UARS and BIPAP data, need help

[KillerFitfh]

Hi guys,

after years of unexplained fatigue, brain fog and other health issues, i found out i have UARS.
I am self treating since this disorder it is not known by most of the doctors where i live.
Could you help me figuring my PAP data out?
I am on EPAP 6.5 with PS 4 using a Philips Dreamstation BiPAP.

While this settings are helping me reducing my brain fog, i still feel symptomatic.
What bother me is that my minute ventilation is very wiggly and my breathing is spiky and something weird happens every like 8-10 min. Maybe an ASV could be better? 


Attached some examples

Can you help me please?

[sheepless]

uars is a form of restriction or obstruction. your obstructive events may be treated out by your machine (and therefore not visible) but your chart shows you having only central apnea. how long have you been papping? what does your sleep study full report say? did you have central apnea in the test? how do you know you have uars? if uars is present, you should see evidence of it in flow limitations, rera events and in the flow rate (for unflagged flow limitations).

[KillerFitfh]

I had a watchPAT test with the following results:

RDI 10 ( 26 in REM)
AHI 3.4 ( 11 in REM)

I didn't have central apneas. My centrals appears when my PS is too high but it's very variable from night to night.
I have been using the PAP since 2 months, but figured out that this settings (2 weeks ago) works better since i am feeling a little better.
I had flow limitations before, but managed to reduce almost all of them with a nasal surgery, chinstrap, and this settings. 

The thing i can't understand is why my wave form is so spiky and why i get random changes that looks like arousals (?!)
Also my min vent is very wiggly.. i don't know if that's normal

[sheepless]

you have some big minute vent spikes that look to roughly correspond to your ca events. post a 10 minute view around spikes, near 1:20, 1:40 &/or 4:40 for example. the M shaped flow rate waveform at 3:05:33 is flow limitation; the corresponding increase in minute ventilation looks like a recovery breath followed by a ca. do you see this pattern before some / all of your ca? I have no experience with PR machines so hopefully someone else will jump in here. I do know they're slow to react to obstructive events often requiring higher min pressure than resmed. until you hear from someone else with better advice, my suggestion would be to raise min pressure and reduce min ps hoping to reduce ca without increasing oa and flow limitation too much.

[KillerFitfh]

you have some big minute vent spikes that look to roughly correspond to your ca events. post a 10 minute view around spikes, near 1:20, 1:40 &/or 4:40 for example. the M shaped flow rate waveform at 3:05:33 is flow limitation; the corresponding increase in minute ventilation looks like a recovery breath followed by a ca. do you see this pattern before some / all of your ca? I have no experience with PR machines so hopefully someone else will jump in here. I do know they're slow to react to obstructive events often requiring higher min pressure than resmed. until you hear from someone else with better advice, my suggestion would be to raise min pressure and reduce min ps hoping to reduce ca without increasing oa and flow limitation too much.

Thank you for helping, i am not on AUTO mode.. i tried it but it was so random that it was not useful for my FLs. I can't attach more file
Even linking is an issue. 
Linked below an 8 min view. 
//ibb.co/6tTtBN3 add https:

[sheepless]

your settings are epap 6.5, ipap 11, ps 4.5. the minute vent spike in the linked screenshot is recovery breathing following a brief pause that looks central to me. until someone more knowledgeable weighs in my suggestion is the same: try to reduce ca by incrementally raising epap and lowering ps.

treatment emergent ca is said to take up to 90 days to abate. meanwhile, minimizing the gap between epap and ipap may help reduce ca. raising epap may (may) offset some loss of ps benefit on flow limitation. it's a balancing act.

I'm no expert but don't think the wiggly spikey minute vent is anything but a function of your disordered breathing, meaning it's just your response to breathing anomalies and will likely settle down with optimized pressure settings to address the anomalies.

asv would probably handle all this but if none in your sleep test you'll have a hard time justifying it.

let's see what others have to say.

[Gideon]

The little wiggles are most likely cardiogenic, ignore them.

Just before the CA at the end of your zoomed graph may be you holding your breath after the arousal which contained significantly higher volume breathing which is reflected in your minute vent spike.

The cluster of CA events at the beginning I suspect is SWJ as you tossed a bit before falling asleep.

What caused the arousal? I don't know.