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UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
(12-04-2019, 12:39 PM)mper6794 Wrote:
(12-04-2019, 11:11 AM)mper6794 Wrote: ....perfectly in LINE, alexp. I am used to disregard tens of events like from time to time. A perfect example of arousal/aw-sleep transition, which i score as "fake".
All the best

.....i could have said this better, i am afraid: i would disregard the CA, but count the arousal, that is, the true metrics for UARS, PLMS, and other sense-driven arousals (noise, warm, touch, etc). You might know, we UARS people are amazingly hypersensitive, with very low arousal threshold.


He didn't say to disregard it; he said to review it more closely for evidence of, for example, RERAs.
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RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
Oh-jeez a little bit beyond my civility comfort level but Supersleeper used this on me one time so it must be okay.
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RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
(11-18-2019, 01:04 PM)mper6794 Wrote: Hi, folks, sheepless (to encourage or discourage you!   Smile  )

The semi-quantitative approach I been suggesting for you guys to use to quickly fine-tuning and determine your tailored EPAPmin and PS, while in bilevel machines, came across some 2.5 months ago in my historic (see attached).

I wish I knew this approach this before. I took me some 6 months to get my fine-tuned EPAPmin and PS. Today, after realizing on the quick, overnight, response of median RR, both to P.S and EPAPmin, I could do this within some 15 days.

First thing to know is having and proxy of your normal RR: could do this as simple as put your hands on your stomach, count BPM and multiply by 0.93 (literature); sleep studies, etc.

While titrating EPAPmin and P.S, such relations, would be useful not only to get those two, but also to know whether or not you would be heading/how far toward trigger CA’s by increasing P.S (see examples elsewhere).

This is empirical. Science wise, why increasing P.S would decrease RR? Not sure. Maybe this could be just apparent. Lowering RR would just reflect “tendencies” toward CA’s (lower/none RR at all) in the overall median; my analyses suggest heading to CA’s would occur only RR runs lower than normal RR (see attached graphs in previous post, above). Moreover, of course: more P.S, more ventilation, less need for breathing.

Why increasing EPAPmin leads to higher RR, for a certain PS? Not sure, likewise. Could be more EPAPmin, more space, more CO2 flush, need from more O2 to balance, higher RR?

This first setp on fine-tuning EPAPmin would have to be followed by approaching the best result we can get on RERA’s reduction, by cross-plotting EPAPmin x RERA’s (flagged+unflagged). A zero interception of EPAPmin+PS can be projected, which would lead to ultimate EPAPmin (see attached above).

Slowriter, I know this last step is hard manually; however, I have been doing this daily; it took me some 10 min, including discriminating between PLMS-driven and RERA-driven awakenings. I would never thrust in any machine to do this for me, as I don’t thrust for events in general. For us, UARS-PLMS, absolute majority of all these events are fake ones.

Shepless: I will return later on the medications, supplements, etc, if you think would worth.

All the best for everyone.

Hi, folks

_ I am adding, attached, example of determination of three tailored P.S (my and two more fellows). Keep myself trying, under a very short time availabe, gradually consolidate a quite simple approach to get fine-tuned/tailored EPAPmin and P.S, as well as make predictions on ways to follow while choosing settings, by using BPAP.

_ there are are a great deal of more information on the approach, above, in this thread; examples for unflagged RERA's, etc.

_not great intentions behind this. The approach is still under test, however seems to work universally;

_ not sure about science explanations. I have some ideas, tough. It works as if were moving a split seesaw (EPAPmin one side; PS, the other one), around a hinge line, the normal respiratory rate - NRR: you move each side at the time, almost never at the same time. 

_ to work with the approach it quite simple: it depend only on the building of three or four graphs, while titrating, overnight: (1) EPAPmin x Respiratory Rate (RR, I ususaly use RR/2 to facilitate plots); (2) EPAPmin x RR; (3) (daily counted Flagged + Unflagged RERA) x (EPAPmin+P.S), and (4) historic parameters, as in the example attached.

_ the more points you have, the more precise would be your tailored numbers. It is well known the increasing either P.S or EPAPmin there is tendency to triggers CA's. The more willing person is to move and to extremes and deliberately provoke CA's, the better and quicker the tailored numbers come. 

