[CPAP] fxsnowy - Therapy Help

[fxsnowy]

So I was diagnosed with UARS 3 years ago via a watchpat study with an RDI of 14 and an AHI of 2. I suffer from all the classic UARS symptoms such as fatigue, headache, cold hands and feet, IBS, etc.

I was prescribed a CPAP, which I couldn't tolerate and felt worse on. I eventually found out that the reason I couldn't tolerate it was because my nasal breathing wasn't good. I eventually saw an ENT that told me I had enlarged turbinates/deviated septum/nasal valve collapse. Instead of surgery I decided to fix my problems with nose strips, flonase and azelastine spray. This fixed my nasal breathing and made me tolerate CPAP. I was still experiencing a lot of flow limitations with CPAP, even with an EPR of 3. I was also getting a lot of central like pauses and irregular breathing/waxing and waning of flow rate, even with EPR off.

I did some digging around and found out that Dr. Krakow recommends BIPAP for UARS, so I bought a used Aircurve S. I have titrated the pressure support up to 5, and this has eliminated my flow limitations, based on the roundness of the inspiratory flow. I have noticed about a 40% improvement in my symptoms since moving to a BIPAP. I've been trying out different EPAPS with a pressure support of 5, so 5/10, 6/11, 7/12, but I don't feel the difference using different EPAPs, and I barely get any obstructive apneas. Upping the pressure support to more than 5 starts to make me feel worse. So it looks like 5 is the sweet spot.

Here is my problem. I am struggling with what seems to be TECSA. Not necessarily in the form of central apneas, because setting the trigger to "very high" has "eliminated" them. I say "eliminate" because I heard some people say that setting the trigger on very high just masks them. If I don't set the trigger to very high, I will experience about 10 CAs an hour with a pressure support of 5. Regardless, even if I have no pressure support or I have the trigger on normal, I still experience these irregular breathing patterns all throughout my sleep that look like the classic hyperventilation - hypoventilation cycle. The pattern is always the same, shallow breathing with long exhales, followed by fast recovery breaths that usually end up in arousal. My charts always look like a mess, with a bunch of arousals.

Anyways, since I have been on CPAP/BIPAP for more than 3 months, and what appears to be TECSA hasn't resolved, would it be a good idea to move to an ASV? Any advice?

Thanks

Chart of last night
   

Waxing and waning pattern
   

Zoomed in flow rate
   

[jcp519]

I would say that the Aircurve S was probably the wrong machine and you should have tried a Aircurve 10 VAuto. But that waxing and waning does look like something related to CSA. ASV would probably help this out.

Do you have any of your old CPAP data that shows the same central events and waxing/waning breathing pattern?

[Crimson Nape]

An AirCurve does not report RDI, only AHI.  The AirSense 10 and 11 report the RDI.   Also, the AirCurve 10-S series does not report Flow Limitations, this is only on the VAuto when it is in Auto mode.

I see you have 2 threads about your therapy.  We prefer you keep all posts in one thread.  This allows the reader easy access to your prior posts and changes.  I will be merging them after this post.  Please keep all further posts that pertain to your therapy in this thread.  I have changed your thread title to, "fxsnowy - Therapy Help to make it a more inclusive title.
- Red

[fxsnowy]

An AirCurve does not report RDI, only AHI.  The AirSense 10 and 11 report the RDI.   Also, the AirCurve 10-S series does not report Flow Limitations, this is only on the VAuto when it is in Auto mode.

Yes, but on CPAP AirSense 10 with an EPR of 3, my flow limitations graph was pretty much perfect, with 0s for 95% and 0.1 for 99%. But I STILL had significant flow limitations based on zooming in on the flow rate graph. It wasn't until moving to a BIPAP with a pressure support of 5 where my flow rate inpsiration curve roundness looked normal.

[fxsnowy]

I would say that the Aircurve S was probably the wrong machine and you should have tried a Aircurve 10 VAuto. But that waxing and waning does look like something related to CSA. ASV would probably help this out.

Do you have any of your old CPAP data that shows the same central events and waxing/waning breathing pattern?

Yes

CPAP data: 
   

Zoomed in a little, all those fat spikes are waxing and waning patterns
   

Flow rate zoomed in to that waxing waning pattern:
   

[Sleeprider]

fxsnowy, do you have a trigger sensitivity setting? What is the setting you are using? What version Oscar is this?

[fxsnowy]

fxsnowy, do you have a trigger sensitivity setting? What is the setting you are using? What version Oscar is this?

yes, right now I am using very high. When I have it on high or normal, I get more CA events. But the waxing and waning is there regardless of the trigger setting. I am using OSCAR version 1.4.0