UARS

[slowriter]

Been at PS 5.6, EPAPmin 6 for the last 4 days.  Sleeping pretty good most of the night, mostly trouble in the early morning hoursI, where most of the CA's are showing up, lots of awake/asleep stuff. I am hoping that it's just everything sorting itself out.  I have been feeling pretty good most days. 

What do you all think of the CA's?  Should I wait it out and hope they go away or lower the PS?

My opinion: wait it out.

You don't have a ton of them, and you say a) at least some proportion are likely while awake, and b) you feel "pretty good."

What is your trigger setting? Have you tried it at high?

[tarah]

I moved the PS up from 5.8 to 6.0 last night.  Looks disastrous.  If I want to continue upping PS, do I then need to also up the EPAPmin to avoid the CA's?

[Sleeprider]

You have tipped over the threshold for central apnea and need to back off on pressure support to 5.4 or 5.6. I also recommend you change the trigger sensitivity to High. I don't want to see the central event index exceed 2.0 and in my opinion there is no need for this higher pressure support. Your flow limitations are effectively zero at 5.4 and 5.6. Keep an eye on the 95% flow limit statistic. If that is zero, you are more than done.

[Gideon]

Forget the numbers, how do you feel? How are you sleeping? How do you feel through the day?

[tarah]

The reason I was continuing to up the PS is because I continue to wake up quite a bit.  Everything looks completely fine during the earlier stages of sleep, nothing happening.  Then once I hit deep sleep, the wakeups and turning from side to side start.  I am struggling to come up with another explanation for that.  The difference since my nasal surgery is incredible, but I feel there is more to go.

Last night, I remember going to sleep at 10:30 and my next conscious thought is not until 4:30.  That is a record in the past few years.  So I want to keep experimenting with PS and see if it is the answer for me.

Thanks so much for your input.  I don't know what I'd do without this group of people to help me on this journey.

[tarah]

For the past 2 weeks, I have been sleeping MUCH better than before the surgery.  Before, I felt like I was awake constantly throughout the night.  Now, I feel like I get better chunks of sleep.  I am still having quite a few conscious wake-ups, especially early morning hours.  I have gone down the road of trying to figure out what is causing the wakeups and gasping and it always comes back to breathing troubles.  When the breathing improves, whether through CPAP or BiPAP or nasal surgery, the wakeups decrease and I feel like a functional human.  When things go downhill, all the problems start again.  I feel very strongly that breathing problems are at the heart of everything I've been through.

During the day, I am also feeling MUCH better than before surgery.  No more crying from exhaustion.  But I know there is still room to feel better.  I know what feeling normal feels like and this isn't quite it.

[mper6794]

Hi, tarah

It looks Sleeprider would be right concerning the P.S. And Fred, concerning imprtance of HYF, maybe more than just numbers.

UARS is hard thing to battle, maybe more than OSA themselves. It appears you are not feeling that great yet, or at least the best you could.

Elsewhere in my thread, I have been referring something could be work as protocol for treat UARS, like this:

As per literature (well-known great names) and my own case, strategies to treat UARS would be, maybe in this order: (1) adequate sleep position, not on the backs, avoiding the so-called tongue collapse, in particular during REM; (2) cervical collar, avoiding chin tucking; (3) BPAP, with properly balanced EPAPmin x PS; (4) dental appliance, and (5) surgery.

At the beginning of your journey, I made some suggestions taking into account my proposal of a semi-quantitative approach to get fine-tuned EPAPmin and PS. 
I am not sure wether or not you have being following my approach. However, independently, you have performed a very good job.
I have been following your steps from a distance, essentially because lack of time. Today, i have returned to It, did the graphs; look very interesting and instructive.
Yes, you may be right and eventually there would be room for improvements. 
To make sure this, and see if I could suggesr something, i was wondering if you could post some five-ten minute windows, anteceding and involving your arousals (peaks on FR and TV); i suspect of unflagged RERA'S at those points or other issues that would be still there.
Please, for a better interpretation, could you please as in the attached template? need curves somewhat enlarged, reference median, like in the template.

many thanks

[mper6794]

...In advance, for next night, before I go through more details of your charts, I could eventually suggest EPAPmin: 6.4, P.S: 5.0.

all the best

[tarah]

Backed off of PS from 6.0 to 5.6 to decrease the CAs.  Tried below 5.6 and it results in too many wakeups.

I have been feeling remarkably good the past 2 weeks (4 weeks post surgery).  I can only hope that it continues as the healing improves.  As far as sleeping at night, I do feel like I'm getting good chunks of sleep.  Too many wakeups in the early morning hours, but again, hoping that improves as my brain calms down about it being safe to breathe.  I also tried limiting the IPAPmax to EPAPmin+PS and it was not good.  A fair amount of OAs.

Here's the latest.

[slowriter]

Have you tried raising the min EPAP at all?