Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]

[Gideon]

Your machine treats by maintaining a constant Tidal Volume, but it cannot because you have it handcuffed by restricting PS to 3. This is something we need to keep in mind as the auto part is trying (but cannot) to maintain tidal volume vs managing Pressure, a different mode than we usually deal with. We need to know what we are trying to treat.
Can you provide a copy of your sleep studies, personal info redacted. And why are you using this machine? Your Title says UARS, I'm not saying that is not the case but PS is the main tool there.

OA - treated with EPAP pressure
H, FL, RERAs, and UARS - treated with PS
CA, is treated with maintaining volume, tidal or minute Vent, depending on brand.

Any correlations should be with the above.

With UARS you need to manually check for flow limits because they are under-reported.

[Gideon]

Having found your history I understand more. KEEP your therapy posts together.

I would have increased PS SLOWLY, since you had CA issues with higher PS, but it is PS that would treat UARS, not EPAP. Go back to the 6-9 you had in feb, and determine which "FEELS" better, that or your current.

Then increase PS in SMALL increments, using the qualitative measure of how you feel to decide which settings to keep.

[ldinks]

Hi Gideon, sorry about that! I figured it was buried or not quite relevant, I'll keep things together in the future.

Does your first comment still apply or do I need to just increase the PS? When you say slowly, how slowly?

Also, why go back to settings with a higher Ahi? Do you think my leak rates are a problem?

I'm happy to post Oscar charts in an hour, if you want to see my flow limit issues (untagged).

Thanks and sorry again for splitting the threads!

[SarcasticDave94]

I would consider leak rates as a possible problem. Maybe I'm wrong, and it's not going to be the first time, when I was in ASV therapy, I can get my Fisher and Paykel Vitera full face mask to a leak rate of 10. So if I'm counting correctly, leak rate of 10 on ResMed should be close to unintended leaks of 10 on Respironics. If incorrect, OK please note it and I'll note it.

Whether I'm accurate or not, my typical leaks of 10 max on the ResMed is with me hitting IPAP of 20 to 25 at times. Your mask seems only able to handle IPAP 12 and leaks in the Respironics scale of unintentional at 12. So if I'm even remotely close, your mask and leak rates could be better. Maybe as I said earlier, might be time to replace a weak cushion or something like that.

[Gideon]

I specifically want you to state which feels better. UARS optimization is based on your perception. Otherwise look at 100% of your flow rate in a detailed view and determine the number and when your non-flaged events are occuring, then relay that info to us.

[Geer1]

Thanks Geer. While an interesting idea, and one I might do if there's no other suggestions soon, I'd be just as lost if I ended up back on 7.0. If it wasn't different, or very marginally better/worse, what would I do after that?

If better you stay at 7, if no obvious change stay at 7, if it is obviously worse increase pressure again either all the way or partially. 

You want to minimize pressure unless it is obviously making a difference.

[ldinks]

I specifically want you to state which feels better.  UARS optimization is based on your perception.  Otherwise look at 100% of your flow rate in a detailed view and determine the number and when your non-flaged events are occuring, then relay that info to us.

Thanks Gideon. I did an all nighter two nights ago, so I'll give it a few days before trying to determine anything. My partner didn't know I'd changed anything but told me she noticed I snored more than usual which isn't filling me with confidence. I'll get the OSCAR data a bit later if you want, but otherwise I'll report back in a couple of days. 

If better you stay at 7, if no obvious change stay at 7, if it is obviously worse increase pressure again either all the way or partially. 

You want to minimize pressure unless it is obviously making a difference.

That makes sense, I guess I thought if there's no obvious improvement it just might not be high enough pressure to overcome whatever structural issues there are. 

I suppose if it's not much different and my PS can't be adjusted upwards, I'm going to have to look into other forms of treatment then?

[Gideon]

You should always post your nightly charts. It provides context if nothing else.

For OA, H, and CA events our machines do an adequate job of flagging events. For UARS and it's associated Flow Limits, not so much.
Feel free to post 3-minute views as they allow evaluation of the flow rate for flow limits. These are best managed with pressure support on a BiLevel or EPR on a ResMed device. Otherwise the only tool is pressure.

So my thought is to use what you and Sleeprider previously determined and increase PS/EPR then, if necessary add pressure.

[Geer1]

If you can't see a difference in data (fewer apnea, hypopnea, flow limitations) or feel a difference then higher pressure probably isn't making a difference. All you can do is try different settings to see what feels best to you.

[ldinks]

You should always post your nightly charts. It provides context if nothing else.

For OA, H, and CA events our machines do an adequate job of flagging events.  For UARS and it's associated Flow Limits, not so much.  
Feel free to post 3-minute views as they allow evaluation of the flow rate for flow limits.  These are best managed with pressure support on a BiLevel or EPR on a ResMed device.  Otherwise the only tool is pressure.  
 
So my thought is to use what you and Sleeprider previously determined and increase PS/EPR then, if necessary add pressure.

Yeah that's pretty much my issue - I've had different settings with fairly low AHI but never resolving problematic flow rate. 

I've attached last night for context then, with two zoomed flow rate issues, there were at least 12 more at a very quick click around and I've got pictures for like 8 of them. Do you need the full OSCAR image with these or just the flow rate part? If it's just the flow rate, I can put multiple into one attachment instead of having to spam the forum.

If you can't see a difference in data (fewer apnea, hypopnea, flow limitations) or feel a difference then higher pressure probably isn't making a difference. All you can do is try different settings to see what feels best to you.

Sorry for not being clearer! I understand that if the number and subjective feeling isn't different, the increased pressure hasn't helped. I was talking more about treatment overall. For example, if I had a PS of 3 and hadn't seen any difference at 4, 5, 6, and 7, is there no chance that I just need a PS of like 10, and wouldn't start noticing much until roughly 8 or 9?