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Yes I definitely need to lower PS. I am mostly waking during REM sleep, it's always in the middle of a dream.
Ok, yes, I expected a slap on the wrist. What I got was a 90 min tirade about my history, with the presumption that I've had some part in receiving suboptimal care. I certainly dont want to be self-titrating. It's because no one will help when I ask for it repeatedly.
Thanks for your feedback, I really appreciate it. I will report back.
Machine: Resmed Air Curve 10 VPAP mode Mask Type: Full face mask Mask Make & Model: Resmed Airfit F20 Medium Humidifier: VAUTO's original: 5 CPAP Pressure: EPAP:8.8 IPAP:18.0 PS:4.4 CPAP Software: OSCAR
Other Software
Other Comments: The goal is to turn data into information, and information into insight. (Carly Fiorina).
Since you started your therapy, there would be this issue between external airways (nasal conditions) and beyond that, at the upper aiways themselves. I have never been sure if PAP could worse nasal conditions?
May I suggest you started up all over again from the zero, as if you had never used PAP. It is quick process (maybe 12 to 15 days). For instance, using the very basic S Mode of the AirCurve 10, following the Resmed protocol (attached), starting up at IPAP: 8/PS:4.0, triggering med, cycle med, ti 0.8 to 2.0 (or something similar)....
I have just doing this (started at Jan 28th). My situation, after some 8 months, had become very complicated with discovery of some catathrenias (rather than PLMS), use of medications, and so on.
02-08-2020, 09:13 AM (This post was last modified: 02-08-2020, 09:13 AM by slowriter.)
RE: UARS
(02-08-2020, 09:01 AM)mper6794 Wrote: May I suggest you started up all over again from the zero, as if you had never used PAP. It is quick process (maybe 12 to 15 days). For instance, using the very basic S Mode of the AirCurve 10 ....
I don't think this is a very good idea, because on S mode, you lose two key things:
FL tracking
the insights of the VAuto algorithms
You can do a similar thing, without those drawbacks, on vauto mode, with the goal simply to minimize pressure swings, which are already minimal with tarah.
Caveats: I'm just a patient, with no medical training.
Tarah it's good to see flow limitations seem significantly reduced after your surgery. I agree that pressure support needs to come down to reduce CA. It will be interesting to see how far you can drop PS and not see a reemergence of flow limitation, so take it slow and be observant of the trends. I do not agree you should start experimenting with S mode. Maintaining comfort should be your first priority.
The "new possible sleep doctor" sounds like a definite reject to me. You are looking for a partner in therapy, and she failed her interview.
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.
Reduced PS down again. Centrals seem to be less, but still happening. I will continue with this PS for a while.
New possible sleep doc is a definite NO. I would never go back to her. Maybe she gets patients in all day who day exactly what she says without needing to talk through things. That's not me. I will find someone that is a good fit.
I saw another "possible" sleep doctor this week. He listened, without judgement, to everything. He said that using a BiPAP for UARS and self-titrating is a perfectly reasonable thing to do, as long as you're watching for Clear Airway events and turning PS down when you see them. He said that self-titrating is a good idea for someone who is willing to do it, rather, than an in-lab titration, especially for UARS, because we are titrating for comfort (EPAP) and less awakenings from FL's (PS). He was supportive of a little bit more turbinate reduction on my right side since I am still congested at night on that side. And then also wanted me to check ferritin levels and supplement if they were on the low side of normal. He basically confirmed everything that the wise people on the board here have been saying. What a relief, I feel like I have someone now who is going to support me in this journey and provide useful direction!
There have been so many variables at play here, it's hard to say if the trigger change made a difference. I am currently at PS 3.4, EPAP 6, and have been sleeping well for the past week. No centrals happening.
