Oscar Data. No events flagged but weird flow rate pattern during REM

[Dormeo]

I see you're still in S mode. In an earlier post, I advised you to change to PAPVauto mode, and I'd still advise that. It'd be good to be able to see flow limitation data.

Try to make just one change at a time and stick with revised settings for at least 3-5 nights. That way you'll have a better idea of what is helping with what.

I'm glad you feel there's some improvement.

[Ynot]

I'll change to vauto for the extra data. I think I will lower the pressure a bit because it gave me aerophagia, which does not happen at lower pressures. This time, if my breathing is more regular at rem, this will serve as good additional evidence for the positive effects of increased trigger sensitivity as I'll have a night with the same pressure to compare. I can then continue to reproduce that.

Thanks for the advice.

[Ynot]

How is rem supposed to look like? It is confusing because rem induces more volatile breathing, and more resistance, even in people with no significant SDB related arousals. I am pretty sure it is not supposed to look like this (attachment - typical flow with cpap in rem), but how stable and regular does healthy breathing in rem look like? I looked at my brother's data, who has a similar diagnosis, and although he is using cpap, his breathing in rem looks similar to mine right now in bipap: some flow limitations (he has a bit more) and some central-like waxing and waning. 

Has any user achieved a stable breathing pattern in rem, similar to that in the other stages of sleep? Personally, breathing always looks great outside of rem. With cpap, the flow limitaton in rem was clearly more severe than normal, but how different does my rem wonky looking breathing with bilevel look compared to the norm. Do we have a model?

[Ynot]

looks worse without epr actually

[Ynot]

It was quite bad

[Phaleronic]

I've not see such waveforms before, it's so staggered in every breath that I don't know what class of inspiratory flow issue you're really having here...

Here's a chart of mine with roughly the same timeline for juxtaposition:

https://live.staticflickr.com/65535/5385...55c_3k.jpg

[Ynot]

Hi Phaleronic.

Yeah very unusual. My diagnosis is UARS. Judging from how much I improved, as of now, with bilevel (Attachment: latest rem flow), I'm guessing it is just severe UARS... wtv that is. It is interesting that it is completely unresponsive to cpap, and even more interesting that the medical community here in Canada is completely oblivious to it. 

Does your flow rate look that regular throughout the entire night. My flow looks like that outside of rem, but as you can see, it still looks wonky with bilevel. One way I know for sure I'm in rem is by looking at the tidal volume and respiratory rate which becomes erratic (attachment) - does that happen to you too?

Thanks for the insight.

[Phaleronic]

Hi Ynot,

UARs is a good guess, has anyone here suggested that too? Most sleep docs are inept is what I've found out here in the US, not so sure about Canada

Yes my flow rate looks very similar all night long, and tidal volume and rr do not fluctuate as yours does, would really like to see you get this figured out

[Fixit50]

I was plagued by waveforms similar to yours but quite a bit worse.  It looked like a random noise generator.  I had those using CPAP and later using BiLevel but on BiLevel the problem wasn't nearly as bad as it was on CPAP (with epr=3).  With either CPAP or Bilevel, using a chin strap to keep my mouth closed solved the problem.  I use the F20 mask, now combined with the chin strap.  I tried to avoid using the chin strap due to comfort issues, but I'm rather acclimated now and it solved my problem.  On Bilevel, my flow limits are considerably lower then on CPAP in either case, with or without the chin strap.
Have you tried a chin strap?  It might be worth a try!  I believe keeping the mouth closed as with a chin strap, decreases flow limits with either therapy method, and in some individuals, like me and maybe you, this abates the jagged and irregular breathing you see during rem.  A full face mask for us may be bad without a chin strap since it pushes the jaw back somewhat, which is not the way to keep the upper airway opened.
If you try the chin strap, let us know how it works out.

[Ynot]

Hi Ynot,

UARs is a good guess, has anyone here suggested that too?  Most sleep docs are inept is what I've found out here in the US, not so sure about Canada  

Yes my flow rate looks very similar all night long, and tidal volume and rr do not fluctuate as yours does, would really like to see you get this figured out

Forum members noticed that the main issue was the flow limitations during rem, and suggested to turn on epr, which helped and ultimately led to me seeking bilevel treatment, which helped much more. It is my understanding that UARS denotes RERAs, which are basically arousals due to significant flow limitation. 


In cpap talks, someone suggested palatal prolapse, but I think it’s just severe flow limitation and expiratory mouth breathing which has a similar pattern. The basics mentioned in this forum is epap to correct OA and sometimes hypoapneas, and ps to correct flow limitation, persistent hypoapneas and RERAs. This fits with my situation and I think UARS is the correct diagnosis.


However, it is very poorly understood. It clearly is not simply a less severe version of OSA like many “experts” think, since cpap often does not work for UARS. It is a different SDB issue, correlated to OSA and caused by very similar factors, but still different.