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+--- Thread: PSG Results: Could this be UARS? (/Thread-PSG-Results-Could-this-be-UARS)
RE: PSG Results: Could this be UARS? - Geer1 - 03-11-2020
Glad to hear you stuck out the test and as I thought you might you seem to have noticed a difference once concluding the trial.
Keep us informed on your results with Vauto. I have been really wanting to try one myself to see if it takes things to the next level but haven't committed to anything yet as I do have an in clinic test lined up.
In the case where you think there is some piece of the picture still missing I think you might benefit from researching the poorly named chronic fatigue syndrome. As I keep learning more about it I can't help but think it is at play with myself and I believe others as well. I have wondered about this for most of the thread but I didn't want to bring it up until the trial was done so it didn't mess up your mindset.
In short I understand it to be an issue with either the autonomic neurological or immune system brought on by a number of possible issues (viral infections are one known cause, genetic predisposition seems to be a possibility, digestion issues or synthesis of neurotransmitters, high periods of stress is thought to possibly trigger it as well). I think treating the symptoms helps the body recover and the more symptoms you recognize and treat the better you will feel. Sleep disturbances are common and I think they have one of the biggest effects due to the fatigue poor sleep causes, that is why I think CPAP and bilevel seem to help. I actually have a bit of a theory that the reason bilevel seems to help some "UARS" people even though sleep results often don't really show an obvious reason for its use is just the fact that the bilevel eases the effort of breathing which makes things a bit easier on the body helping it to recover.
This following article is what kind of opened my eyes about the issue and in a way confirmed to me that there was more at play than just a random bunch of unexplained symptoms. Just using myself as a personal example I have a CPAP machine and take dymista (steroid, antihistamine combo spray) for non allergic rhinitis, a PPI for LPR reflux and polyethylene glycol for IBS (as well as eating healthier and smaller portions and also trying probiotics etc). All have provided improvement both physically and also mentally since the unexplained physical issues don't bother me as much.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761639/
RE: PSG Results: Could this be UARS? - deebob - 03-25-2020
So I finally got my Aircurve 10 VAuto and tried it for the first time last night. I had actually been sleeping quite a bit better the past couple weeks, even without the CPAP, and I was almost thinking I may not even need it....but sleep was still not perfect, it was probably just good relative to the really bad sleep I had been having since October. But it definitely seems like I broke out of the anxiety/low arousal threshold cycle that I was in previously. I have been only waking up a few times per night, rather than like every hour.
The first not with the Bipap wasn't great though....mainly because they sent me the wrong nasal mask, the N30i instead of the N30 that I was used to...and I'd also been sleeping with no PAP for a couple weeks so I wasn't used to it, and the feeling of the bilevel was quite a bit different than the Airsense 10. I could really feel a noticeable difference in every inhale. I tried using the "S" mode instead of VAuto, because I wanted to be at more of a fixed pressure, but it looks like it didn't record Flow Limitations....is this machine not capable of that? Or do I need to be in VAuto mode for that? Because FL was definitely one of my main problems before so it would be nice to be able to see that in Oscar.
https://i.imgur.com/C6ghHqW.png
I had some issues getting to sleep for a while, and that's what the CAs are - fiddling with the mask etc. And I woke up at like 630AM and took the mask off and slept a few more hours without it. I'll probably give this mask another try but I'm mainly waiting for them to send me the other mask before I hope to get comfortable with this machine.
RE: PSG Results: Could this be UARS? - geauxdbl - 03-25-2020
Sadly the Aircurve does not record flow limit data in S mode. My advice, having gone down the same path, is to give it a week or two and go by how you feel.
Breaking out of the low arousal threshold is an important thing. I hope that trend continues.
RE: PSG Results: Could this be UARS? - deebob - 03-25-2020
Ok good to know. Does it record FL in VAuto mode? Because couldn't I just set a small range for VAuto ?
