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PSG Results: Could this be UARS?
#61
RE: PSG Results: Could this be UARS?
Ok thanks for the advice, I really appreciate it. I guess I'll just go for switching the pressure and hopefully don't get any sh*t for it.

My main hope with this CPAP trial is to determine if UARS is actually responsible for my awakenings, since the PSG wasn't really helpful in doing that. There does seem to be some clues in my OSCAR data that SDB is involved in my awakenings but it's still a bit hard to tell. Hopefully the different pressure will show some improvements.
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#62
RE: PSG Results: Could this be UARS?
(02-15-2020, 03:32 PM)Geer1 Wrote: I really think you should be running in cpap mode at 7 cm, 3 EPR. The changing pressures are not helping you and the main time the pressures are changing is during SWJ which is when your apneas were occuring. Pressure fluctuations disturb sleep and also mentally effect u, 5 cm pressure with 1 epr feels significantly different than 7 cm with 3 epr and as this change is occuring your brain and body are sensing the changes and trying to understand why your breathing is different. A steady consistent pressure setting removes this and will likely improve your sleep as it did mine. 

Geer1: you're the person who seems to always be arguing, often perfectly reasonably, for simplifying the adjustment process to the minimal of variables. 

Yet here you're suggesting introducing a pretty significant new variable: a different mode.

Yet, as dormeo made clear, there's zero benefit in doing that.

Beyond the fact that raising min pressure to 7 in auto mode will likely lead to pretty consistent pressure for the OP, if you or they are super concerned about ensuring that, all you need to do is cap the max pressure; to 7 or (better) 8.

I'd suggest 8, just because it can be helpful diagnostically to see when the machine is trying to raise pressure.
Caveats: I'm just a patient, with no medical training.
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#63
RE: PSG Results: Could this be UARS?
(02-15-2020, 03:47 PM)deebob Wrote: Ok thanks for the advice, I really appreciate it. I guess I'll just go for switching the pressure and hopefully don't get any sh*t for it.

My main hope with this CPAP trial is to determine if UARS is actually responsible for my awakenings, since the PSG wasn't really helpful in doing that. There does seem to be some clues in my OSCAR data that SDB is involved in my awakenings but it's still a bit hard to tell. Hopefully the different pressure will show some improvements.

Part of the challenge of UARS and PAP therapy in general, in my experience, is that you're being assaulted with a pretty significant shock to your body and brain. And if you have UARS, you probably have a sensitive autonomic nervous system.

Even notwithstanding all the details of the PAP therapy itself (what mask and how well it fits, what machine, which precise pressure settings, etc.), which ARE important, it can still take your body and brain months to adjust. Even when I was finally titrated for a bilevel, it took me another probably two months before I'd say I was sleeping pretty well.

Changing your setting, though, should give us more info.
Caveats: I'm just a patient, with no medical training.
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#64
RE: PSG Results: Could this be UARS?
Slowriter I would argue the opposite... His pressure will likely still fluctuate 1-2 cm after increasing to 7 cm minimum especially because many of his pressure changes appear to be due to SWJ.

The advantage of APAP is being able to vary pressure requirements due to varying levels of SDB when in different stages of sleep or positions. I don't see any such variations in his data and his sleep studies barely indicate SDB.

You need positive benefits to outweigh the negative side effects that APAP has. One example of APAP negative is as follows. When he has a brief arousal that causes a false breathing issue flag then nothing changes and it remains a brief arousal. In APAP mode the brief arousal can turn into an awakening because the nervous system which is awake and on edge (especially if this is UARS) is then hit with a pressure increase. Like you yourself said he is likely dealing with a dysfunctioning autonomic nervous system(to OP this may sound bad but it is actually fairly common and stress and anxiety both wreak havoc on it, this is pretty much why doctors believe anxiety is capable of causing all sorts of health issues). 

