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UARS
#61
RE: UARS
O.k., I think there's alot going on here so I'll try to explain.  I went to the ENT yesterday and she had a camera up my nose for a long time.  She said my nostrils are collapsing with each sharp inhale, the turbinates are swollen and she couldn't get the smallest camera past the septum to take a look at my adenoids.  As a trial of what needs to likely happen with nasal surgery, she wants me to use Afrin for 3 nights and report back as to whether the congestion was controlled and how my sleep goes.  She doesn't believe allergies are the culprit because I do not have any other symptoms of allergies, like sneezing, watery eyes, etc, it's only severe nasal congestion.  My nasal passages were extremely sore and swollen after all the camera'ing around up there.

Beginning of the night to the first wakeup around 1:30
Min EPAP:  6
PS:4
Max IPAP: 15
I was sleeping on my back very soundly.  When I woke up, I was starting to have increasing trouble breathing through my nose and eventually at 2:45 took the mask off to have some relief.  Went back to sleep without the mask.  When I woke up, I put the mask back on until around 4:30 a.m., tried sleeping on my back, sleeping on my side, back and forth, and when I just couldn't tolerate the EPAP with my nose being so congested. turned the Min EPAP: 4, PS: 4.  I was able to go back to sleep but it was like asleep for 15 min, awake 15 min, asleep 15 min, awake, etc, etc, and I did take it off once more for some relief of feeling like I was breathing through a straw, until I finally got up at 8 a.m.
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#62
RE: UARS
Upper airway surgery is an option you will have to consider and talk about with your doctor. I'm sure she will suggest that while there will be considerable short-term discomfort, the procedures to open the nasal passages are pretty well established and work well. Whether you pursue a second opinion is up to you, but it sounds to me like you're heading that direction. As you probably suspect you had more flow limitation after the wake-up. I think the CA events are actually a consequence of nasal congestion. I use flonase for allergy related congestion because it doesn't have the rebound effect of Afrin.

AS far as bilevel therapy, you have the option to increase pressure support in 0.2 cm increments. I would try to slowly increase to see if you find more relief. Keep in mind your nasal endoscopy probably made matters worse temporarily.
Sleeprider
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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.
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#63
RE: UARS
(10-23-2019, 11:23 AM)tarah Wrote: O.k., I think there's alot going on here so I'll try to explain.  I went to the ENT yesterday and she had a camera up my nose for a long time.  She said my nostrils are collapsing with each sharp inhale, the turbinates are swollen and she couldn't get the smallest camera past the septum to take a look at my adenoids.  As a trial of what needs to likely happen with nasal surgery, she wants me to use Afrin for 3 nights and report back as to whether the congestion was controlled and how my sleep goes.  She doesn't believe allergies are the culprit because I do not have any other symptoms of allergies, like sneezing, watery eyes, etc, it's only severe nasal congestion.  My nasal passages were extremely sore and swollen after all the camera'ing around up there.

Beginning of the night to the first wakeup around 1:30
Min EPAP:  6
PS:4
Max IPAP: 15
I was sleeping on my back very soundly.  When I woke up, I was starting to have increasing trouble breathing through my nose and eventually at 2:45 took the mask off to have some relief.  Went back to sleep without the mask.  When I woke up, I put the mask back on until around 4:30 a.m., tried sleeping on my back, sleeping on my side, back and forth, and when I just couldn't tolerate the EPAP with my nose being so congested. turned the Min EPAP: 4, PS: 4.  I was able to go back to sleep but it was like asleep for 15 min, awake 15 min, asleep 15 min, awake, etc, etc, and I did take it off once more for some relief of feeling like I was breathing through a straw, until I finally got up at 8 a.m.
Hi,
as an UARS-bearing person, first thing to do, to achieve the best outcomes with BPAP, would be fine-tune  your PS and EPAPmin+PS. One could get these two parameters quickly, empiracally, semi-quantively (see attached, please, and link). Your normal RR (lab study; hand on your stomach counting and multiply by 0.89; or carefullly observation on your charts) would be the key to fine-tune your PS (preliminarily something between 4.2 and 4.8, likely 4.4), whereas daily counting of the respiratory restrictions which lead you to awakenings (flagged + uflagged RERA's) would be the key to estimated your EPAPmin. 
http://www.apneaboard.com/forums/Thread-...#pid316308

