Bilevel self-titration for UARS

[ChickenTenders]

I've used CPAP for several months and while I have certainly noticed an improvement in some of my symptoms, things have since ceased to improve. This is despite having a near 0 AHI and RDI from day 1. I suspect this is because I have UARS on top of mild sleep apnea. I believe this because I have noticed flow limitations after importing my data into OSCAR and they tend to correlate to an elevated heart rate on my pulse oximeter and awakenings. I have found that increasing EPR to 3 have reduced the severity of these flow limitations and although they still persist. Increasing pressure didn't seem to do very much, and I was getting a lot of clear airways.

While I am waiting to get a new doctor to look at this, I got some advice and did some research and it seems like a bi-level device might help me, so I got one (Resemed Aircurve 10). I am going to go with CPAPFriend's method for self titration by following Resmed's bilevel titration protocol, substituting X-minutes with 1 night. I'll start with the default of EPAP 4 and IPAP 8 since I've found while I was on CPAP that even the minimum pressure was enough to stop events. Since the S mode doesn't record flow limitations, I'm actually going to set my device to Vauto on minEPAP 4, pressure support 4, maxIPAP 15. I'm going to assume that I can treat flow limitations similarly to "Sp02 desaturations w/o Events" on this flowchart. I'll be posting my charts and changes here in the hopes that if this works, maybe someone in the future can use it as a reference.

Anyways, that was a giant wall of text. If you see any problems with my plan of action, please point them out to me. I would greatly appreciate it.

   

[PeaceLoveAndPizza]

What will help is seeing some OSCAR reports. A few days if possible. The links for downloading and formatting the charts are in my signature.

[ChickenTenders]

Yup, I'm on it. This was my first night on the bilevel. The data looks a lot better than I was expecting, which is pretty promising. Unfortunately it seems like I still woke up multiple times. I'm not sure if I should change any settings since there doesn't seem to be any problems to "fix", kinda making my plan moot. Maybe I need to just give it more time to get used to it?

[PeaceLoveAndPizza]

Give it more time. Things look good.

Your wake-ups are not CPAP setting related. Most likely you just have to get used to it, which takes time.

[ChickenTenders]

Unfortunately it appears that yesterday was likely a fluke, the automatic hose temperature the device set was too low and likely caused condensation to form. As a result of the vent on the mask failed (which explains why I woke up more than usual). I have corrected that last night.

It appears that I am still getting some flow limitations, although it's considerably less severe than how it was when I was on CPAP. However I would still like to see if I can reduce them just in case they are causing arousals. Looking at the titration diagram I guess I should increase pressure support? Or should I be increasing minEPAP (overall pressure) instead?

[ChickenTenders]

I've had a rough few days but was able to get back on track last night and last last night. Last last night I went back to the default settings except I limited Vauto such that it wouldn't adjust pressure to see if that does anything. I also tried increasing pressure support by 0.4 last night, although I started getting clear airways. Flow limitations seem quite minimal, so it sucks that I'm still getting awful sleep.

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Additionally I started looking through the flow chart and took some screenshots of non-normal breathing. These aren't marked by any events but they seem odd. I am curious as to whether they are significant or just noise?

[quiescence at last]

 shows just normal brain body discussion on whether or not you want to sleep or to be awake, where the higher volume breaths show continuous in-out-in, while the sleepish breathing adds pauses of various lengths to the end of exhales.  There are no failures ie. "events" in that snapshot.

 shows starts out as asleep, gets startled awake stuttering small breath holding and greater volume breaths.  Apparently, your brain figured out all is well and transfers the control back to in-out-pause of sleep breathing. The longer pause is just fine, and I would not call it a failure "event", but simply a yield back to the autonomous breath.

You're good.

QAL

[ChickenTenders]

Thanks for taking a look at it for me. I think I'm probably overthinking this, I'm going to end up losing sleep over losing sleep.

[jkossis]

Did you ever end up finding a set of pressures that improved your quality of sleep? I’ve been struggling with a pretty similar set of symptoms as yours (Bi-Level improving flow limitations, but still having unrestful sleep).

[ChickenTenders]

For me it was because I had severe anxiety causing insomnia on top of my sleep apnea. I ended up hyper-focusing on my data and pressures (which just ended up creating more anxiety), however it's likely that my default settings (4IPAP, 3EPAP) were and still is treating my sleep apnea just fine. If you've gotten the clear from the forum (you can also try posting on other forums if you really want to be sure) that your data is normal (normal sleep data has some amount of flow limitations as well), and you don't have any unusual circumstances or conditions, then you should probably just pick the pressures you find comfortable while producing good data results.

I cannot say for sure that your settings don't need adjusting, but if I could do this whole thing all over again I would have tried attacking my insomnia from multiple angles (sleep apnea, sleep hygiene, diet and exercise, and finally therapy). I was simply unwilling to do so because of the stigma of psychological illness in my family.