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Noobie Question: CPAP or BiPAP? UARS? Alleries
#1
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Noobie Question: CPAP or BiPAP? UARS? Alleries
Hi all,

I'm a 22 year old guy (145 lb 5'8), suspecting that I have UARS since my AHI is low with higher RERAs / RDI. My symptoms include fatigue and brain fog symptoms: cannot concentrate/focus... poor memory, lack of internal monologue at most parts of the day, every day. My symptoms started when I moved into a new apartment that I was super allergic to (likely mold and dust, maybe pet dander), and I have had them for two years. My ENT said I have swollen, enlarged inferior turbinates, likely from the allergies, and I have nasal congestion when I sleep. I recently had a sleep study and a titration test, and they diagnosed me with sleep apnea (though my AHI < 5). 

I was mainly wondering, should I get a CPAP or a BiPAP? In my titration study, I used a CPAP (pressure 4, 5) and it helped a lot, but over the 5 hour night, I still had 4 RERAs and 1 apnea event (compared to ~20 RERAs and 10 OA/CA/hypopnea events). Subjectively, I felt a fair amount better the next day, but not substantially so (though I also understand it takes weeks/months in many instances). I read online in forums that BiPAP is better for UARS anecdotally. Would getting a BiPAP (or ASV even? That has been recommended as well) allow me reduce my 4 RERAs and 1 apnea down to zero?

Here's my graph for my sleep study and titration test for reference, both attached.

(Notes: I went to sleep at pretty much exactly 12 am for both of them. For the titration test, I used a full-face mask for the sleep study and my nose felt really congested. For both, this is earlier than I usually sleep, which is 2-3 am in general. But I had no issues falling asleep at all.)

Thank you so much for the help!


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#2
RE: Noobie Question: CPAP or BiPAP? UARS? Alleries
If you are able to purchase a ResMed Aircurve 10 VAuto, that would be your best bet for tackling UARS. Just realize that it's not always possible to achieve an AHI of 0, but it is possible to eliminate most Flow limitations, Hypopnea and Reras if using the right machine like an AirCurve VAuto. The goal is to feel better.

An ASV might be overkill, unless you are diagnosed with Central Sleep Apnea, which I don't see on your reports.

Assuming you have insurance, according to your study with an AHI under 5, you wouldn't qualify for coverage.

Another issue right now is that these machines are in limited supply, and hard to find.

If no insurance coverage, you can look around for a lightly used (low hour) Bipap.  
Check places like Marketplace, Craig's List, DotMed, etc.

There is also a Supplier list at top of every page where you can compare prices and availability of new units.
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
OSCAR Chart Organization
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



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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#3
RE: Noobie Question: CPAP or BiPAP? UARS? Alleries
Got it, thank you for your recommendation! Is that BiPAP? How would you suggest I set the inhale and exhale pressures?

I got the idea of using an ASV based on this popular post on r/uarsnew: https://www.reddit.com/r/UARSnew/comment...m_archive/ 
The person seems quite experienced, and if ASV helped him finally resolve his brain fog, I'm totally down for that. FWIW I had a few central apneas on my sleep study, but not in my titration study. 

Thank you so much for your help!
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#4
RE: Noobie Question: CPAP or BiPAP? UARS? Alleries
(05-25-2022, 06:50 PM)newuser1002 Wrote: My symptoms started when I moved into a new apartment that I was super allergic to (likely mold and dust, maybe pet dander), and I have had them for two years. My ENT said I have swollen, enlarged inferior turbinates, likely from the allergies, and I have nasal congestion when I sleep.

What has your ENT suggested for your allergies and nasal congestion? Has he/she prescribed anything? Some here in similar situations claim that Flonase has helped.
Also, saline nasal rinses work well.
Are you considering surgery for the enlarged turbinates? You should discuss this with your doctor.

When you decide what device you want to purchase, come back and we can advise on how to set up. And yes, to answer your question... the ResMed AirCurve VAuto is a Bilevel.
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
OSCAR Chart Organization
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



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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#5
RE: Noobie Question: CPAP or BiPAP? UARS? Alleries
Regarding the ENT, I have been using Flonase for years, and I'm currently using Azelastine (nasal antihistamine) and Nasacort, along with a saline rinse multiple times a day. I think the only option at this point is surgery, which I'm putting off since maybe PAP therapy will already solve my problem.

