[Treatment] Treating UARS with CPAP and bilevel

[slowriter]

You seem to benefit from pressure support, or in your case, EPR.  If you had an Aircurve 10 machine, you would have considerably more control over trigger and cycle sensitivity, minimum and maximum time of inspiration for IPAP, and of course a finer control of pressure support at 0.2 cm increments, rather than EPR settings of 1, 2 or 3.  I think if you have found a pressure that feels most comfortable to you, it might be worth trying an EPR setting of 2 to evaluate if flow limitation increases or CA events are decreased.

Thanks for the explanation.

Key point: I now (as of two days ago; see above) have an Aircurve 10 VAuto!

Here's the settings I have, with the ones marked with asterisk changes I made based on reading threads here.

Mode - S
EPAP - 7
IPAP - 12
Ti Max - 3.0*
Ti Min - 0.3
Trigger - Medium
Cycle - Very High*

[slowriter]

Titration study results (to eliminate the RERAs):

EPAP - 6
IPAP -12

I forgot to ask, but the tech didn't mention any centrals, so am pretty much assuming what the machine's been reporting there is not worth worrying about.

They did it on a Respironics System One which, interestingly to me, felt very different (much less "natural" transitions between IPAP and EPAP?) than the VAuto.

[Dormeo]

I'll be curious how the new settings work for you. I'm not completely sure that the optimal settings on the PR machine will translate directly into the optimal settings on your ResMed machine, but it's good they actually titrated with RERAs in view. About the different feels of the brands: I had home titration on a PR machine and always felt it was trying to hustle into my next breath, but my keeper ResMed machine just followed my lead. Different and, for me, much superior algorithm. I look forward to hearing how things go with 6/12.

[slowriter]

I'll be curious how the new settings work for you.  I'm not completely sure that the optimal settings on the PR machine will translate directly into the optimal settings on your ResMed machine, but it's good they actually titrated with RERAs in view.  About the different feels of the brands: I had home titration on a PR machine and always felt it was trying to hustle into my next breath, but my keeper ResMed machine just followed my lead.  Different and, for me, much superior algorithm.  I look forward to hearing how things go with 6/12.

Exactly my impression as well.

And yeah, I was wondering how well the titrations transfer across machines.

I think the key point that I appreciated confirming is that I need a fair bit of PS to resolve the RERAs. I think I'll start (well, continue, as I've had success with this the previous couple of nights) at a PS of 5 tonight, because 6 felt a bit odd.

The tech that did this study was also the one that did the initial sleep study, and the first person to introduce me to UARS. So once I saw she was doing it, I figured she'd get it right.

[Sleeprider]

Once you post some charts, you ca fine-tune. I think the PS of 6.0 looks pretty good, and I don't have any problem with using S-mode. Be sure the option for Easybreathe™ is turned ON.

[alexp]

Titration study results (to eliminate the RERAs):

EPAP - 6
IPAP -12

I forgot to ask, but the tech didn't mention any centrals, so am pretty much assuming what the machine's been reporting there is not worth worrying about.

They did it on a Respironics System One which, interestingly to me, felt very different (much less "natural" transitions between IPAP and EPAP?) than the VAuto.

Probably because Biflex was turned off on the Dreamstation.

[slowriter]

Yes. When I complained, she mentioned something about turning on biflex.

[slowriter]

Is S mode (6/12) w/Easy Breathe functionally equivalent to tightly-controlled VAuto (6 min EPAP with 6 PS and max IPAP of 12)?

Does appear that flow limitations aren't recorded in S, so that's one difference.

But beyond that?

[slowriter]

Below was the night before the study; an example where I slept pretty well. 

Following is last night, with settings derived from the titration study, where I didn't sleep very well.

Only significant difference is the PS (4 vs 6).

Just wondering on strategy; should I:

1. stay with the higher number and expect to adjust over next few weeks, or ...
   
2. ... work up to that gradually over a similar time-frame?
   

[attachment=15239]
[attachment=15240]

[slowriter]

BTW, I still think the CAs the machine is reporting are not significant. When I sleep through the night, they mostly go away (as with the first screenshot). When I don't, they come back, regardless of the pressure settings.