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UARS - Treatment Assistance required
#1
UARS - Treatment Assistance required
Hi Guys,
This is my first post on this forum as I feel i need some questions answered by the CPAP/BiPAP/ASV Boffins! 
About 18 months ago i got the diagnosis of UARS and was thrown a CPAP (S10 Autoset) given the usual "4-10 + EPR 3" and leave it at that, well that didn't suit.. after about 12 months in and much research I pulled the trigger on a VAuto(Learning that it works much better with UARS) and have had what i feel is a reasonable success with that however my treatment is still not great and I just feel some days i go through these particular bad patches that bring me to my knees.. I'm not an expert on this by any means so i think its time to share a few screenshots and see what you all think? 

The worst symptoms i seem to get from all of this and what triggered me to get help initially was what i  believe is called "Sleep Starts" fall asleep - wake up - fall asleep - wake up in a vicious scary cycle that seems to trigger an adrenal response that combined with light sleep + ALOT of tossing and turning which is what seems typical of UARS now however that's mostly under control since starting CPAP/BiPAP however sometimes unavoided which makes me think the treatment is suboptimal. I've had a bad run over the last 1.5 weeks and I've been messing around with pressures but all of this is largely uninformed.
So!
What I found comfort in setting-wise for the last 4-6 months has been these pressures on the VAuto: 8.6-12.8 PS: 3.8. I'll attach those screenshots and use them as the reference as its my most used setting. 
Another thing that has prompted me to create this is after scouring through other people's graphs my flow curves look bizarre compared to most others and my Insp time vs Exp time seems to be way off balance and wanted some thoughts around this? Is it the Vauto? Anatomy etc? 
I did check my OSCAR of the old CPAP which i can posts screenshots of too and IPAP/EPAP 95% were a lot closer so I'm assuming it's a dynamic of the Vauto I just wondered if I needed to get those figures closer together somehow? 
Thanks,
see attatched multiple screenshots Smile
Overview - Settings + Typical Run (Not a bad night per-say)
2Min Flow
4Min Flow with disruption
Its worth mentioning i have a Full Face F20 Resmed Mask + Headgear.
Let me know if you need anymore information,
Cheers.


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#2
RE: UARS - Treatment Assistance required
A lot of how you are doing is based on the very subjective how do you feel.
Your 2 min zoom had a minor interruption but mostly normal but with some lower volume breathing starting at the end of the chart, possibly flow limit.

The other zoomed chart shows a more significant arousal 3:58:20 - 2:59:10. How many of these did you have? 1 is insignificant.

Click the triangle between the month and year to lose the calendar.
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#3
RE: UARS - Treatment Assistance required
Thanks for your very fast reply! 
I will attach a more broad look at the issue at hand, I'm getting those flow "Jitters" or limitations quite often it would seem - I wish I had a machine that could mark RERA because I'm sure I would be getting many: 
See attached.
Overviews + 30-minute look at the "Rattyness"
Do you think my 95% Inspiratory vs 95% Exp time is an issue at all(From the earlier posted Overview screenshot?) 
Cheers,


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#4
RE: UARS - Treatment Assistance required
Probably also worth attaching: A look back at my 2.5min flow curve from the Autoset days ~12months ago.  It may add some value.


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#5
RE: UARS - Treatment Assistance required
In the zoomed-in views, I can see a little bit of cardioballistic artifact. That just means your heartbeat telegraphs to your airway. This shows up as a little oscillation around the 0 line in the flow rate. I have it; lots of people have it; it's nothing to worry about. It can sometimes louse up the I:E ratio and/or the respiration rate if the oscillations are read as breaths, though your data look like they're probably not getting loused up. Looking at the median I and E lengths, your expirations are a little bit longer than the classic length of twice the inspiration length, but nothing to worry about, I'd say. But maybe Gideon or another expert can speak to that.
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#6
RE: UARS - Treatment Assistance required
(08-29-2021, 06:09 PM)Dormeo Wrote: In the zoomed-in views, I can see a little bit of cardioballistic artifact.  That just means your heartbeat telegraphs to your airway.  This shows up as a little oscillation around the 0 line in the flow rate.  I have it; lots of people have it; it's nothing to worry about.  It can sometimes louse up the I:E ratio and/or the respiration rate if the oscillations are read as breaths, though your data look like they're probably not getting loused up.  Looking at the median I and E lengths, your expirations are a little bit longer than the classic length of twice the inspiration length, but nothing to worry about, I'd say.  But maybe Gideon or another expert can speak to that.

Thanks for the reply Dormeo. 
I certainly seem to have good and bad runs! i was told by an ENT i have whats called Septum "Spurs" and definitely a "pin-hole" airway his words not mine? Do you think the sleep starts are related to potentially not enough EPAP Stenting the airway open at sleep onset causing getting kicked out of sleep repeatedly?
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#7
RE: UARS - Treatment Assistance required
Are the sleep starts involuntary muscle jerks? Or are they repeated awakenings without involuntary muscle jerks?
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#8
RE: UARS - Treatment Assistance required
(08-30-2021, 11:21 AM)Dormeo Wrote: Are the sleep starts involuntary muscle jerks?  Or are they repeated awakenings without involuntary muscle jerks?

Its a jolt more than anything like right on the cusp of "asleep" then bang booted back into being "awake" with an adrenal response HR etc.. Have been checked for Leg movements etc during sleep study and came back OK.
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#9
RE: UARS - Treatment Assistance required
There's something called hypnic jerks that involve jerks of the muscles, but it sounds as though that's not what you're experiencing. Another possibility is that there's a glitch occurring during the complex neurochemical hand-off from your waking controls of breathing to your sleeping controls.

It's good that PAP is helping some with this problem, and perhaps with time it'll fade away. In the meantime, when you experience this during the night, could you check the time and then the next day post a zoomed-in view of the period when you were having the jerks? Maybe a ten-minute zoom.
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#10
RE: UARS - Treatment Assistance required
(09-01-2021, 11:07 AM)Dormeo Wrote: There's something called hypnic jerks that involve jerks of the muscles, but it sounds as though that's not what you're experiencing.  Another possibility is that there's a glitch occurring during the complex neurochemical hand-off from your waking controls of breathing to your sleeping controls.

It's good that PAP is helping some with this problem, and perhaps with time it'll fade away.  In the meantime, when you experience this during the night, could you check the time and then the next day post a zoomed-in view of the period when you were having the jerks?  Maybe a ten-minute zoom.

Will do.. i'll go back in time and find an OSCAR trend that suits.. How would you correct this "Neurochemical" issue if that indeed was the potential issue? It was always explained to me as when flow limitation occurs the abrupt awakening can occur with it?
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