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History: I was having sleep issues back in 2012, going to sleep was not an issue but I always woke up after 5/5.5hrs and could not get back to sleep even though I felt tired and foggy but also felt a little wired. Had in lab sleep study done but did not find sleep apnea but had a number of reras (>5, don't remember the exact number) and very little deep sleep (10%). Sleep doctor said there was little they could do for me since I did not have apneas. Went to an ENT who was a family friend who looked at my report and thought it may be UARS. He recommended I go see a sleep doc on Long Island who specializes in UARS. Went there and was titrated to 5cm and over 50% deep sleep but still only 5 hours. I tried the 5cm but was not feeling any improvement so I started playing with the pressure. I think I ended up at 9cm and after 6 months or so was feeling better and sleeping longer. I used it for maybe another year or 2 then started going to bed without it and was feeling alright waking so I stopped using the CPAP (Resmed S9 Elite).
Present: Started having sleep problems about 6 months ago, waking up early (5/5.5 hrs again) and groggy for entire day. Thought it was because bad sleep schedule, tried cleaning that up, tried sleep restriction for a month (6 hrs in bed) but didn't get any more sleep and was falling asleep at work. Decided to try CPAP again and scheduled an appointment with a sleep doctor in the area (didnt want to go to Long Island since it was a drive). Bought an AirSense 10 Auto and was trying to figure it out on my own with SleepyHead but I don't know enough about tweaking things and why I'm here now looking for help. Been using it for almost three weeks now. Still waking after around 5 hours but fog is slightly better (starts to slightly lift in afternoon instead of lingering all day). I'm currently doing a 3 day Home Sleep Test and boy do I feel it today.
Basically I'm not sure what numbers to examine cause AHI is useless for me since I don't have any apneas. I set it on auto for 9 - 11 cm auto with no EPR. I've read a lot here about EPR helping flow rate but I'm not sure why so if someone can answer that. All I can think about is rounding flow limitations with the flow rate graph. My snore numbers look good and flow limit I believe is fine but flow rate I still don't always get the rounded and look a bit ragged. On a whim, I raised my pressure range from 11-15cm with EPR of 3 (I'm at work so I'll post those when I get home) and have a few days data from that as well.
I'm all for experimenting so looking for recommendations. I posted some SleepyHead data from last week (sorry I'll remove the calendar next time) but is there any other data that needs to be seen.
Based on your success at 9
Try Min 12 Max 14 (just to give it a little room) with an EPR of 3. That is keeping your EPAP at 9 (where you have had past success) and bringing in EPR to help a bit with comfort.
There is, as you stated, nothing in your numbers to suggest a change is needed.
Gideon - Project Manager Emeritus for OSCAR - Open Source CPAP Analysis Reporter
02-16-2019, 11:39 AM (This post was last modified: 02-16-2019, 11:47 AM by Sleeprider.)
RE: Self Titrating UARS - Need Help
Please read our wiki on UARS and Flow Limitation http://www.apneaboard.com/wiki/index.php..._and_BiPAP http://www.apneaboard.com/wiki/index.php...Limitation
Most people with UARS, which is closely relatedto flow limitation from the upper airway restriction, respond better to bilevel pressure. The higher inspiratory pressure helps normalize inhale, while the relatively low exhale pressure makes exhale more comfortable and offers the contrast needed. I disagree with Fred that you need the higher pressures with EPR for your flow limitation problem. I would suggest a range of 8.0 to 12.0 with EPR 3, full time. The image you provided shows classic flow limitation.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Sleeprider Wrote:Please read our wiki on UARS and Flow Limitation
Most people with UARS, which is closely relatedto flow limitation from the upper airway restriction, respond better to bilevel pressure. The higher inspiratory pressure helps normalize inhale, while the relatively low exhale pressure makes exhale more comfortable and offers the contrast needed. I disagree with Fred that you need the higher pressures with EPR for your flow limitation problem. I would suggest a range of 8.0 to 12.0 with EPR 3, full time. The image you provided shows classic flow limitation.
Thanks for your help as well as Freds. I'll give your suggestion a try first, unfortunately I won't be able to give it a go till Monday because I have two more nights of the at home sleep test.
Also thanks for the article. I've read thru (what I like to believe lol) every UARS article and medical journal publication out there and it seems how to make it better is limiting flow limitations which seemingly requires scanning thru the flow rates at a fine level of detail if trying to handle it myself. The doctor I had went to (on Long Island) said UARS was made better in the majority of cases was solved with a pressure of 5 to 9 cm. I've read thru all of Dr K's literature and he has quite a different approach. If I can't solve with help from this board, he may be next stop but figured I give this board a go since there seems to be a lot of knowledgeable people here reading thru past threads dealing with similar UARS problems....Again Thanks
Nicko, if you are self-funding a PAP machine, consider getting the Resmed Aircurve 10 Vauto from Supplier #33. The true bilevel machine will fully resolve your UARS, while the Airsense 10 CPAP with EPR will likely help, but is limited to 3-cm of pressure support. I have dealt with hundreds of members with the same problem you are experiencing, and can nearly always achieve much better comfort and results using pressure support, than using CPAP pressure. I think a doctor that is not aware of the much greater efficacy available through bilevel pressure should reconsider advising UARS patients. The worst machine for you is a Philips CPAP. Your AHI would bloom with numerous hypopnea events and you would feel a lack of sync to your breathing rate.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I've been looking at a bilevel but do not have a prescription (had one for straight cpap back in 2012 but that's probably expired) so the online places seem to be a no go. How do I get a doctor write a script for a bilevel if they aren't really knowledgeable about UARS and think cpap will be fine? I'm investigating getting one (VAUTO) thru other means (craigslist) but they aren't as available as cpap and the like so it may take some time on that front.
