Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]

[SarcasticDave94]

ResMed's 10 series ASV has 3 modes: CPAP which is straight single pressure with no exhale relief, ASV which is single EPAP pressure and PS Min Max, and ASV Auto which makes EPAP a Min Max.

[ldinks]

Great, is a variable EPAP that desirable? Is there a similar machine without variable EPAP that moght be cheaper? A second hand resmed is $3k + delivery for me, which seems like a lot.

[SarcasticDave94]

I myself was treated better on ASV Auto, with EPAP range. Others can do well on ASV mode which is EPAP as single pressure.

I think the cost involved is just due to the ASV machine being the top machine on the stack, not the EPAP range ability.

[ldinks]

Realistically it will take me about a year or so to afford it, not including if I get any ENT private treatment, professional apnea/uars scans/titration/whatever. 

I think I'll see what else can be found through settings, and if we reach a point where the data looks good but my symptoms seem unusually Persistent, or CAs won't budge and need to, I'll also try cutting all medication for a month. If it seems like asv makes most sense and I should try another machine still, I'll go for it.

[Geer1]

You can see the obvious central breathing periods where you take very small slow breaths but instead of hitting you with high PS and trying to force you to breath it doesn't really even attempt to do so. I am hoping that is juts because you turned BPM back off, I would turn it back on and see what the results look like. Since your issue is central apnea you need backup rate to deal with that.

I would definitely be curious to see your results on a Resmed ASV, I wonder if it is possible to find somewhere to trial one since you already have prescription for ASV.

[SarcasticDave94]

I'd caution to be careful of dropping medications cold turkey. Some medications have withdrawal symptoms that could be rather bad to cope with, some even life threatening. I don't know what your meds are, even so check it out with your doctors and get proper medical advisement.

[ldinks]

I'm on Intuniv (extended release guanfacine) and vyvanse. During adaptation to guanfacine, rem is slightly reduced. I'm passed that but who knows if it has a tiny impact. Vyvanse is a stimulant. I saw an EERS study for people who gave up on PaP treatment after trying everything and being too sensitive to TECSA that wouldn't go away while simultaneously needing higher PS, and 50% of participants happened to use stimulants. Do stimulants cause it, or do those suffering turn to stimulants to prevent their dysfunction messing their lives up, wasn't a focus of the study unfortunately. Both are safe to come off and I've got a Psychiatrist that can titrate me down on the intuniv. So no worries there! 

As for BPM, I'll give it a go Geer, but if it's within the PS range of 2.5 to 4, I thought it wouldn't be able to go past 4 and wouldn't do anything a constant PS 4 wouldn't. Shall I set BPM on tonight or get more data with it off first?

Unfortunately I'm not able to be treated in my area, my current ASV was bought second hand so I have no prescription. A local charity has outlined what my options are, which involve lots of time and money, so even if I really try to get a proper professional, we're talking over a year at least.

[LordEthan2]

Agreed, we'd need OSCAR charts to see what's going on.

If your inspiration to exhalation are actually inverse, you might have pulmonary disease that's affecting breathing. Or something else that's restricting your breathing. However data from the PAP on this I:E ratio may not be accurate.

Your medications could be affecting or creating these issues.

Your settings might be influencing this badly.

Those are some possible things.

Out of interest.. (Sorry not meaning to Hijack just a learning) my Insp Time is 95% 1.2-1.4s and my Exp time is 3.8-4.2s - my pressures are 8.8-13.0 PS: 3.8 (VAuto BiPAP) with diagnosed UARS, Is a higher exp time a problem? What could be causing this?

[Geer1]

BPM and PS are very different settings. BPM supplies an increase in pressure to try to force you to breath when you don't spontaneously do so. PS is just the amount the pressure increases during inhalation.

With BPM off the machine relies on your spontaneous breathing effort to determine when to supply PS. The problem is that you are having central apnea and therefore do not have spontaneous breathing effort... So while you sit there not breathing the machine is sitting there twiddling its thumbs wondering when you are going to take another breath. Simply put this machine cannot and does not treat central apnea when you have BPM turned off.

LordEthan2, best to ask that question and show some zoomed in examples of breathing in your own thread.

[ldinks]

I appreciate the explanation - I'm not sure where I got confused, but it makes sense again now. Thanks for keeping it simple!

Symptom-wise, I feel somewhat improved, but I'm going to ignore it for now while we don't have lots of days of data.

Data-wise, my tagged CA was fully resolved, tagged H's only happened immediately after a timed breath, and tagged FL was lower than usual. I still had the odd flow issue. I had 169 timed breaths. Good night overall I think! Hopefully timed breaths would decrease over time..? Although they may not even be an issue. 169 beats 4000 anyway!

I've attached the day, a H event (they all look similar), and I can't attach FL due to reaching my 15mb limit. Is that a permanent issue on my end?

Do you think it seems good? Shall I continue this for a week? If today isn't a fluke, I think I'd be rather happy actually.