Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

Therapy for LPR, OSA, and… UARS?
#1
Therapy for LPR, OSA, and… UARS?
I have to say this is one of the most inspiring places I have yet seen on the internet. Patients helping each other with a level of care and technical knowhow that are rare even in the many doctor’s offices I’ve visited. I honestly think the Staff and regulars here are heroes. SleepRider, Dave, OpalRose, CrimsonNape, Gideon, to name but a few I’ve read… Cheers to you all. 

I am a 38 year old with no history of health problems until recently. In roughly March 2019, I started waking up in the middle of the night with a racing heart and numb right arm. Eventually, my heart would slow, but I found it hard to fall back asleep. The next day invariably I would feel terrible, unable to work or even think. 

I was diagnosed with LPR. The docs put me on PPIs and a strict diet. I lost 60 pounds and started walking for an hour each day. Over the spring and summer of 2020, my episodic awakenings seemed to improve, and I was often able to make it through the night. The right arm numbness ceased. I used the Snorelab app to try out different positions and pillows, and eventually things got to the point that I wasn’t snoring at all.  However, I would still wake up feeling miserable most mornings, and functioning throughout the day at a very low level. I assumed it was just a bad sleep, but I couldn’t remember ever feeling like this even three years ago. 

In November 2020, I had another racing heart awakening. Throughout December and January, these episodes have been accelerating and sleep in general has gotten much worse. It started to affect my daytime in debilitating ways again. Lately I’ve been in a state of constant inflammation and complete mental disorientation and unable to function, haven’t done any work or even driven for weeks. 

The doctors I was seeing made it clear they are going to take months to do inlabs and get me treated. So I bought a WatchPAT two weeks ago, attached. AHI/RDI both high enough for an OSA diagnosis. But the RDI is conspicuously higher — looks like I’m an edge case leaning UARS. I suspect flow limitation and RERAs could very well be a main issue impacting my quality of life. 

After studying posts for a while, I decided to buy the VAuto out of pocket, as it seems to be the recommended option for my particular issues and the most flexible overall. I had my first full sleep last night.

I remember being awake from 5:00 to 5:30. Dry mouth and some discomfort. When I ultimately woke up a second and final time, my ears had popped and I had some aerophagia. I feel strange this morning and mildly out of sorts but it’s honestly better than what I’ve been living with. Keep in mind this is my first use of PAP Therapy. 

That being said, by the numbers it looks like a centrals nightmare. I planned on getting three nights or so to establish a baseline on mild settings, but I clearly need to rethink my approach. Paging the gurus of Apneaboard.

+ Closeups of a few of these central clusters.


Attached Files Thumbnail(s)
                   
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: Therapy for LPR, OSA, and… UARS?
Welcome to the forum and congrats on the progress you made losing weight. Lots of centrals in your charts and they look to be real with no evidence of obstruction. This may be therapy onset central apnea, and less pressure support and more steady is usually the direction we take. For starters, I want to try to keep the PS 2.0 in place but narrow pressure and change the trigger sensitivity to high. High trigger sensitivity still requires that you spontaneously initiate inspiration, but lower the flow threshold for the machine to switch to IPAP, and it often helps. With your LPR, do you have any sense of aerophagia or air-swallowing?

Suggested settings:
Mode Vauto
EPAP min: 4.4
PS 2.0
Maximum pressure 8.0
Trigger sensitivity High
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#3
RE: Therapy for LPR, OSA, and… UARS?
Thank you so much for the welcome, observations and settings SleepRider! I will implement tonight.

With the LPR I don't notice swallowing or aerophagia, but gaseous reflux seems to be the main mechanism which gives me airway symptoms. Thus minimizing the PAP aerophagia should help the overall inflammation and hopefully breathing improve considerably. I should mention that I am sleeping on a Medcline Reflux Pillow system which keeps me elevated at 30 degrees all night. It's been a week and already made a significant difference. I plan on returning to a more normal pillow setup as I've seen recommended for PAP once I get things a bit more under control.
Post Reply Post Reply
#4
RE: Therapy for LPR, OSA, and… UARS?
Subjectively, I had a worse night. The first night I felt unusual/disoriented but pretty refreshed. This night, the trigger being set to high kept me breathing more and although I know it acts on my spontaneous breathing, it made the cycles *feel* more involuntary, as if I was on a ventilator. Which I am of course lol, but for some reason that *feeling* was harder for me to acclimate to and it took me an hour to get to sleep (around 1:15). The breaths also felt somehow shallower. I remember waking once around 5am. On my second and final wake at 7am, I didn't feel great waking up - a bit short of breath and like my throat is closed (I still feel this atm). Ears popped again and had some aerophagia on final wake, which notably seems milder than yesterday's.

