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[Treatment] Treating UARS with CPAP and bilevel - Printable Version

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Treating UARS with CPAP and bilevel - slowriter - 08-07-2019

I was recently diagnosed with UARS, based on an in-lab sleep study, with an RDI of 24.

Sleep doc prescribed APAP initially with 5-15 pressure setting. No titration study as of yet.

In the few weeks since ...

Aside from one day (which gave me hope!), I feel no improvement. Some days I feel worse than pre-treatment.

Most nights I also wake up at least once, often for 30-60 minutes.

I have experimented with increasing the minimum pressure. My newbie confusion lies in the fact that raising the minimum pressure still leaves a somewhat active-looking (to me) flow limitation graph. I stopped at 11, and then backed off, and am stable at 9.

Current plan is to follow up with doc for a proper titration study, and to include assessment of whether BiPAP is warranted.

Any others suggestions or words of wisdom?

I'm not allowed to post the image of the data as a new user, but will below.


RE: UARS and APAP - slowriter - 08-07-2019

Last night, and pretty typical. Activity towards end was while awake.

[Image: 7Etg1rv.png]


RE: UARS and APAP - Dormeo - 08-07-2019

Actually your flow limitations don’t look too bad; it’s the CAs that look rough. Were you awake during some or all of that time? And did you have fewer CAs when your minimum pressure was lower? Answers to those questions could be useful to the experts.

Small matter: I’m puzzled why the event flags before the break aren’t appearing on the flow rate graph.


RE: UARS and APAP - slowriter - 08-07-2019

Pretty sure the CAs correspond to when I'm awake.

Here's at 5.

[Image: X5gJ8HP.png]


RE: UARS and APAP - alexp - 08-07-2019

Can you do a zoom in on a couple of breaths just to see the shape they have?


RE: UARS and APAP - slowriter - 08-07-2019

Sure thing. 

A mix of "normal," and not so normal, from last night.

[Image: ArI607Q.png]


RE: UARS and APAP - alexp - 08-07-2019

The normal breaths look great to me. From what I read, UARS tend to flatten the inhalation peaks so this is what you should be looking at to see if you need more pressure or not. My AHI is 20 (mainly hypopneas) and RDI 36 so like you I have a lot of RERA. 

Here's how it looks in my case when I have a RERA  :

[attachment=14252]

As for the other breaths, I will let more experienced members comment on them.


RE: UARS and APAP - bonjour - 08-07-2019

(08-07-2019, 12:00 PM)slowriter Wrote: Sure thing. 

A mix of "normal," and not so normal, from last night.

[Image: ArI607Q.png]
Look at the height and volume under the curve.  Your breaths on the left are bigger the decrease then a bit of recovery breathing starting about 1:05:10.  Pretty much the definition of a RERA but it looks like it was not enough duration or volume change to get flagged.
So yes, this detail does show something going on.  The question is are there enough of these to cause you a problem?  I assure you that 1 is not enough.


RE: UARS and APAP - slowriter - 08-07-2019

(08-07-2019, 02:22 PM)bonjour Wrote:
(08-07-2019, 12:00 PM)slowriter Wrote: Sure thing. 

A mix of "normal," and not so normal, from last night.

[Image: ArI607Q.png]
Look at the height and volume under the curve.  Your breaths on the left are bigger the decrease then a bit of recovery breathing starting about 1:05:10.  Pretty much the definition of a RERA but it looks like it was not enough duration or volume change to get flagged.
So yes, this detail does show something going on.  The question is are there enough of these to cause you a problem?  I assure you that 1 is not enough.

So if the machine isn't flagging these (and it's not), then the only way to answer your question is to go through the graph and manually count?

Because I am speculating there's a lot more than 1.


RE: UARS and APAP - slowriter - 08-07-2019

Quickly looking through and bookmarking similar odd fragments, I count 25 in the period before I first awake/take off the mask (a bit over four hours). I mean things like this.

[Image: yRRJU6m.png]