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Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
#1
Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Hi all,

I posted back in early February as I had no knowledge or experience UARS or my BiPaP, and no professionals in my area to help.

We settled on EPAP 6 to 9, PS 3, leading to a AHI of 2.5ish most days, a range of 1.5 to 3.8ish with CA, H, and FL events. I got a neck brace to use with my full face mask too.

I didn't feel any better, but my sleep paralysis episodes stopped. In April I tried a new strategy after talking to someone else online. 
This consisted of setting my EPAP and PS to constants. EPAP 6, PS 3. I then raised EPAP or PS by 0.5 each week, looking for changes. I'm currently on EPAP 11, PS 3.

Subjectively my sleep isn't really any different than the february settings, maybe very very slightly better. My flow rate still shows issues (RERA's? There are "cliffs", flat peaks, jagged peaks..) and I have an AHI of 1.2 to 2.5ish, occasionally getting 3.2. However, EPAP 6 PS 3 and EPAP 11 PS 3 doesn't have much difference between them if at all. I'm wondering if I should keep going up, if it's even doing anything?

Things to note:

- Decreased Bi-Flex from 3 to 2, 1, and as of last night, 0. No noticeable change regardless.
- My Insp time is roughly double my Exp time value at any given point.
- My leak rate has two graphs on it, I've read that the bottom line should be at 0 if I'm not leaking excessively. I've not had a single day at 0.
- A PS of 4-5 back in February in my old post led to crazy high CA, yet CA has never been an issue on lower PS even with EPAP significantly higher. 
- I take Inutiv (Guanfacine) before bed. It stops heart rate / pulse increases and is used for controlling blood pressure. I take Vyvanse (stimulant) during the day. I take days off Vyvanse but days off don't seem different to me on OSCAR or subjectively.

It's been seven months since I got the machine and I'm starting to feel a bit hopeless with it. I'd really appreciate any suggestions on what to try or do, and I'm happy to post OSCAR data or anything like that. Thanks!
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#2
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Please look at my signature for what charts in Oscar to post. That is the only way anyone would be able to give you a suggestion.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Agreed, we'd need OSCAR charts to see what's going on.

If your inspiration to exhalation are actually inverse, you might have pulmonary disease that's affecting breathing. Or something else that's restricting your breathing. However data from the PAP on this I:E ratio may not be accurate.

Your medications could be affecting or creating these issues.

Your settings might be influencing this badly.

Those are some possible things.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
(07-25-2021, 06:37 PM)staceyburke Wrote: Please look at my signature for what charts in Oscar to post. That is the only way anyone would be able to give you a suggestion.

Thank you. What would you like to see? An EPAP 6-9, PS 3 day from my last post, a EPAP 6 day, and an EPAP 11 day? The full day, or my RERAs, or the worst events? I've attached full day for two nights ago, EPAP 11, and another from 6 weeks ago at EPAP 9, both full day.
(07-25-2021, 07:35 PM)SarcasticDave94 Wrote: Agreed, we'd need OSCAR charts to see what's going on.

If your inspiration to exhalation are actually inverse, you might have pulmonary disease that's affecting breathing. Or something else that's restricting your breathing. However data from the PAP on this I:E ratio may not be accurate.

Your medications could be affecting or creating these issues.

Your settings might be influencing this badly.

Those are some possible things.

Hi Dave, I remember you from my other post! Thanks for listing the possibilities. I looked up pulmonary disease and I don't have the symptoms apart from I did cough a little more than most when I was in school, my parents used to smoke. That seems to have gone now though and I may have never had anything more than a cough with a cold. My breathing is restricted by my anatomy though, hence my need for treatment! Especially if I look down but I've got my neck brace for that. 

I'm happy to provide OSCAR charts, is there anything in particular you'd like to see? I've attached the chart from two nights ago and 6 weeks ago. One is EPAP 9 another EPAP 11.


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#5
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
OK, now it clicks a bit for me. DreamStation SV Auto. The OSCAR part looks OK to me, any negatives in the therapy from comfort and hour you feel?

So the coughing and such; but not a diagnosis of any lung or airway disease?
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Sorry for not being clearer - I coughed a bit at times as a child but I doubt it was an issue and I've got no reason to believe in pulmonary issues, it's the only thing i could think of that could be related in the slightest. 

I'm not uncomfortable with my mask or machine, no negatives with my treatment. I still don't feel rested after sleep, oversleep if not using an alarm, and struggle with typical cognitive issues, the only thing treatment has helped with is a drastic decrease in sleep paralysis and snoring. 

The main thing for me is reducing RERAs I think, of which I seem to get quite a few. My initial sleep study (WatchPAT at home) had a significant RDI but low AHI. So really treatment hasn't addressed the core issue yet, but I'm not sure what settings to change as an EPAP increases doesn't seem to address my RERAs, nor my residual few snores, Hypnopneas and FL events.
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#7
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
A good test would be to step down to a lower pressure again (say EPAP of 7, PS of 3) and use that a few nights to see if you notice an obvious improvement or worsening. When you slowly increase pressure you see minimal changes and it is easy to convince yourself you are seeing improvement when in reality you may be seeing no difference or even having worse sleep. The noticeable decrease in pressure should make it obvious if the pressure was actually helping, my opinion is that if the results aren't obviously better then the lower pressure is probably better.
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#8
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
First thing I've noticed: your leak rate is too high.  You have a constant unintended leak of 12.  Doesn't that feel uncomfortable?  I'm well aware that the F30 is the diva of the masks concerning adjustment.
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#9
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Thanks Geer. While an interesting idea, and one I might do if there's no other suggestions soon, I'd be just as lost if I ended up back on 7.0. If it wasn't different, or very marginally better/worse, what would I do after that?
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#10
RE: Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]
Hey, thanks for that. Is that different on the earlier image with the lower EPAP?

I'm not sure how to keep the mask sealed during movement when asleep, at the higher pressures. It doesn't bother me aside from the occasional worse day, often predictable with a dry mouth. But I've got a tape on the way to measure my head and get a chin strap and mouth tape to see if that helps at all. It's full face, I clean it daily, I shave, I secure it best i can and have tried loose, tight, and everything inbetween. Not sure what else I can do!
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