Iosen's UARS therapy

[Iosen]

Hello everyone,

UARS sufferer here - RDI 15.
I tried CPAP a few months ago but stopped due to crippling aerophagia. I'm now willing to give it another try, this time slowly ramping up the pressure.

Availables machines: Resmed Autoset 10 + bipap + ASV
My current plan is to try out CPAP, see how I feel. If I cannot get rid of flow limitations, I'll try a bipap with more pressure support. Lastly, I could try the ASV, as Barry Krakow recommends.

Current Therapy Goal : figuring out what to optimize, and how.
There aren't any hypnopneas or apneas on OSCAR's graph. Instead, I see more subtle signs : flow limitations and signs of respiratory effort. I think stabilizing these will be the key for a succesfull therapy.

First night with CPAP :
Test night, EPAP 5 EPR 3.

   
EDIT : clear airways events are not central. They are "sleep wake-junk".

I see a pattern here. A handful of flow limitation, and a trending decrease in tidal volume, leading to arousals (big spikes).
What do you think ?

   

Here is my typical breathing pattern. We can see alternating increases and decreases in flow rate. Overall the flow rate decreases, which is then followed by an arousal.
Am I correct in assuming this shows respiratory effort ? Would it even be considered periodic breathing ?

And of course, I've also got classic flow limitations ! Lol
   

What's next :
My instinct would be to try to get rid of these patterns. Maybe using Krakow's titration protocol for UARS (see wiki).

What do you think ? I'd love to hear your insight ! Discussions are welcome.

[Gideon]

Welcome to the forum.

To start
Set min pressure=7, this is to allow the EPR to work, it will not if pressure=4
Set Max pressure to 10 so we can see if the algorithm is trying to raise your pressure
Set EPR =3, Fulltime.

Try this then repost

[Iosen]

Here is some data from the past few months. Min EPAP 6 Max EPAP 12

The algorithm definitely ramps up in response to events. But I was still having flow limitations leading to arousals. Wondering if the solution would be more pressure support instead of EPAP.

What do you think about the trends in tidal volume and flow rate (shown in post #1) ?

[Gideon]

On an AutoSet EPR is PS and at a pressure of 4 you have NO PS or EPR. You NEED a min of 7 to get an EPR or PS of 3.

[Iosen]

Mode : APAP
Pressure : 8 - 13, EPR 3

Here is a fresh night. I see the same patterns as above.
Lots of awakenings, which I feel correlate with the pressure swings. Aerophagia was present too.