I got this information from an experienced sleep therapist who explained to me they get the best results by minimizing treatment. Minimizing pressure, minimizing EPR/PS, minimizing mask influences etc. The more minimalist you can go while successfully treating the underlying issue the better the result will be. This is the very reason that APAP works better then CPAP in people that need it because it allows for lower pressures which are more comfortable and then only supplies higher pressures if required. 

Here is some information from an analysis on CPAP vs APAP.

https://www.google.com/url?sa=t&source=w...6oCj3gyriI

"More patients requiring higher fixed pressure (≥ 8cm H2O) preferred APAP, whereas those requiring lower pressure (< 8 cm H2O) preferred CPAP (p = 0.03)"

Deebob feel free to proceed with either APAP or CPAP mode. There isn't a huge difference between the two and if either are going to help the other will still help. I personally believe CPAP suits you better and as you can tell slowriter believes APAP does. I may be premature in recommending the switch to CPAP but the only way to confirm that is to try APAP and see that increasing pressure stabilizes moments of flow limitatio, problem is this is hard to do as the data usually isn't that cut and dry. There also isn't much value in trying to determine this from your past data as the increasing EPR will have been making a more substantial difference then the increasing pressure.
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#65
RE: PSG Results: Could this be UARS?
Geer1, I wonder if there is some discussion at cross-purposes here. There are two ways to have an unvarying pressure setting of X: using CPAP mode set at X, and using AutoSet mode with max = min = X. With the latter, but not the former, you get FL data.
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#66
RE: PSG Results: Could this be UARS?
(02-15-2020, 07:41 PM)Dormeo Wrote: Geer1, I wonder if there is some discussion at cross-purposes here.  There are two ways to have an unvarying pressure setting of X: using CPAP mode set at X, and using AutoSet mode with max = min = X.  With the latter, but not the former, you get FL data.

You get FL data in CPAP mode on Autoset. I am surprised that you supposedly don't with Aircurve. Here is one of mine just to prove the point since you guys didn't believe me earlier Wink. Part of me wonders if that is an OSCAR issue related to Aircurve machines. 

[attachment=19979]

Slowriter I believe your experience is actually a really good example of how a nervous system can react to pressures. Just increasing your aircurve trigger sensitivity so that the machine was more inline with your nervous system stopped treatment induced central apneas from occurring.
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#67
RE: PSG Results: Could this be UARS?
So I’m a little unclear after everyone’s advice what exactly I should do? Set CPAP mode to 7 (since that is where my auto pressure was going most of the time anyway)?

 I’m still learning about all this but I think Geer1 is right that the changes in air pressure are probably not helpful since I’m definitely very sensitive and am dealing with nervous system issues that probably don’t respond well to sudden changes. My current range currently goes up to 9 but it’s never gone past 7 so I don’t know if there’s any point in setting it higher. I could do APAP at 7min - 8 max just in case.
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#68
RE: PSG Results: Could this be UARS?
If you want try 7-9 APAP tonight and then post your chart tomorrow as well as some zoomed in shots of times the pressure increased, that would really be definitive as to what should be done going forward.
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#69
RE: PSG Results: Could this be UARS?
Thanks, Geer1, for your follow-up. And for what it’s worth, I do a lot better myself with avoiding pressure changes. I don’t need them for obstructive events, and they wake me up.
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#70
RE: PSG Results: Could this be UARS?
(02-15-2020, 09:01 PM)deebob Wrote: So I’m a little unclear after everyone’s advice what exactly I should do? Set CPAP mode to 7 (since that is where my auto pressure was going most of the time anyway)?

 I’m still learning about all this but I think Geer1 is right that the changes in air pressure are probably not helpful since I’m definitely very sensitive and am dealing with nervous system issues that probably don’t respond well to sudden changes. My current range currently goes up to 9 but it’s never gone past 7 so I don’t know if there’s any point in setting it higher. I could do APAP at 7min - 8 max just in case.

Right; that makes sense.

How'd it go?
Caveats: I'm just a patient, with no medical training.
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