Resmed VAuto, ST or ASV

[dcg494]

Hi Sleeprider, I've been tracking my case for a decade now since i got the diagnosis and it's clearly physiological (and ofc, as w everyone, it also a psychological component). But just fyi to take into account, there are a lot of people who only tolerate very low pressures and where the FLs are very subtle and barely any sleep labs score data to properly capture these micro-awakenings. LIke i said, a proper sleep lab figured out i wake up 40 x an hour. I have a hunch that with UARS it's more about lowering overall respiratory effort, and every bit of positive pressure will make a difference. Also have a hunch that UARS part of the symptomology is due to a more reactive nervous system than is typical in people living with OSA, so lower pressures will often be better. In my titration study for instance, arousals increased suddenly/dramatically after 7 or 8 cm pressure, but lowered in the 4-6cm range. Curious whether you've found other members in a similar situation. And why did you write "If you have resolved flow limitation with current settings, then we're really not dealing with UARS", just curious.

[Sleeprider]

UARS is by definition flow limitation. We can use the absence of flow limitation as a good indicator that pressure and pressure support has mitigated the airway restrictions that cause poor or limited inspiratory flow. So it's a legitimate question to see how often or how much inspiratory flow is limited or flattened by your airway resistance.

[dcg494]

Right, makes sense in theory, though ofc the way FLs are flagged or identified in a clinical setting (including our Oscar/sleepyhead) is at best somewhat random. Ideally they would be defined and then measured according to everyone's own physiological response in an EEG to those FLs, to see whether they are relevant/signficant or not.  (e.g. at what magnitude of FL and what duration does the FL lead to an arousal and sleep fragmentation). See here in the attachment, i added user defined flags for FL defined by limits in flow of 50 and 80% lasting at least 3 seconds. Now i have 11.5 events/hr. If we reduce the parameter to 2 seconds, it'll go up to the 30/h range, more in line with what the sleep studies find in my case (which do measure sleep fragmentation based on EEG). My hunch is that this is a huge factor in why people find relief from treatment (whether CPAP or otherwise) and some others don't, even if some objective measures seem to indicate that the treatment is being effective.

[Sleeprider]

Please minimize the monthly chart by clicking on the triangle in the current date. Flow limitation is something we identify in a zoomed view, generally 3 to 4 minute segments give us a good view of the flow rate wave form and lets us see how you respond to any inspiratory "flattening". It allows us to see events that are not flagged. Notice in your chart there are places where flow limits increase and you also show some UF events. We want to focus on the minutes leading up to a flow spike like the ones at 01:30, 00:30, 02:00, 03:05 etc. Those look like arousals or RERA.