Started on BiLevel for UARS, how does chart look?

[squashedlikeabug]

I've just got going on a rented Aircurve 10 vauto, hoping to get my UARS with its savage symptoms under control.  For now I'm using it with my MAD.  The plan is to get used to it then stop using the MAD as I cant get palatal expansion or MMA (both of which I've been trying to get for over a decade) if I'm using the MAD and I cannot sleep at all without something providing effective protection against my symptoms.

I want to get a read on how my initial data looks as I have to order my own machine in the next few days while there's a very good discount to be had.  I'm currently swaying towards getting a vauto, same as I'm testing on now but I could get an ASV instead if it is likely to make it easier to get my PS up higher without being stopped by centrals.  I've been trying to get the Pressure Support up to a good level in order to target the flow limitations which seem to be the main driver behind my UARS.  I left my EPAP low since neither machines nor sleep studies have caught a significant number of obstructive events in the past, it seems to be mostly flow limitation...and of course my MAD is preventing my jaw from falling back and closing the throat.

I think I'm seeing a combination of actual centrals and arousals followed by burps caused by aerophagia which the machine will either ignore or tag as centrals, alongside many flow restrictions and a generally ratty, inconsistent breath flow.

[Sleeprider]

You're over-compensating with IPAP (PS) and need to back off a bit. Increase trigger sensitivity to high and reduce PS until centrals are gone. I will suggest using IPAP 9.4 or less. Leaks are an issue. You won't really know what your flow limits are in VPAP-S mode because FL detection is turned off in S-mode. Change to Vauto, EPAP min 4.0, PS 4.2, IPAP max 9 or 10.

[squashedlikeabug]

Thanks, I implemented the settings you suggested before sleep last night.

I had a terrible time in that first hour or so trying out vauto mode, catching myself not breathing and then waking in fright three times that I was consciously aware of.  The machine didnt tag any of these.  At some point I adjusted the machine settings to stop the IPAP going above 8.4 as I knew that area was causing trouble for me but the experience continued to be traumatic until I switched the machine back to S mode, after that I was able to sleep normally.  I know from experience that if I had incurred another couple of startled awakenings I'd likely have been stuck awake for several hours.

Given how extremely touchy my system is, I may have to carefully acclimatise to a pressure range in S mode before I can tolerate it in vauto mode, or last night may have just been the wrong night for it.

For the rest of the night I had a lot of trouble with mouth leaks, some of which would wake me up.  I went through five fresh sections of mouth tape so I must have awoken to fix it at least seven or eight times.  My MAD and my undersized palate make mewing properly impossible, also if I sleep on my side with the pap machine I tend to drool which wrecks the mouth tape.  I may start training myself to sleep on my back while papping to see if I can prevent this.  I'm not concerned about my jaw falling back as long as I'm using the MAD, my most refreshing sleep is usually supine.

Tonight is the last night I have for experimenting before ordering either the vauto or the ASV.  Do you see any reason to consider the ASV?  For tonight I was thinking to maybe try S mode again with a higher EPAP like 5.

[Sleeprider]

You can have fixed pressure in Vauto mode, by simply setting EPAP min at 8.0, PS 4.0 and IPAP max at 12.0. Pressure will be constant. The mask issues you describe are typical of new PAP therapy, and you may need to consider a full face or other modifications to address the leaks and drooling. I don't have experience with tape, and can't imagine it would be a good long-term solution.

ASV can used fixed EPAP pressure but IPAP must allow for 5-cm of difference between minimum and maximum PS. For example, if you continue with EPAP 8.0, your PS will need to be 3.0 min and 8.0 max. Judging from how disruptive you find Vauto, I don't think ASV is for you, and certainly you have no central sleep apnea to treat. I hope you will not go that direction.

Nothing in your results would contraindicate the use of an Airsense 10 or 11 Autoset CPAP. The Resmed CPAPs offer up to 3-cm of pressure difference between inhale and exhale and should produce similar results.

[subconscious]

Just wondering, if your palate is so narrow, why not have it expanded by the dentist? It could certainly benefit. After all, sleep improves w CPAP, but not daytime breathing which is also affected by a narrow palate...

[squashedlikeabug]

Just wondering, if your palate is so narrow, why not have it expanded by the dentist? It could certainly benefit. After all, sleep improves w CPAP, but not daytime breathing which is also affected by a narrow palate...

I first started trying to expand it back around 12 years ago, that was before I found out that palate expansion in adult males using tooth-borne devices is a scam.  Tech has moved on and it's now doable but I'll need a process called EASE which involves a bunch of cuts to open and loosen various sutures in the skull, along with a bone-borne expander so the whole midface can be expanded.  My reliance on the MAD has been a deal-breaking obstacle for this (you can't expand the arch while using a MAD), hence I'm trying BiLevel.  I did normal CPAP years ago and absolutely failed it - cases like mine need the pressure support of Bi-level and sure enough I can at least tolerate it at low pressures which is like a miracle in itself.  Where normal CPAP was an evil torture device for me, BiLevel feels friendly.  I'm hoping I'll be able to tolerate much higher pressures after a couple of months acclimatising to it, then I'll be able to rely on it for the couple of years it will take to do the expansion. After that I'll get MMA and may not need any treatment after that.