmany online I am not allowed to post a link due to forum rules but if you do not like it, you can return it within 14 days.
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#9
RE: I cant figure out if I could have UARS from my sleep study results.
(06-30-2020, 05:36 PM)AHIvictim Wrote: you can buy Aircurve 10 Vauto in GErmany online I am not allowed to post a link due to forum rules but if you do not like it, you can return it within 14 days.

You can name any supplier of machines in any country as provided you don’t use a link or the link suffix like .com or.de. I know it sounds crazy but we can say Amazon, EBay, Dotmed or SecondWindCPAP, and you can even post a phone number or address. Just no links.
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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#10
RE: I cant figure out if I could have UARS from my sleep study results.
I missed all your replies yesterday so following up on them all now.

(06-30-2020, 04:06 PM)bonjour Wrote: I agree in that you do not NEED another sleep study. What you have reported is much better resolved by a BiLevel. ResMed's algorithms aggressively treat flow limits. Thus the strong suggestion for ResMed VAuto. The question is will the sleep study help you to get a ResMed VAuto?

I honestly dont know if it would help, I am not familiar with how these things work in Germany. My CPAP was fully covered and I think I pay 0.50 euro cents each month for it. I really need to talk to my sleep doctor about this but I cant seem to reach her for a while now.

If I go and buy the ResMed VAuto from my own pocket, it will cost me almost 2000 euros, which is a big amount of money. Would you guys here be able to fully help me set it up ?

(06-30-2020, 05:28 PM)Sleeprider Wrote:
(06-30-2020, 02:11 PM)vrapche031 Wrote: Thank you both for the detailed answers. I was supposed to have a sleep study in a month with a over the counter MAD device but I couldnt get used to it, so I am trying to change that for a follow up sleep study with my CPAP. Its not in the same sleep lab where my initial one was , so I will ask them to check for UARS and push for more information after.

I also need to push for another CPAP machine which is supported by Oscar because its driving me insane that I dont have access to almost any data.

Could anyone maybe suggest other BiPAP machines that are good and supported by Oscar? I would like to check if they are available in Germany because the Resmed Aircurve 10 Vauto can only be bought from one shop. So I dont think that I will be able to get it from the company thats given me my CPAP.

Also, Sleeprider - when you say that I should make my pressure a bit higher, what exactly do you mean? I have APAP on 7 to 14 currently and on most nights the average is somewhere between 8 to 12. To what do you suggest to raise it?

My disadvantage is I don't know your full range of settings.  You seem to be using pressure that is within the range the machine provides with its auto pressure, but I don't know if you're using a pressure relief feature and at what setting.  If your machine likes being at 8 to 12, I would certainly change the minimum to 8.0 or perhaps 9.0 to make sure you're starting in the sweet spot, and as I said, maximize the use of exhale pressure relief.

I have an option called SoftPAP which is used to help you exhaling. Its on max level currently, which is 2. I just adjusted the pressure from 7 - 14 to 9 - 13. Lets see if that makes a different.

(06-30-2020, 05:36 PM)AHIvictim Wrote: you can buy Aircurve 10 Vauto in GErmany online I am not allowed to post a link due to forum rules but if you do not like it, you can return it within 14 days.

Could you please tell me the vendor or send me a link in a private message ( if thats not against the rules ) ? I only saw it at cpap-shop and find it weird that only one vendor sells it in the whole country.
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