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My Theories on UARS (upper airway respiratory syndrome)
#1
My Theories on UARS (upper airway respiratory syndrome)
Being diagnosed this year with UARS and an OCD engineer, I spent the next 6 months experimenting with my CPAP and reading all I could find.

UARS is different from Apnea in that there is usually no "apnea" events in the sleep study.  The individual generally suffers from a combination of hypopneas and RERA's.  Basically, their throats don't close all the way and the problem is more struggling to breathe than not breathing.

At first this just seems to be a mild form of apnea.  However, upon further research, they really differ a great deal.  UARS sufferers usually have a structurally narrow throat.  Weight really doesn't matter that much as it does in OSA patients.  The other big difference is that people with OSA are often sound sleepers while is it common for UARS to be light sleepers.  Thus the RERA's and hypopneas cause UARS people to have severe insomnia.  However OSA people (not all) often sleep through the night not knowing there is a problem.

There is a debate whether UARS patients need more or less CPAP pressure than apnea patients.

Here is my theory

I believe that often the majority of the problem can be taken care of with light CPAP pressure.  I discovered this much by accident when I turned my CPAP down from 12 which was keeping me up all night, to 5.  That is a pretty big drop, but I noticed that my AHI actually improved or stayed the same.  I e-mailed this to an ENT online who said he had a great deal of UARS patients that did better with light pressure.  So, the question is why?

Some have argued that due to the structural narrow throat, it requires more pressure to open the airway than just pushing back relaxed muscles.  This may be true, but we have to ask if the problem is really the narrow throat?

Since UARS patients are actually getting air through, the problem is not blockage, but a struggle to get enough air.  RERAs are very common with UARS.  If you have RERAS, you know that you are getting air in and in enough quantities to not cause an oxygen drop.  However, in order to do so you are straining to get the air in to the point that it interrupts your sleep.  Enter the CPAP.  Whereas an OSA sufferer needs a certain pressure to force open the relaxed muscles.  The same principle may not apply to UARS.  Just using a light pressure may not open the airway anymore, but makes it easier to breath by forcing air through the narrow passage thus taking the strain off of breathing and thus reducing the RERA's. 

Love to hear your thoughts.
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#2
RE: My Theories on UARS (upper airway respiratory syndrome)
My observation has been that UARS responds well to low pressure to stabilize the airway, but bilevel works to reduce flow limitations and hypopnea better than CPAP. When someone has the characteristics you describe, I will ask them to try a low pressure, and if their machine has the capability of EPR or pressure support we will use that. For example a Resmed machine with a minimum pressure of 8 and EPR at 3 will result in pressures of 8/5 which may work better than straight pressure. I have often seen a need to limit maximum pressure because the auto CPAP and Bilevel machines respond to the flow limits and volume reductions by raising pressure without any apparent benefit to the therapy.

I agree with your observations, but would encourage anyone with this condition, or presenting with mostly hypopnea at a sleep test, to get bilevel or a machine that can at least reduce expiratory pressure. Straight CPAP can improve their comfort and results, but bilevel really changes the game.
Sleeprider
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#3
RE: My Theories on UARS (upper airway respiratory syndrome)
Thinking-about Thanks for being so articulate on such a complicated topic. This is definitely a major bookmark for me.
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#4
RE: My Theories on UARS (upper airway respiratory syndrome)
Yes the Autosense does have an EPR.  However, since I am only using pressure 5, EPR isn't really important.  That being said, I concur that an EPR would great for UARs since I don't believe the constant pressure is as important as it is for Apnea.
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#5
RE: My Theories on UARS (upper airway respiratory syndrome)
I'm UARS myself mostly, and I'm experimenting with settings.
My issue with EPR is that it inflates and deflates the amara view mask horribly and I can't stand it.
Been trying higher pressures with no EPR lately and have gotten lower ahi.

Still experimenting,...

I'm a dentist and I am totally engineer-ocd type of personality also.
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#6
RE: My Theories on UARS (upper airway respiratory syndrome)
I have to ask.  ...If you are a dentist, did you  experiment with a mouth guard?
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#7
RE: My Theories on UARS (upper airway respiratory syndrome)
I'm another UARS patient. the reason there is so much debate about it is that there are so many permutations and combinations that go into UARS and OSA. Some folks have narrow airways that contribute to UARS, others it's more like OSA, but with the body responding before things get as far as "full" apnea events.

Personally, I fall into the latter group, so I found that I actually had better optimization of my therapy at a higher pressure (12-13) than was originally prescribed (6-7). I know that looks like quite the jump, but it took a fair bit of time and data review to get to that point. The higher pressure dealt with the few apneas I did have, but also nixed the hyponeas and sleep disruptions...won't be the same solution for everyone, but it is what work for me personally (AHI usually <0.2, feeling rested when I get up and no "zombie" mode during the day).

I found the EPR on my machine was enough to make the experience better (for me) than straight CPAP....did not have to go to a BiPAP to make it work.

Take my experience with a grain of salt....everyone is unique, especially when it comes to UARS which is where they lump us "problem child" patients Wink
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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