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Possible UARS Sufferer?
#11
RE: Possible UARS Sufferer?
Yeah, those aren't rounded.

So when the VAuto comes in, you might want to start out with something like a min EPAP of 6 or 7, and PS of 4. That should probably help.
Caveats: I'm just a patient, with no medical training.
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#12
RE: Possible UARS Sufferer?
(02-18-2020, 01:38 PM)slowriter Wrote:
(02-18-2020, 01:34 PM)cbailey1616 Wrote: Interesting, here is my OSCAR report with machine on Auto. Looks like I average = 6.  Is my statement typically accurate that when you have flat humps in flow rate, that can indicate UARS?

The average was six, but it went a fair bit higher, which tells me you need more minimum pressure. As, if you were insisting on CPAP mode, I'd do 9 instead of 6, for example.

On your question, it can. The non-rounded waveforms indicate flow limitation. Whether they cause arousals for you is another question, which is why I asked about the sleep study.

Gotcha, will do. Yeah, I guess Ill have to wait on my sleep study results. For what its worth I have a pulse ox sleep tracker called Beddr and my arousals went from 10/hr to less than 5/hr on cpap. So thats something Dont-know
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#13
RE: Possible UARS Sufferer?
(02-18-2020, 01:17 PM)slowriter Wrote: In fact, there's one recent research study that argued you can use a cpap auto mode to diagnose UARS, with the idea that if you have a low AHI like you do, and the machine raises pressure (in their study, their subjects averaged about 7), that can reasonably confirm UARS. I can't find the link ATM though.

If the pressure increases and you have a low AHI all it means is that you either have flow limitations or snore. Neither flow limitations or snore are necessarily a problem. The problem is only if the flow limitations or snore are causing RERAs or desats. Lots of people without UARS or SDB symptoms could cause these machines pressures to increase, you cannot use APAP pressure increase as a definitive diagnosis.

In short higher amounts of flow limitations may indicate a higher likelyhood of having UARS but it is far from confirming UARS... 

cbailey, I am a strongbeliever of set pressure if it is UARS but part of that requires finding the right set pressure. Pressure differential increases flow which helps overcome flow restrictions. On the autoset pressure differential is called EPR and yours being set at 2 is limiting the machines capability, increasing this to 3 will help. In order to take advantage of EPR of 3 you also need to increase pressure to 7 as the machine can only drop EPAP as low as 4. EPAP = pressure - EPR so minimum pressure to maintain 3 EPR is 7.

Sometimes flow limitations respond to pressure (decrease or are resolved with higher pressures) and sometimes they do not. Running the machine in APAP mode for a few nights can help determine if increasing pressure helps reduce flow limitations. If the increasing pressure does not reduce flow limitations and stop RERAs from occuring then it is not advantageous. Learning what flow limitations, RERAs and arousal breathing looks like in your OSCAR data(specifically flow rate chart) is the most important thing you can do to tell if different pressures/settings are improving your sleep. Unfortunately there is no statistic or graph that can clearly tell you if there is an issue or obvious improvement like say in OSA where you can kind of rely on AHI.

My recommendation is to at the minimum increase pressure to 7 and EPR to 3. I also recommend turning ramp off as it is just a crutch and at low pressures like this it doesnt help much anyways. 

What would probably be beneficial is running in APAP mode for a couple nights, min pressure 7 and max pressure 12, EPR 3. Then trying to interpret the data to see if the increasing pressure helps you or not. We can help interpret the data as you learn. 

You need to be careful chasing pressure, for example in your APAP chart the only time your pressures really spiked were due to obstructive apneas which may or may not have been real. It is not uncommon for OAs to be flagged when rolling onto side etc and if you are only having a couple of OAs each night they probably aren't signs of real issues and needing increased pressure to deal with them.
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#14
RE: Possible UARS Sufferer?
(02-18-2020, 02:06 PM)Geer1 Wrote:
(02-18-2020, 01:17 PM)slowriter Wrote: In fact, there's one recent research study that argued you can use a cpap auto mode to diagnose UARS, with the idea that if you have a low AHI like you do, and the machine raises pressure (in their study, their subjects averaged about 7), that can reasonably confirm UARS. I can't find the link ATM though.