02-16-2019, 12:58 PM (This post was last modified: 02-16-2019, 12:59 PM by zzzZorro.)
RE: Self Titrating UARS - Need Help
(02-16-2019, 11:39 AM)Sleeprider Wrote: Please read our wiki on UARS and Flow Limitation http://www.apneaboard.com/wiki/index.php..._and_BiPAP http://www.apneaboard.com/wiki/index.php...Limitation
Most people with UARS, which is closely relatedto flow limitation from the upper airway restriction, respond better to bilevel pressure. The higher inspiratory pressure helps normalize inhale, while the relatively low exhale pressure makes exhale more comfortable and offers the contrast needed. I disagree with Fred that you need the higher pressures with EPR for your flow limitation problem. I would suggest a range of 8.0 to 12.0 with EPR 3, full time. The image you provided shows classic flow limitation.
SR; Please explain so I understand how this is determined: "The image you provided shows classic flow limitation".
Thanks in advance
(02-16-2019, 12:57 PM)NICKO Wrote: I've been looking at a bilevel but do not have a prescription (had one for straight cpap back in 2012 but that's probably expired) so the online places seem to be a no go. How do I get a doctor write a script for a bilevel if they aren't really knowledgeable about UARS and think cpap will be fine? I'm investigating getting one (VAUTO) thru other means (craigslist) but they aren't as available as cpap and the like so it may take some time on that front.
Any doctor can provide a prescription. Try your primary doctor. The only difference between CPAP and bilevel is that a separate inhale and exhale pressure is possible. My primary writes all my prescriptions. If you can get one, then Supplier #2 is selling the Resmed Aircurve 10 Vauto for $799, which is pretty exceptional. SecondWindCPAP may accept your old CPAP prescription. Call and ask. Supplier #33 won't ask for a prescription, but will charge $1250 shipped. Those are two of the best prices I know of for new with warranty machines. In addition to Craigslist use the SearchTempest search tool. It lets you see a wider selection of locations.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
02-16-2019, 03:14 PM (This post was last modified: 02-16-2019, 03:16 PM by Sleeprider.)
RE: Self Titrating UARS - Need Help
(02-16-2019, 12:58 PM)zzzZorro Wrote:
(02-16-2019, 11:39 AM)Sleeprider Wrote: Please read our wiki on UARS and Flow Limitation http://www.apneaboard.com/wiki/index.php..._and_BiPAP http://www.apneaboard.com/wiki/index.php...Limitation
Most people with UARS, which is closely relatedto flow limitation from the upper airway restriction, respond better to bilevel pressure. The higher inspiratory pressure helps normalize inhale, while the relatively low exhale pressure makes exhale more comfortable and offers the contrast needed. I disagree with Fred that you need the higher pressures with EPR for your flow limitation problem. I would suggest a range of 8.0 to 12.0 with EPR 3, full time. The image you provided shows classic flow limitation.
SR; Please explain so I understand how this is determined: "The image you provided shows classic flow limitation".
Thanks in advance
Flow limitation is discussed in the wikis I linked and the Beginners Guide to Sleepyhead. Inspiratory flow limitation is characterized by a normal start to inhale with the flow rate rising rapidly from the zero-flow line (red dotted line), however the flow-rate stalls, and even diminishes, even though inspiratory effort is being used. This results in a flattened, or downward-sloping peak, before flow returns to zero ahead of expiration (everything below the red line). The flattened peak in flow rate is caused by upper airway restriction, and can be compared to the flow through a hose that is kinked, vs one that is open. It takes longer to fill a bucket (lungs) even though the same pressure (respiratory effort) is present. Read this in the Beginner's Guide http://www.apneaboard.com/wiki/index.php...ailed_look
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Hi. I'm so new to CPAP that I haven't even started yet! I've ordered my equipment, hoping to receive next week. I've been doing a lot of reading, trying to learn as much as I can. This thread interests me because I may have UARS. From my home sleep test:
AHI: 3 RDI: 6
I have restless sleep, lots of arousals. No headaches, or dry mouth, but wake up (for last time) tired/exhausted, and chronic fatigue during day.
It sounds like I may end up having to look into a bi level machine, which is a bummer, because they are a lot more expensive, and I'm paying out of pocket. And I just bought an auto CPAP. My question is: once I start with the Resmed Airsense, and try different settings, how will I know if a CPAP just won't work and a bi level is needed? Will something show on the charts? Or is it a matter of how I feel? I guess the question is: how will you know if you need a bi level?
