ASV - How to know if UARS is treated?

[IUsedToSnore]

Thank you in advance for any help!

I'm still struggling with middle-of-the-night insomnia after undergoing extensive CBT-i at National Jewish Hospital. The CBT-i didn't really help much as my time in bed is totally normal and sleep restriction wasn't necessary. The clinician was baffled. Still - major middle of the night insomnia most nights that can extend 30 minutes to several hours.

I've also had some chats with Dr. Barry Krakow who seemed to believe these could be UARS type events. Is there a way I can detect these on OSCAR? It looks like my Apneatic events look like they are pretty well treated with my ASV (AHI under 1 - thanks to all the help on this sub), but how do I know if I'm still having some sort of RERA/UARS type events?

[Geer1]

You have to look at detailed flow chart. RERA's show up as progressively worsening breaths (lower amplitude and higher flow limitation) followed by an arousal and recovery breathing. This gets a bit tricky to interpret on ASV because of the variable PS that acts to fight the restricted breaths.

Only other way to confirm would be to get a sleep study done to see if having RERA's while using ASV.

Insomnia can be caused by a lot more than just personal thoughts/habits or breathing. If you are already following good sleep hygiene and CBTi practices and have no obvious breathing issues then imo is more likely insomnia due to another cause.

[Sleeprider]

Flow limitation from UARS has a characteristic inspiratory wave pattern with flattened peaks that is very easy to see on an Oscar chart with either the Airsense 10 or Aircurve 10 machines. If you have read our wikis on flow limitation you know what to look for. Connecting middle-of-the night insomnia with your CPAP therapy is nothing more than a possibility, rather than a likelihood unless you can connect the arousals with respiratory events that might contribute to it. We have had a number of members that follow Barry Krakow's work try to use ASV as therapy for flow limitation. It is my opinion that the Vauto bilevel is by far the preferred therapy as ASV itself can be very disruptive to sleep when not being used for its intended purpose of treating central and complex therapy.

Take a look at your Oscar charts and note where flow limitation increases, and terminates in a significant change in respiratory volume or rate. That may be a RERA. The event still needs to be analyzed to see if it really led to arousal, or if the source of the arousal led to the changes in respiration. In general, if you have significant ongoing flow limitation, then an Aircurve 10 Vauto which can provide consistent therapy to treat that, is a better option than ASV for most people.