[CPAP] Question about cpap/bipap prescription UARS

[tugboatxd]

So I have been suffering from UARS for over a year and have been using CPAP for about 8 months. It is not effective for me. I have read that BIPAP is much more effective for many people with UARS. My question is do I need a separate prescription to try BIPAP? I already have a prescription for CPAP (although my insurance would not cover it) I'm pretty desperate at the moment as I am really suffering every day.

[Crimson Nape]

Hi tugboatxd!  -  

Before we can offer any recommendation, we need to see data from your current CPAP.  Please download the free app, OSCAR from this site only.  Besides embedding the link in the OSCAR name, you can find the download page at the top of every page here.  You will also need an SD card.  Its size can be anywhere from 2 GB to 32 GB.  It must be in your CPAP when you sleep in order to record your detailed sleep data.  You will then import the data into a user created profile in OSCAR.

For additional information on how to organize your Daily screen and posting a screenshot of it here, please see the links in my signature.  As a "heads-up", depending on your computer's OS, please use the "Standard" view (OSCAR's default) and the F12 or Fn+F12 for a Mac to take the screenshots while you're in OSCAR.  Using the F12 or Fn+F12 collapses the calendar and shuts off the right side menu, if you have it displayed.  This allows us to see more of your detailed data on the left and your graphs.  Also, the graphs are ordered in the order of importance for us to see.

Take care and I look forward to seeing your data.

- Red

[tugboatxd]

A little more back ground. I am waking up constantly. Not just rera's I think also consciously waking up. I'm getting no real help from my providers as most of them dismiss UARS as not even being real. My sleep study awhile back was an AHI of .2 and an RDI of 15

[Crimson Nape]

Your low numbers would indicate you are in your sweet spot. Don't expect to get an AHI of 0.0. They may happen, but it is not the normal for most people. Based on your low numbers, the main question is, "How do you feel"?

A side question; did you use the F12 key to take the screenshots? It's supposed to collapse the calendar. If it isn't doing that, you can do it by selecting the up arrow (pyramid) to the left of the date.

- Red

[tugboatxd]

Yea I feel horrible. Every day I feel like I got 0 rest. Severe fatigue, unable to focus or concentrate. Waking up constantly at night. I've read a lot of people saying only BIPAP helped them with UARS thats why I want to try it. But im wondering if I need to get a completely new prescription. Oh no I was using built in pc screenshot. Ill try f12 next time.

[Crimson Nape]

Based on your low Flow Limits and the occasional CAs using an EPR of 2, a Bi-level machine will not offer any benefit.  You can try increasing your EPR to 3 and see how you feel.  Using a bi-level setting is a double edge sword.  The pressure difference aids flow limits, but can also increase occurrences of CA events.

Just to make sure, zoom in to a 2-minute span.  This will provide a magnified view of your Flow Rate's waveform. Before you do this, right-click on the Flow Rate label and select "Dotted Lines > Zero".

- Red

[meatwagon42]

completely wrong and dangerous misinformation. BIPAP's PS will and is proven to help with flow limitation.

[Crimson Nape]

Please explain where I'm wrong. What information is dangerous, and why is it?

- Red

[meatwagon42]

https://www.apneaboard.com/forums/Thread...apy?page=1

PS, EPR is what helps flow limitations. The higher the PS/EPR the better flow limitations get. 
"EPR adds a sawtooth pressure wave that is triggered by inhalation and this will tend to make the inhalation flow rate waveform less flat than it would otherwise have been (increased pressure during the saw tooth EPR leads to increased flow rate). Hence the "flow limitation" number will be lower"

It assists inspiratory flow limitation by bringing "pressure support" behind the spontaneous effort of the user, which is effectively a mechanical assist that helps to mitigate airway resistance, resulting in a more normal breath profile. In general, it helps to shorten inspiratory time and reduces effort to achieve normal tidal volume. It does not work equally for everyone in all cases, and does not have the timing and sensitivity settings available on the Aircurve. Compare charts of an Aircurve and Autoset, and it is clear that the IPAP/EPAP wave pattern is identical.

[meatwagon42]

"Based on your low Flow Limits and the occasional CAs using an EPR of 2, a Bi-level machine will not offer any benefit."

You cannot see his flow limitations unless you zoom in far enough. Note that machines most often times don't pick up flat form inspiratory flow limitations if it doesn't meet a certain threshold of the algorithm. Just because it's not reported does not mean it does not exist.

---

Your advice is dangerous because it is wrong. It is preventing him from getting the proper treatment for his UARS/SLeep apnea. 
And we all know the risks of sleep apnea.