I just spoke with the doctor, and they prescribed me an Airsense 10. I saw here: http://www.apneaboard.com/wiki/index.php...ded_Models that Airsense 10 Autoset was recommended, Airsense 10 Elite was okay, and Airsense 10 CPAP is to be avoided. I tried clarifying with the doctor's assistant which one I would be getting, but I don't think they understood my question, just telling me repeatedly that they were going to preset my pressure as 5 (maybe this implies I'm probably just getting the Airsense 10 CPAP?). They said insurance won't support Bilevel. Furthermore, it only arrives in 2-5 months, which is soooo long from now Sad.  They said I could get a travel Airsense mini though in around 1 month for $1200.

Should I just craiglist/facebook marketplace for an Airsense 10 autoset? Thanks so much for your advice.
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#6
RE: Noobie Question: CPAP or BiPAP? UARS? Alleries
Hi there newuser1002, there are a few things that pop into my rusty old brain here, and so I hope I can bring these issues some justice…
Having enlarged turbinates combined with UARS and allergies currently being treated with various meds and saline wash: my query is whether the enlargement is of the underlying bony structure, or is it a case of dramatically thickened soft tissue (and then if so, is it fibrous or oedematous) - this would determine the course of therapeutic action, however it must be said that elimination of allergens in the first instance is paramount, and my suggestion here is to do a steam clean of carpets and soft furnishings, wash blinds and curtains, use a good static duster on walls, ceiling and light fittings, and if pets have been in the house prior, set and leave a few flea bombs in the place, then vacuum well the entire place and furniture. I’d also look into buying a hepa filter system to clean the air - this will greatly reduce the particle load of debris, odours, and most germs, so your airway isn’t having to do that job (I use one made in Tuggerah NSW Australia, the type can be googled using terms like ‘hepa air purifier’ and if you’d like to see the particular type I use in my own home, feel free to include the town above in your search and that should bring up their web site). Ok, having said that, with the dynamic changes that can occur in an airway regarding the varied response to medications that tissues can have, if you’re looking to get a PAP device, the bare minimum should be an auto (APAP) device. However, in the interim, I suggest buying the cheapest mouth appliance with a hole in it between the upper and lower teeth (the device I speak of has an upper and lower teeth trough - like an upper and a lower pair of mouth guards fused together, but with a breathing slot in the front that will allow you to mouth breathe instead of using the nasal passages), to gather information as to where the UARS problem actually lies…if it is predominantly in the nasal passages and you don’t have any issues breathing through the mouth using this appliance, then there is the opportunity to review the type of turbinate issue in further detail (any surgery has risk and potential compromised goal outcomes, so this should be a last resort), combined with allergy reduction measures and a hepa filter, to come to a resolution of the UARS issue.
If mouth appliance doesn’t work and you’re still having the issue of UARS, then I recommend seeing if you could rent an APAP device on a wider settings range with EPR of 3, highest humidification and temperature that you can tolerate (if rain out is a problem in winter, wrap cling film - Saran Wrap..? - around the tube and wind a crepe bandage around it which holds it still and insulates it a bit more, otherwise you can buy a tube wrap), to warmly and gently wash your sinuses each night - which in itself can soothe oedematous mucous membranes and reduce their swelling, sometimes. I’d recommend a ffm with a breathe-strip across the nostrils to start with, which will encourage nose breathing in the ffm to get that nice warm moist air washing over those turbinates for hours. Selection of ffm needs to be aided by an experienced tech who is open to hearing your comfort issues, while assessing the shape of your face and selecting the mask size and shape accordingly (each manufacturer has a different depth and width profile - I find Phillips suits narrower/ more ‘pointy’ faces, while ResMed suits broader, shallower/flatter faces, for instance).
Once the location of UARS is determined and eliminated, it would be interesting to see what happens with your patterns of breathing: are you still going to have unusual waveforms…? This could be determined using the trial of an auto adjusting machine and then reviewing the download - however I think it is integral to determine the baseline UARS after eliminating the lability of turbinate interference.
I hope that is helpful, and all the best to you Smile

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE EVEN WHEN COMING FROM A MEDICAL PROFESSIONAL. ALWAYS SEEK THE ADVICE OF YOUR OWN 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: Noobie Question: CPAP or BiPAP? UARS? Alleries
Thank you so much for your comprehensive and logical response! I truly, truly appreciate your help. I just got an APAP (Airsense 10 Autoset) and am wondering what to set the pressures at.

