nileriver's therapy thread (UARS)

[nileriver]

Hello!

A couple of weeks ago I was diagnosed with UARS, and have since been trying to get some relief with an APAP. After an initial two days of waking up after using PAP and feeling amazing, I've had two weeks of feeling pretty terrible.

I've attached a screenshot from OSCAR of my therapy from last night, and I have data going back just over a week. I've been trying to tailor my therapy as best I can based on other threads in this forum. Right now I'm trying to reduce my mask leaks (got a chin strap last night, but I think it wasn't tight enough), as well as reduce my flow limitations. I've been trying to increase my minimum pressure by 1 cm H2O every ~2 days in an effort to reduce flow limitations, but I don't see it making any significant changes yet. I appreciate any other specific advice you might have.

[Sleeprider]

You have been doing your homework and clearly have maximized EPR to reduce flow limits, and have pressure optimized to avoid large pressure swings. There is not much to criticize with what you have accomplished so far, including a very low AHI. The erratic flow rates can only be visualized in a closer 2 to 3 minute zoom scale. I think looking at zooms around 00:20 and 00:40 might tell us more. Your best results are around 02:20-02:40

[nileriver]

Sleeprider, thank you for your encouragement and help. I've attached 2.5 minute zooms around 00:23:30 and 00:40:00.

How did you gather that my best results are around 02:20-02:40? When I looked at those times in OSCAR initially, I saw small blips on the flow limitation chart, and assumed they were problematic times of the night. But sure enough, after reading your message, I checked my pulse ox readings from last night, and that time frame was one of the few that was free from heart rate spikes... are you looking at the general shape of the zoomed-out flow rate?

[Sleeprider]

I was looking for periods of descending pressure and a less erratic flow rate. I try to look for what is working, rather than the big problems. It's kind of like skiing in the trees, look for the openings, not the trees. I really think your results will work themselves out. There is nothing wrong with your pressure or EPR, but there is clearly some erratic breathing going on that is disruptive to your sleep. I wish I had a better solution to make the early "feel-good" results come back, but you're not on the wrong track. If the leaks can be resolved, I think you're onto something. If you want, we can look at the more problematic times of the night, and I think we will see flow limits that might do better with more pressure support, for example 02:00 or 06:20. How? गुरु

[nileriver]

Ha, fair enough. I'll keep working on the mouth leak for a few days and see where we end up after that. Will post back here!

Thanks again for all of your help.