NEW TO CPAP - NEED HELP UARS

[Samthesleeper]

Hello everyone. So im new to cpap/bipap for suspected UARS. And need some help/advice on calibration. Ive attached my OSCAR charts for first 2 nights of use. 

First, I've made some notes below, sorry for long read but it gives context and I want to provide full picture to get right advice. 

Note: I skipped the sleep doctor, due to previous negative “at home” sleep study and becoming desperate to fix my sleep issue. So I bought a used Resmed AirCurve 10 Vauto as I suspect I have UARS that has been missed. 

First just a quick primer of symptoms if it will help with advice/settings etc. 

Basically, I’ve always been tired for as long as I can remember. And ive always had VIVID dreams in the 2nd part of the night - usually anxious dreams of trying to “get somewhere on time”. Ive also had quite a few of the famous “drowning” dreams. 

I have woken up gasping for air a few times after a night out of drinking (this doesnt happen when I abstain). Wearing an 02 ring after a night out revealed o2 drops to 82% multiple times which would explain that. 

(Is it possible to only have “drunk” apnea? Or is existing “hidden” apnea simply revealed by drinking?)

My usual sleep schedule goes something like this… 

Fall asleep at 10pm… wake up at 2-3am without fail. Usually no dreams in this period. But if I do have one, then I awaken immediately after it and remember it clearly. 

Spend about an hour awake, then fall back asleep about 3-4am. This is where it gets dicey. I will have about 3-5 dreams in this period all in a row. All of them vivid. And after/during each dream sequence, I will wake up, roll over, fall back asleep, almost immediately back into another dream. Wake up, rinse, repeat. 

I remember all my dreams. Sometimes I have caught myself waking and hearing the last few snorts/snores coming from my throat. 

Therefore I suspect I have REM induced respiratory arousals/ UARS when sober. Which evolve into full blown apneas when I drink alcohol. 

When I finally get up, I feel foggy/unmotivated/exhausted. This has been getting a ton worse after about a 10lb weight gain which I am now in the process of losing to hit this thing from all angles as my quality of life is deteriorating quickly. 

NOW ONTO THE MACHINE AND RESULTS: 

Night 1: 

-results below. Mask felt “tight”. Slept ok with it on. Did feel a little claustrophobic. Woke up in middle of the night, tore it off, went back to sleep. 

-saw that there were some flow limits in line with respiratory rate increases - I assumed these were RERAs? Is that the case? 

-I noticed that before I woke up, the flow limits, respiratory rate, and pressure all increased right before I woke up. 

Night 2: 

• I increased min epap from 6 to 7. Reduced max ipap to 15 from 20. And increased PS from 4 to 4.6. 
  
  
• mask felt great. Slept with it on all night. 
  
  
• I still woke up at 3amish (i think) again. 
  
  
• I still had vivid dreams (but less than usual, only about 2) that I woke up from early morning (5amish). 
  
  
• However, still feel foggy, tired. 
  

Am I on the right track here? Anything from the charts that I need to asjust/recalibrate? Or anything at all? 

Noticed a few CA listed on night 2 but they were all around 10 secs and I think were due to me rolling over after an RERA. 

Thoughts? Thank you all! 

---

[Sleeprider]

You are on the right track and have essentially eliminated flow limitation, which is the signature of UARS. Your first night results with EPAP 6.0 and PS 4 did not show much indication of a pressure increase, had a reasonable leak rate and actually resulted in more hours of therapy time. With higher minimum pressure and PS you started to trigger some CA events and leaks and had no real benefits to show for it. I think you should return to your first night settings and use them for a week before moving on. If CA events should arise, a high trigger sensitivity should extinguish them. Your first night results show very steady respiration, and appears to be a more comfortable session, so I think you nailed it on the first try and proved that higher PS and pressure are not beneficial. The arousals you experience at 2-3 PM do not appear to be respiratory, but we can look at that closer. You may be expecting too much to assume your first night on Vauto therapy that those habitual arousals would fully resolve.

[Samthesleeper]

You are the man, thank you so much for getting back to me.

I will return to Epap 6 and PS 4, will test for a week and then check back in,

In terms of Max Ipap, should I return to 20? Or keep it lower at 15?