My titration study did a static 5 pressure, which helped quite a bit, but still left a remaining 4 RERAs and 1 obstructive apnea across 5 hours (more details attached to the original post). I'm hesitant to set my pressure too much higher than 5 (since people have mentioned a pressure too high could lead to central apneas, and my doctor recommended not to go higher than 5), but I'm open to your thoughts. Smile
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#8
RE: Noobie Question: CPAP or BiPAP? UARS? Alleries
It’s a pleasure; no worries at all Smile
Nice choice of machine! Just between you, me, and the lamp post, I’ve been through the factory several times in Au where these are designed and put together…it’s what I’d consider a workplace filled with pride in precision engineering and manufacture. Not to mention a wondrous place to see, with gardens, artwork and sculpture, and beautiful grounds of serenity. 
Anyway, back to the business at hand… Wink
Now depending on the type of titration study (sometimes the sleep tech manually scouts for the pressures themselves, adjusting the machine remotely in real-time while observing all the other waveforms and data coming to the screen in front of them, or there is an auto machine doing it’s thing and the sleep tech is watching remotely to ensure it’s responding accordingly), you would’ve been exposed to either slightly higher pressures at times and then titrated down, and vice versa (or something like it, if it was manual), or the auto machine plugged into the system would’ve been given a large pressure range in the instance you needed it; after all, they wouldn’t have known your required pressure until after the test was completed. So, in theory, you could set the machine to range between its lowest available pressure setting to its highest available pressure setting (which is common for machines to be set as during some kinds of titration), and it would still deliver around your required 5cm H2O pressure as it’s an autoset and thus detects and delivers what’s needed Smile
The events you’ve mentioned in your last post don’t appear to be excessive in quantity for that time period, however it all swings on how you feel when you’ve had time to adjust to therapy and you’re waking up in the morning - do you feel refreshed and ready to go..? That’s one of the biggest indicators of treatment efficacy imho Smile
In terms of your doctors’ recommendation not to go above 5cm, when considering this statement it makes me think logically, and the outcome is that this refers to a CPAP machine being set no higher than 5cm H2O as a static therapeutic pressure; otherwise, again having an auto machine means that even if the upper range is higher, the machine detects and delivers what’s needed only. 
And then, if you consider this fact, the influence of having a wider setting range is of little influential consequence on CA’s due to it being an auto Smile
Usually, in my experience, I’ve seen some patients have increased CA’s while their body adjusts from a state of trying to breathe and yet still having moments of reduced oxygen or pauses in breathing, to a state of abundant ability for gaseous exchange, which sometimes resulted in momentary or intermittent lesser effort to breathe during some moments in the night. 98% of cases this would resolve or become such a low level of events (combined with the gold standard of feeling good on waking) that the CA’s were of no consequence thus not clinically relevant or addressed. The people whom had CA’s persist/felt still yuck on waking, followed a path of further investigation with the aim of determining the underlying cause. However, that doesn’t seem likely here, from what you’ve mentioned. 
I hope that’s helpful; please do feel free to update when you’re ready Smile

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE EVEN WHEN COMING FROM A MEDICAL PROFESSIONAL. ALWAYS SEEK THE ADVICE OF YOUR OWN 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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#9
RE: Noobie Question: CPAP or BiPAP? UARS? Alleries
I see - that makes sense! It seems safe to set the upper limit a bit higher then, which could help remove the remaining RERAs/apneas. Does an upper limit of 7, lower of 4, with EPR 3 sound good to you?
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#10
RE: Noobie Question: CPAP or BiPAP? UARS? Alleries
I usually increase max pressures by 1cm at a time, and reduce min by .5cm (or so depending on the machine increments) at a time, however what you’ve put forward seems reasonable Smile
I would experiment with the EPR between 3-2, if (after making pressure changes) you still want to see if that any difference. 
I hope that’s helpful…?

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE EVEN WHEN COMING FROM A MEDICAL PROFESSIONAL. ALWAYS SEEK THE ADVICE OF YOUR OWN 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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