If the pressure increases and you have a low AHI all it means is that you either have flow limitations or snore. Neither flow limitations or snore are necessarily a problem. The problem is only if the flow limitations or snore are causing RERAs or desats. Lots of people without UARS or SDB symptoms could cause these machines pressures to increase, you cannot use APAP pressure increase as a definitive diagnosis.

In short higher amounts of flow limitations may indicate a higher likelyhood of having UARS but it is far from confirming UARS... 

cbailey, I am a strongbeliever of set pressure if it is UARS but part of that requires finding the right set pressure. Pressure differential increases flow which helps overcome flow restrictions. On the autoset pressure differential is called EPR and yours being set at 2 is limiting the machines capability, increasing this to 3 will help. In order to take advantage of EPR of 3 you also need to increase pressure to 7 as the machine can only drop EPAP as low as 4. EPAP = pressure - EPR so minimum pressure to maintain 3 EPR is 7.

Sometimes flow limitations respond to pressure (decrease or are resolved with higher pressures) and sometimes they do not. Running the machine in APAP mode for a few nights can help determine if increasing pressure helps reduce flow limitations. If the increasing pressure does not reduce flow limitations and stop RERAs from occuring then it is not advantageous. Learning what flow limitations, RERAs and arousal breathing looks like in your OSCAR data(specifically flow rate chart) is the most important thing you can do to tell if different pressures/settings are improving your sleep. Unfortunately there is no statistic or graph that can clearly tell you if there is an issue or obvious improvement like say in OSA where you can kind of rely on AHI.

My recommendation is to at the minimum increase pressure to 7 and EPR to 3. I also recommend turning ramp off as it is just a crutch and at low pressures like this it doesnt help much anyways. 

What would probably be beneficial is running in APAP mode for a couple nights, min pressure 7 and max pressure 12, EPR 3. Then trying to interpret the data to see if the increasing pressure helps you or not. We can help interpret the data as you learn. 

You need to be careful chasing pressure, for example in your APAP chart the only time your pressures really spiked were due to obstructive apneas which may or may not have been real. It is not uncommon for OAs to be flagged when rolling onto side etc and if you are only having a couple of OAs each night they probably aren't signs of real issues and needing increased pressure to deal with them.

Thanks Geer. I have attached a log with CPAP set to 6 and then an APAP log that takes advantage of the EPR=3 setting. Is there anything you can determine from these 2 logs?


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#15
RE: Possible UARS Sufferer?
You can't draw conclusions about pressure when both EPAP and EPR are changing. You need to set minimum pressure to 7 and test that out for a couple nights.
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#16
RE: Possible UARS Sufferer?
The other way to test this is to stay in CPAP mode. Try 4 or so days at 7 cm, the same at 8 cm, same at 9 cm etc. Then you look at graphs and see if flow limitation chart appears to be better at higher pressures. You need multiple days of data though because this stuff fluctuates a fair bit so need to be looking at trends/averages not single nights which are influenced by too many factors.
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#17
RE: Possible UARS Sufferer?
(02-18-2020, 02:55 PM)Geer1 Wrote: The other way to test this is to stay in CPAP mode. Try 4 or so days at 7 cm, the same at 8 cm, same at 9 cm etc. Then you look at graphs and see if flow limitation chart appears to be better at higher pressures. You need multiple days of data though because this stuff fluctuates a fair bit so need to be looking at trends/averages not single nights which are influenced by too many factors.

Ok thanks, I’ll give that a try. What is a “better” flow limitation chart? Less spikes?
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#18
RE: Possible UARS Sufferer?
Yes fewer/lower spikes and you can kind of go off the 95% Flow Limit statistic on left hand panel (lower # is better).
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#19
RE: Possible UARS Sufferer?
(02-18-2020, 03:22 PM)Geer1 Wrote: Yes fewer/lower spikes and you can kind of go off the 95% Flow Limit statistic on left hand panel (lower # is better).

What would you say the UARS threshold is for that number?
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#20
RE: Possible UARS Sufferer?
There is no such thing.

That is the tricky thing about UARS, it is a syndrome meaning there are multiple causes and flow limitations are just part of the picture. It isn't really the flow limitations that cause the problem it is the arousals and those aren't always due to flow limitations. Flow limitations are just the best thing we can track in this data. 

The only truly accurate way to diagnose UARS is to measure esophageal pressure while performing a polysomnogram but this is almost never done outside of research studies since measuring esophageal pressure requires inserting a probe through nose, down throat into esophagus and leaving it in place for the night.
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