UARS

[jaswilliams]

I would not make any pressure changes for now 3cm of pressure variation is not very much

[tarah]

day 13 post surgery.  Another horrible night of waking up all the freaking time.  I am waking during REM cycles, during dreams.

I had a long discussion with the respiratory therapist when I picked up new masks today.  I am having inspiratory snoring, which I could try to eliminate with a higher EPAPmin.  He thought I should probably try limiting IPAPmax since I don't have apneas and fluctuating pressure can cause wakeups.

The other thing we talked about was what was causing the little blips in the Leak Rate.  He said it could definitely be a change from nasal to mouth breathing.  You can see them occuring regularly in the second screenshot.

I am so discouraged about all of it.  I know I'm still healing from surgery, but it seems like the exact same problems exist, except that nasal breathing is improved.

[jaswilliams]

Your leak rate is tiny, not sure it’s causing your issues

[slowriter]

He thought I should probably try limiting IPAPmax since I don't have apneas and fluctuating pressure can cause wakeups.

Except, you have UARS, which is to say a bigger problem with RERAs, which are addressed by higher PS and IPAP.

Though we don't know what impact the surgery had on your RERAs.

[tarah]

It wasn't really about whether the leaking was causing the issues.  It was more of whether the blip in the leak rate is me switching from nasal to mouth breathing, which can disrupt sleep.

[tarah]

Continuing to try to adjust settings to decrease wakeups.

Last night, I changed PS from 4.0 to 4.8.  Left the EPAPmin at 5.  Used the chin/jaw strap and cervical collar.  Used a FF mask because I can't seem to get a good seal with my old nasal pillows.  In general, I feel like I woke a decent amount, and feel o.k. today, not great.  

1.  Continue to raise PS?
2.  Start work on increasing EPAPmin?
3.  What are the little squiggles on the flowrate graph at 0?  They are always present.  Do I need to increase the sensitivity of the IPAP trigger?

Thanks all for any and all suggestions.

[Gideon]

I would bump up PS. The show flow limitations and disturbances snf the increased PS should help with that.

[slowriter]

To give yourself room, particularly if you raise PS, I'd raise max IPAP; say to 14.

[tarah]

Thanks for your feedback.  

What do you think the squiggly lines after exhalation are all about?  To me, it appears that I am trying to inhale, airway probably closed down (maybe increase the EPAPmin?), and then after 1-4 atttempts, the machine detects that I am attempting to inhale and gives the IPAP.  Anyways, I was thinking of increasing the trigger sensitivity.

The other sort of unusual thing I've been noticing is that the maximum IPAP is only being delivered at the very end of exhalation.  I don't know if this is a variable that can be manipulated, perhaps it's specific to each machine.  The only reason I'm looking at it is because of an article I just posted a link to in which it says that the IPAP should be being delivered through the inhalation.

[slowriter]

You need to minimize the calendar (there some relevant info missing as a consequence) ;-)