By the numbers, it looks like a better night. My observations: no OAs and very few hypopneas. CAs reduced but I still had a couple very long ones (~45 seconds). I seem to go into CAs when the pressure rises. Based on my Samsung Watch, they are clustered mostly around the beginning of my sleep and REM. Crazy I can't even handle these low pressures. 

What do you think SleepRider?


Attached Files Thumbnail(s)
   
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: Therapy for LPR, OSA, and… UARS?
The pressure looks about right, and AHI is less than half. If you want to put the trigger back to Medium that's fine, but I think once you get used to it, the queue to breathe can be a good thing.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#6
RE: Therapy for LPR, OSA, and… UARS?
Thanks! I guess I'll have to think about that. The CAs and oxygen saturation are certainly much better with High. Having watched my oximeter a couple weeks, I don't desaturate that much at all even without PAP (hence the RDI in the Sleep Study being 4X AHI), but on the first night with Medium when I had the two 60 second CAs, I had a pretty precipitous drop. On the other hand there's no question Medium felt more comfortable and now that I've spoken out loud I think my voice may even have changed somewhat. But perhaps I can acclimate.
Post Reply Post Reply
#7
RE: Therapy for LPR, OSA, and… UARS?
God I love OSCAR, it really is incredible. After picking through some other threads I figured out how to add my pulse oximetry to my OSCAR data. Thought I would share my system since it can be a pain to do with some devices.

I have a Wellue O2 Ring that I wear on my right thumb, that uploads results via Bluetooth to my phone. In Dropbox, I set up a folder within my OSCAR data directory with the serial number of the device. Then I got an app called Dropsync that was $2, that lets you sync a folder on your Android phone to a Dropbox folder (there's also a version for Google Drive). I set the O2 Ring folder (in my case /ViHealth on the phone) to automatically sync with the serial number folder on Dropbox. Now in the mornings, I can just transfer the O2 Ring data to m phone, then go into OSCAR and import my SD Card and Viatom data.
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: Therapy for LPR, OSA, and… UARS?
That's great! Could you copy that post and put it in the Software Support Forum under a new title like "How to Sync Wellue O2 Ring in Oscar"? This could become it's own discussion and help others.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#9
RE: Therapy for LPR, OSA, and… UARS?
Assuming the LPR is similar to my GERD, what I do to combat mine while trying to sleep is raising the head area on the bed some and more left side sleep.

With the CA, we'll need to consider settings as Sleeprider has begun suggesting. The higher trigger setting that's mentioned seems to help for some, but that's just one thing. Something I've noticed generically is reduction of setting pressure swings. But this must be balanced with addressing other Apnea treatment needs. Possibly we might need something nearly straight pressure, a setup that varies only a small amount. Trends on this CA need watched, but this is possibly headed to ASV.
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.
Post Reply Post Reply
#10
RE: Therapy for LPR, OSA, and… UARS?
Dave, thanks so much for your thoughts and very glad to hear you think we are on the right track here. It's nice there are other things we can try down the line too. In your experience, what is the right time window to make a determination of whether these CA are Treatment Emergent? Do TECA tend to resolve on different timelines for different folks?

The last two weeks have shown left side and elevation are the two best things for me too. After I move on from this crazy pillow, I suspect I will try using bricks or a full-length wedge mattress topper like Avana makes. Because I no longer eat within 6 hours of sleeping, I was really confused about why my reflux kept giving me airway symptoms after I'd wake up. Then I read Steven Park's Sleep Interrupted where he suggests that pressure differentials due to apnea can actually vaccuum pepsin out of the LES/UES into the airway. It was a big aha moment that led me to get the WatchPAT. I had done a Resmed sleep study last year but my AHI was 4.7 so the neurologist minimized it without treatment and I had more or less forgotten about apnea. Meanwhile, RDI.

SleepRider, thanks! I posted it Smile
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Dapal's Therapy Thread. dapal 128 3,725 5 hours ago
Last Post: Sleeprider
  Need help with wife's therapy GuyScharf 6 201 02-22-2021, 07:12 PM
Last Post: SarcasticDave94
  Bipap Titration for Preliminary UARS Diagnosis marasmus 1 101 02-21-2021, 04:22 PM
Last Post: Sleeprider
  New BiPAP user! (UARS). Need serious help please! Data included, much appreciated CentralApneaUser909 55 1,116 02-21-2021, 07:13 AM
Last Post: slowriter
  low AHI, poor sleep, UARS/mild OSA JEDP 8 231 02-09-2021, 11:19 AM
Last Post: staceyburke
  Went ahead and bought a BiPAP. Why is it better for UARS? CentralApneaUser909 6 247 02-04-2021, 09:52 PM
Last Post: CentralApneaUser909
  Optimizing UARS Therapy From ASV to Vauto UARS.DDS 17 533 01-31-2021, 10:40 AM
Last Post: UARS.DDS


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.