[Treatment] Treating UARS with CPAP and bilevel

[slowriter]

Increase your pressure by 1 cmw wait several days then repeat if necessary.  Keep an eye on your numbers.

Sounds like a plan.

But what numbers are most relevant here? 

Obviously AHI isn't, and RDI is I'm assuming misleading, since it's not based on accurate RERA reporting, and does not include the user flagged events.

Should I just be focused on the event graph, and in particular the user events, plus the flow limitation graph?

Thanks much for your help, BTW; much appreciated.

[slowriter]

I suppose I could use the user flag numbers reported on left sidebar?

[Gideon]

Yes, but changes in the numbers do mean take a deeper look.
UF1 and UF2 are meaningless unless I know both the time and percentage of each.
Your 33 and 66% don't have context, The intent is to shorten the duration looking for frequent short events

Apneas are 80-100% for 10 seconds (20%)
Hypopneas are 50-80% for 10 seconds (50%)
Flow Limitations are 0-50% for 10 seconds

[slowriter]

So I should set one user flag to 50% and 10 seconds?

And the other?

[slowriter]

Or 50 at 8 (one of the defaults), and something tighter, like 70 at 8?

[slowriter]

OK, did three days at 8 (but forgot to put the SD card back for first night), and then one (so far) at 9. 

I attach an example of each.

Per above, UF1 is 70% and UF2 50%, both at 8 seconds.

At 7 there are some UF2 flags, but at 8 and 9 none.

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P=8

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P=9

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Subjective impressions: no improvement; if anything, my impression is sleep was more fragmented at 9.

Questions:
 

1. What's the significance of those jagged fragments right at 0 of the detailed flow rate graph at 9, but not present (or at least don't seem as significant to me) at 8?
   
2. Stay at 9 and potentially keep going, or back off?
   

[alexp]

OK, did three days at 8 (but forgot to put the SD card back for first night), and then one (so far) at 9. 

I attach an example of each.

Per above, UF1 is 70% and UF2 50%, both at 8 seconds.

At 7 there are some UF2 flags, but at 8 and 9 none.

---

P=8

---

P=9

---

Subjective impressions: no improvement; if anything, my impression is sleep was more fragmented at 9.

Questions:
 

1. What's the significance of those jagged fragments right at 0 of the detailed flow rate graph at 9, but not present (or at least don't seem as significant to me) at 8?
   
2. Stay at 9 and potentially keep going, or back off?
   

From what I've read on the subject, the jagged fragments mean the higher pressure is giving you a harder time expiring. I'll let more experienced members answers the rest.

See this article (especially the section Start Connecting Some Zzzzzots):  http://www.apneaboard.com/wiki/index.php..._and_BiPAP

[slowriter]

From what I've read on the subject, the jagged fragments mean the higher pressure is giving you a harder time expiring. I'll let more experienced members answers the rest.

See this article (especially the section Start Connecting Some Zzzzzots):  http://www.apneaboard.com/wiki/index.php..._and_BiPAP

Thanks. I was wondering about that.

So if that's the case, I guess my followup questions would be:

1. are those expiratory limitations significant enough to explain my subjective impressions of less restful sleep (granted, just one night)?
   
2. notwithstanding that, is there any evidence here to say higher pressure on inhalation is more beneficial for me?
   

Behind these questions is one of the larger questions I am hoping to answer over the next week: whether I have the right machine.

[alexp]

From what I've read on the subject, the jagged fragments mean the higher pressure is giving you a harder time expiring. I'll let more experienced members answers the rest.

See this article (especially the section Start Connecting Some Zzzzzots):  http://www.apneaboard.com/wiki/index.php..._and_BiPAP

Thanks. I was wondering about that.

So if that's the case, I guess my followup questions would be:

1. are those expiratory limitations significant enough to explain my subjective impressions of less restful sleep (granted, just one night)?
   
2. notwithstanding that, is there any evidence here to say higher pressure on inhalation is more beneficial for me?
   

Behind these questions is one of the larger questions I am hoping to answer over the next week: whether I have the right machine.

I see quite a difference between the two signals you have provided. See how round and regular the top of the inhalation curve is when the pressure is set to 9 versus 8? That's exactly what you want. Of course, this is just one sample so take a look around to see if it has the same effect during all your sleep. 

When you see the top of your inhalation flattening or diminishing gradually, it means you are dealing with some flow limitations. Increasing the pressure is usually the way you solve it(or using a collar if you are dealing with positional apnea). It may takes quite a lot for some people. The problem with high pressure is that it comes with side effects and some people are a lot more sensible to it than others. So a Bipap is usually the answer if you have already max out your EPR setting.

[slowriter]

Well, I do see things like this elsewhere, also at 9 (BTW, I am using a collar, to try to avoid that as a variable).