Need Help With Settings - UARS - Charts Included

[Crimson Nape]

. . . Unfortunately I cannot post images as I've exceeded my MB limit . . .

Since you are getting good advice and seem to have a handle on everything else, I will address your attachments.

The long version: Go to UserCP (top right of every page) > Miscellaneous (lower left of the list) >  Manage Attachments.  Delete your oldest attachments to free up some storage space.

The short version: Click this link to take to your Manage Attachments section.

- Red

[Samthesleeper]

Got it! Thank you! 

Okay, see the attached screenshots from the latest night. Let me know if you need a ZOOM on anything.

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Attached First Night - the one with the centrals - as well for comparison - Night 1 on the left - Night 2 on the right.

[Crimson Nape]

Not too shabby! Your FL is still 0.0 at 95%tile. Since you are experiencing some Hyoponeas, I think I would bump up the minimum pressure to 8 cm. It is your EPAP pressure that controls these.

If you zoom in on your flow rate, about a 2-3 minute window, and look at the waveform. If it has a normal, smooth sine wave pattern, then all is good. On the other hand, if your upper wave (above the zero line) resembles a cursive lowercase "r" (flat topped or almost), then additional PS pressure is needed.

- Red

[gainerfull]

@SamtheSleeper - your confusion around my math and your 15cmH20 number is because I was presuming you were on static bilevel pressure when you're using vauto mode which is a range.

With a 0.53 AHI I think I would focus on your leak first & foremost because you had 9 large leaks last night and based upon your leak data (green line) your mouth was open at least partially for the entire night. When I was taping my mouth I used cloth medical tape you can buy from almost anywhere and would purse my lips when applying it and make sure I covered both corners liberally with a single piece. I also turned humidity down to 1 as it was set to auto and it was drenching the tape at night.

The reason you're tired is not entirely because of your AHI, it's your sleep being fragmented by leaks and likely RERAs based upon the large spikes in the flow rate. It may be helpful to have you zoom in on a couple of those spikes so we can see what's up.

If it were me I'd let it ride for a couple of nights with your current setting and really figure out a way to keep your mouth closed at night or transition to a simple full face mask like a resmed f10 or f20.

[Samthesleeper]

Okay,

See attached some zoomed in flow rates spikes.

It seems to me I do like a double breath. sh*t hits the fan, and then maybe a move around/get aroused which causes a leak.

What could mitigate this? What could cause this?

Also: are the flow rate numbers kinda low before these arousals? They average 16-19 flow rate scores on the inspiration curve peaks before I do that double breath each time.

Thanks guys, what do you reckon from the charts? Attached 2 from the arousal portions and 1 from a normal looking stretch.

[Crimson Nape]

It appears they are pretty good. The 03:42:00 looks is the ideal shape, and the 3:42:05 is the cursive "r" that I was referring to. This is the start of an airway restriction. If you have them occasionally, no worries. If they are predominant, then increase the PS.

- Red

[Samthesleeper]

Okay cool. 

So, I think I will do this tonight

1. Double tape my mouth
2. Back to side sleeping 
3. Increase PS back to 4
4. Increase EPAP to 8. 

I have also ordered nasal pillows - hopefully this will mitigate leaks further. 

Anything im missing?

[Crimson Nape]

For me, the F&P Evora Full Face Mask allows for a nasal pillow style with a mouth covering. This eliminated the taping of the mouth. I have to admit that I have had excellent luck with all F&P masks, so my opinion is slighted.

- Red

[Samthesleeper]

Ill look into those. 

Thanks again for all of your awesome help. I really appreciate it. 

Will do those changes and report back tomorrow

[Samthesleeper]

Alrighty! Some good progress I think! Will give it a few hours and see how I feel but I 100% feel better than yesterday. 

NOTE: I used nasal pillows this night for the first time.

What are your thoughts? 

Very interesting to note that despite me putting PS back up to 4 again I did not trigger even 1 Central event. On night 1 I had a PS of 4.2 and triggered 4-5 Centrals.

This makes me believe they weren't really 'true' centrals and were a result of me holding my breath and clenching my teeth which sometimes happens during an arousal/me tossing and turning. Therefore, since the arousals are being taken care of, with the new mask and settings, my arousals have decreased and the 'centrals' have also disappeared. What do you think? 

This makes me think I could even bump up the PS a little more to see if that would reduce the last straggling Flow Limitations I have - thoughts? I am still getting those spikes in Tidal volume and Flow Rate that also correlate with my Flow Limitations and then a Leak, which suggests arousals to me. 

Either way, from my limited knowledge this looks a lot better, unless I'm missing something. Will report later in the day on my energy.