[Treatment] Treating UARS with CPAP and bilevel

[slowriter]

A followup question.

What do you make of this detail (notably the constant pressure preceding that event)? Reasonable to conclude that suggests 7 is too low?

[Gideon]

Your chemo receptors are sensitive to fluctuations in your blood co2 content.

[slowriter]

Your chemo receptors are sensitive to fluctuations in your blood co2 content.

I'm not following. Is answer to my question thus "no"?

[Gideon]

No. That is a central, never raise pressure for Centrals. And never react to a single event

[jaswilliams]

No. That is a central, never raise pressure for Centrals.  And never react to a single event

It is also less than 10 seconds long so the machine won’t flag the event or react unless it was obstructive  It has been hi-lighted by the custom flagging

[slowriter]

I think you are sensitive to pressure changes, and that you don't benefit a great deal from pressures above 7.0/4.0. I'd like to see you set the minimum and maximum pressure to 7.0 and EPR to 3.0.

7.0 static + 3.0 EPR results attached.

Beyond what the data say, the setting felt comfortable, but I still woke up multiple times. Ultimately, hoping I can eliminate that.

Should I give it more time at these settings, or is this enough to draw conclusions?

Note that I changed the user flags to 33% and 66% (not really sure what they should be for me though).

[slowriter]

No. That is a central, never raise pressure for Centrals.  And never react to a single event

It is also less than 10 seconds long so the machine won’t flag the event or react unless it was obstructive  It has been hi-lighted by the custom flagging

My problem is I really don't get OAs. I've got UARS, so question is how to use the data from the machine to set the right pressure to minimize or eliminate RERAs, that are alas not (properly, it seems) flagged.

[Gideon]

With flow limitations the problem isn't detecting flow limitations, it's detecting normal. If all or most of your breaths are restricted, what is normal?

To classify an event as hypopnea or flow limited, or even Apnea the device sees how it compares to NORMAL.

In these cases we still rely on titration principals but in lieu of hard data we have to go by how you feel. The detailed waveform would show irregularities but those must be visually identified

[slowriter]

In these cases we still rely on titration principals but in lieu of hard data we have to go by how you feel.  The detailed waveform would show irregularities but those must be visually identified

Does "how I feel" include when and how often I wake up, assuming that may be caused by flow limitations (so possible RERAs that turn into more extended awakenings)?

That certainly also impacts how I feel, of course.

In looking through my notes, in the almost four weeks since I started, I have had only a single night of more than 8 hours of "uninterrupted" sleep; where I did not wake up once early. That was at a pressure of 9-15, and I felt terrible the following day!

I have multiple variables at play here (quality vs quantity of sleep, flow rate data, pressure settings, subjective feel) that are hard for me to disentangle.

[Gideon]

Yes it does.
Increase your pressure by 1 cmw wait several days then repeat if necessary. Keep an eye on your numbers.
And stay in touch.