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cwhyd - Therapy Thread
#1
Question 
cwhyd - Therapy Thread
Hi folks,

Whilst inconclusive for sleep apnea, my recent WatchPAT study showed a showed a significantly raised Respiratory Disturbance Index in all sleep positions.

From my report:

Total pRDI events: 262
REM: 36.2
NREM: 48.
All night pRDI: 46.7

I'm trialling a Resmed Autoset 10 with a full face mask, and would appreciate your comments on my OSCAR charts. :-)

Both nights show quite different results.  You'll see a gap of an hour or so on night 1 where I woke up, took the mask off sat up for a little while.

Night 1
   

Night 2
   

Thanks in advance!
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#2
RE: Opinions sought on OSCAR results - new UARS case
Night 1 shows that you experienced "Positional Sleep Apnea.  Notice the apneas that are clumped together.  This means you are sleeping in a way that is cutting off your air supply... probably on your back and allowing your head to tilt forward into your chest.

This can also occur if you are using a too tall of a pillow.  Try using a thinner but firm pillow.  Also sleeping on your side is helpful.

The good news is that the second night doesn't show that issue.

All in all, your charts look decent.   How you feel is important.
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
OSCAR Chart Organization
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



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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#3
RE: Opinions sought on OSCAR results - new UARS case
Thanks so much for taking a look.  Smile 

You're right - I was sleeping on my back that evening.

I'm starting to research flow rate restrictions and can see those through the night of day two.  Is the graph data worth digging in to further on those, or is this again nothing to worry about?
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#4
RE: Opinions sought on OSCAR results - new UARS case
@ cwhyd

In what way was your watchPat inconclusive for sleep apnea?
The info from the AS10/OSCAR show a need for pressure support, especially on your back, clearly suggesting sleep apnea. 

Flow restrictions are definitely worth looking into as they interfere with quality sleep.

On the left side bar of the OSCAR report are measures of Flow Limit. The experts here like to see the 95% (95 percentile) lower than 0.1, ideally lower than 0.03.

That's usually achieved with settings and position adjustments, sometimes more is needed.
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#5
RE: Opinions sought on OSCAR results - new UARS case
The 95% flow limitations is at .07 on that chart, and we like to see it under .10, so you're ok.

You are experiencing this throughout the night though, so there may be some room for improvement. Here's the thing... we use EPR to lower FL and you are already using that. The only way to improve on it is by switching to a BiLevel machine where you can use PS (pressure support).

I think that you're numbers are ok unless your sleep is disturbed by it.

Post again tomorrow as every day can be different.
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
OSCAR Chart Organization
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



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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#6
RE: Opinions sought on OSCAR results - new UARS case
Thanks for the reply  Smile

I had a terrible night's sleep during the WatchPAT survey, so I don't feel it was properly representative.  I'm going to get a new one scheduled in over the coming weeks.

Here's the output of the WatchPAT survey:

   
   
   

And some comments from the report:

"In conclusion, this study was performed in a sleepy and symptomatic patient. However, the
results reveal that the AHI is within the normal limits (AHI< 5) and do not support the diagnosis
of obstructive sleep apnoea and hypopnea syndrome (OSAHS). Note the results of this study
showed a significantly raised Respiratory Disturbance Index (RDI), suggesting the possibility of
Upper Airway Resistance Syndrome (UARS). Therefore, the patient may want to seek further
advice about this from a specialist sleep centre. Also, note the AHI in the supine position was
raised, while remaining normal in the other postures, which suggests a positional component
to the respiratory events. However, because the possible UARS events were observed in all the
sleeping positions, positional therapy may not be effective."

For what it's worth, I'm feeling so much better today after last night's sleep! I'll post tomorrow's results when they arrive. :-)
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#7
RE: Opinions sought on OSCAR results - new UARS case
@cwhyd
Thanks for the additional details.

UARS is a type of sleep apnea that often requires a Bilevel machine to treat.
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#8
RE: Opinions sought on OSCAR results - new UARS case
Unfortunately, many doctors/insurance don't recognize UARS.

Of course, we know it's a real thing. Doctors will usually go ahead and prescribe Cpap, even though a Bipap would be better treatment. It's hard to get docs onboard because they know insurance will probably deny the need for Bipap. With an AHI 1.4, they aren't seeing much else.

I think if you can stay off your back, you "might" see less FL. Time to experiment?
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
OSCAR Chart Organization
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



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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#9
WatchPAT pRDI score - could this be UARS, or is this insignificant?
Hi everyone,

For years, I've suffered with terrible fatigue and problems with my sleep.

I'd started to suspect OSA after repeatedly waking up gasping for air and suffering with insomnia, so have commissioned a few WatchPAT studies to see what's going on.

Of the 2 studies, I'm showing a pRDI of 50.5 and 46.7.  pAHI is low, at 3.0 and 1.4:

   
   

I've recently started using a Resmed Autoset 10, which I believe is making a huge difference to my quality of life.  I've dialed in the APAP to minimum 8, maximum 20 and I'm seeing a typical 95% pressure of 11.28, AHI 1.57.  At the default 4-20 and without EPR, I was seeing a large number of CA events and wasn't sleeping well.

Here's an example of last night's sleep.  From what I can see, this looks (and felt) like a great night's sleep on APAP:

   

So, to my question - I've seen varying information online, but do these pRDI values look significant enough to indicate a potential UARS case?  The AHI score looks far too low to be anything related to OSA. I'm looking to book an appointment with a specialist, but don't want to be laughed out of the room with the data I've collected so far.

The Resmed is making a huge difference to my quality of life - I genuinely feel like a different person, but equally, want to make sure that this isn't a placebo effect.

Any thoughts or opinions would be appreciated.  Thanks
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#10
RE: WatchPAT pRDI score - could this be UARS, or is this insignificant?
And one other question that I've been struggling to answer - flow limits.

Is there a 'good' or 'bad' range for flow limits? Here's an example of a few sleeps that you can view. In addition, I've noticed that I often get big clusters of CA events at the beginning of my night's sleep. I've adjusted my sleep position to make sure this isn't positional apnea, but this doesn't seem to have helped.

https://sleephq.com/public/7714331c-8eef...605e4a1405
https://sleephq.com/public/6cb88243-ff1a...49c879b0ee (I get the odd night where I have a lot of CA events as I'm falling asleep - this was one)
https://sleephq.com/public/7efe3f9d-65ce...ed5d359ca6
https://sleephq.com/public/36f1c9a8-0a90...abf822247b
https://sleephq.com/public/3648ef19-ddf3...c6e5e669c1
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