_changes in parameters can be overnight or not; however, there would be no need to wait acquaintance. Our body respond overnight to changes on P.S and EPAPmin. Once one get their numbers, you may want waiting some time for acquaintance.
_In graph (1), which is still an underway case, includes some predictions which can be made by using the approach, while mapping tendencies toward trigger CA's, while changing P.S

_ please, be pacient; pictures are little bit crowded, however maybe not difficult to get through;

_ main goals of the approach is getting the tailored EPAPmin and P.S, suffcient to bring FL max to zero, within some 15 days. Getting zero on Max FL would not be so important by itself, maybe. However, from my experience, when you get FLmax =0.0 or close, there would be also a general improvment on flow air reductions in general (FR constrictions, quasi-H/H, out and within REM, and so on).

_It may happens, even you got absolute zero, is going to remain some unflagged RERA's, which should be counting daily and graphed against EPAPmin x P.S, so that one could get the otptimum EPAPmin .

_ However, concerning UARS treatment, tailored EPAPmin and P.S would be only part of the history. Elsewhere, on my thread, I have been suggesting what could be eventually a protocol for UARS, like this:

As per literature (well-known great names) and my own case, strategies to treat UARS would be, maybe in this order: (1) adequate sleep position, not on the backs, avoiding the so-called tongue collapse, in particular during REM; (2) cervical collar, avoiding chin tucking; (3) BPAP, with properly balanced EPAPmin x PS; (4) dental appliance, and (5) surgery.

See one recent result of positioning here  http://www.apneaboard.com/forums/Thread-...ce?page=12 in which our fellow experienced dramatic change from back to side sleeping.

As I mentioned above, my intention would be eventually selecting one UARS case each time, among so many out there, and keep testing the approach. Hope it keeps working. If so, I would have helped. If not,  nothing to loose; no risk involved.......

all the best
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RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
.....in time, RR and all parameters in the historic até the Oscar's median.

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RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
....following up the post above, I am attaching detailed explanations on the sheepless case, here.

all the best

Attached Files
.pdf   ASV to BPAP - End Sheepless.pdf (Size: 160.54 KB / Downloads: 27)
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RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
MPER, thank you for the detailed explanation. It's going to take some time to go through it and understand it, but I'll do that in the next few days.
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RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
Hi, DB, folks

Following earlier suggestions and keep on trying to illustrate the semi-quantitative approach to fine-tuning EPAPmin and P.S, I am attaching here my own 7-month journey in this APAP to BPAP world, while struggling to succeed with my own UARS+PLMS example; now preety much worked out at some 85%, I think.

Some drawbacks in my current situation are still related with PLMS+Respiratory arousals/awakenings (in particular, associated with REM's). I have an hyphotesis I could improve this by increasing EPAPmin, but have been facing problems with leaks. I am going to try new alternatives with new masks, etc. Let us see!

all the best

Attached Files
.pdf   Historic_as of Dec 8th.pptx.pdf (Size: 286.36 KB / Downloads: 18)
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RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
I have a few detailed questions to help me try and understand...
  • You mentioned "unflagged RERA". If it's not flagged, how do you measure it? Do you do a detailed search of the flowrate looking for anomalies?
  • Ditto re PLMS arousals. You mentioned you make an overnight audio recording and other members use video. I don't think this is something that most people would do. Is there anything in the charts to indicate this?
  • Respiratory rate varies significantly throughout the night. Which particular RR do you use - min, max, median, 95%?
  • You mentioned trying to determine your own normal RR by placing your hands on your stomach, counting the breaths and multiplying the outcome by 0.93. I don't believe its possible to get an objective RR in this way. While you're awake the RR can vary tremendously - especially if you are conscious of it. This needs either a 3rd party observation or else get the rate from your machine. Also, where did the 0.93 factor come from?
  • The graphs are still quite cluttered. Can you post just the EPAPmin, PS and RR in a single graph and leave everything else out?
  • I suspect some of the trends you've highighted in the graphs may be coincidence. You've highlighted where two lines are trending the same direction but ignored the times when they are diverging.
  • The scatter graphs don't fill me with confidence - there is just too much scatter to form a meaningful relationship. The R2 values are all very low - as an engineer I would want a minimum of R2 = 8.

Please note I'm still trying to get my head around your basic concept - these questions are to try and eliminate the "noise" - inconsistencies and variations which don't really seem to follow the data.
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RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
regarding your second bullet, DeepBreathing, I have posted a number of flow rate screenshots of my typical plm pattern. it's quite distinctive. I can't be sure it's the same for anyone else, but I have seen it in other people's charts. happy to post another pic here if you'd like.
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RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
Thanks Sheepless - I'd appreciate that.
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