good luck
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#64
RE: UARS
.....aiming at better analyses on you charts, wonder If could eventually amplify your scales, in particular tidal volume (maybe maximum 800).
All the best..
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#65
RE: UARS
I used Afrin last night as directed by my ENT and wow, what a difference.  I'll keep doing it a few nights and then go without for a while as well as I've also changed to BiPAP and want to tease out what is happening.  I still had a fair amount of what appears to be unflagged RERAs?  And I consciously remember awakening 3 or 4 times for a few minutes, but I really felt like I slept pretty well from 10:30-6:30 and was ready to go out and enjoy the day.

I was again able to sleep on my back for the first half of the night (with a soft cervical collar) and my nose works much better in this position.  I am seeing that I had some OAs the first half of the night which weren't present the second half when I began mostly sleeping on my side.

I think nasal surgery is likely.  I'm in the process of getting referrals from some pulmonologists I used to work with for a good ENT who does alot of UARS cases.  My current ENT seems like a very nice person, but I'm in a small town and not so sure about the local hospital, just want to get the best possible outcome from this after so many years of suffering.
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#66
RE: UARS
Great, tarah!
Well, you are right: what counts in the end is How you feel.
Yes, your awakenings look (at least top three charts) associated with unflagged respiratory flow reductions/minor snoring. Now, whether these Will turn out important or not would be up to you to decide.
You could eventually keep on plotting your median RR PS EPAPmin, just in case you want to ultimateley adjust these parameters.
Good luck
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#67
RE: UARS
Another very restful, successful night!  The most striking thing is how little FLs I'm having and how that directly translates to sleeping soundly.  Makes me so unhappy that my sleep doc saw the FLs and because my AHI was good, said everything was fine. Boo.

I need help with what further setting changes to make please.  Is this an acceptable number of CA events?  I was having zero before I started on BiPAP.

Thank you everyone for helping Smile
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#68
RE: UARS
(10-25-2019, 09:22 AM)tarah Wrote: Another very restful, successful night!  The most striking thing is how little FLs I'm having and how that directly translates to sleeping soundly.  Makes me so unhappy that my sleep doc saw the FLs and because my AHI was good, said everything was fine. Boo.

I need help with what further setting changes to make please.  Is this an acceptable number of CA events?  I was having zero before I started on BiPAP.

Thank you everyone for helping Smile

Just based on my experience (so take for FWIW):

There's probably going to be a balance between higher PS to reduce your FL further (which you still have room to do), and CAs.

And it can take your body/brain time to adapt to higher PS.

I would go by what you feel in trying to figure out the balance.

I also found changing my trigger setting (to very high) helped resolved machine-reported CAs, for reasons I don't really understand.
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#69
RE: UARS
This looks really good, and I think the number of CA events will go down in time. It's important to consider the duration of these events. The fact you are feeling more rested and successful tells you everything you need to know. These appear to be short events and are surrounded by event breathing without flow limits or recovery breaths. That suggests no arousal.
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.
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#70
RE: UARS
(10-25-2019, 09:22 AM)tarah..... Wrote: I need help with what further setting changes to make please.  Is this an acceptable number of CA events?  I was having zero before I started on BiPAP.

Thank you everyone for helping Smile

....from a distance, looking at your compressed Full night, It looks your absolute majority of events, either CA or OA are false, coinciding with periods of awakenings (still your main problem).
....from my own experience, CA all gone once you properly set your EPAPmin and PS. So, this would be your priority. 
 .... The quickier way to get this would experience a little more, starting gradually move your PS to 4.2...4.4...4.6...4.8, cross ploting the median RR outcomes against PS, until calibrate both with your normal RR (the way i mentioned above); easy thing to do.
....then, once you have PS (likely around 4.4), you would start working on your fine-tuned EPAPmin. This would demand a little more effort from your side, maybe during a month. You would have to count daily, flagged+non flagged RERA awakenings, and cross plotting them against your EPAPmin+PS ( as in my own example above), until you get the correlation and projected zero for the overall RERA's. I am still on this right now, still with some RERA's. It may happens we would never get zero absolute, but only certain minimum, which we would be comfortable with (It looks my case currently).
Good luck
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