RE: PSG Results: Could this be UARS? - Dormeo - 03-25-2020
In VAuto mode, you can set EP, then PS, then set max IP to equal their sum. E.g., EP 5, PS 4, max IP 9. You will see FL this way and be effectively at fixed pressures.
RE: PSG Results: Could this be UARS? - slowriter - 03-25-2020
(03-25-2020, 02:15 PM)Dormeo Wrote: In VAuto mode, you can set EP, then PS, then set max IP to equal their sum. E.g., EP 5, PS 4, max IP 9. You will see FL this way and be effectively at fixed pressures.
Dormeo is right here, but I still don't think you should constrain the machine that much deebob.
The night you posted was set for PS of 4, min EPAP of 4, and max IPAP of 8.4.
I would change max IPAP to 10, and min EPAP to 5; keep PS at 4 for now.
RE: PSG Results: Could this be UARS? - deebob - 04-19-2020
So I've had the BIPAP for about 3 weeks and I haven't managed to see any positive results. I'm not sure if this is because the BIPAP itself isn't working for me, or if the problem is just due to something else. Obviously the current Covid situation is not helping with positive lifestyle habits and mental health, but I'm still not sure if that's the main issue or if I just haven't gotten the BIPAP to work yet.
I started with the Resmed N30i mask that SecondwindCpap sent me by accident...and I tried using that for a couple of weeks without any good results. I thought originally that I just wasn't use to the mask and it was more bulky than I like, and once they sent me the N30 (which is much smaller), that I would start sleeping better, since that is the mask I was using with my CPAP trial and seemed to see good results in the last week of the trial.....but I've had the smaller N30 mask for over a week now and I've been sleepy just as poorly with it - despite it being quite comfortable.
One thing I'm wondering is if the BIPAP is just functioning differently than the Airsense CPAP, maybe I didn't need a BIPAP after all? I find it to be comfortable, the exhaling feels good...but I'm almost suspicious that it isn't as effective as the CPAP was, because it almost feels like it's doing less. I guess that's the point, but I'm wondering if it actually is doing less for me.
Before I got the BIPAP I was almost sleeping better without any machine, waking up only a few times per night, and getting some good stretches of a few hours at a time....but over the past month I've gradually gone back to my worst kind of nights, waking up almost every hour or less...even with the BIPAP and comfortable mask. It makes me wonder if the quarantine lifestyle has been gradually making me depressed, which is causing the problem. I currently feel pretty depressed since I'm sleeping really poorly, but I'm not sure if there was a more subtle depression creeping up on me the last few weeks that I didn't notice until my sleep was severely affected by it. It's kind of a chicken or egg things. My sleep problems over the past year have definitely coincided with depression/anxiety or stress, so there's certainly a connection, it's just hard to tell if it's causing the problem or is a result of the problem.
My Oscar charts don't look bad most days, but there do seem to be more OA and CAs than I remember having with the CPAP in February...not sure if they're real events, though I have noticed that a lot of the OAs don't coincide with times that I woke up, so they probably aren't RERAs or SWJ. https://imgur.com/a/IN7skG6 I included a few close-ups that show my breathing curve with a little flat plateau at the beginning, which is pretty common for me. I'm not sure what that's indicative of?
I experimented with some slightly higher pressures, and higher pressure support, but I've found it to be a bit uncomfortable anywhere around 9 IPAP, and PS above 3-3.5 doesn't seem to be helpful, so I'm almost finding myself falling back to EPAP 8 with PS 3, which is basically where I settled with the Airsense CPAP. Which means I almost don't even need a BIPAP. I could experiment with higher pressures and higher PS, but the few nights I tried that didn't seem to go well. I know Bipaps have some other features that differentiate them from CPAPs, but it almost feels like it's not intervening the same way the CPAP was, unless I'm just not noticing it ? I remember the Airsense would very noticeably increase the pressure and 'step in' if I didn't breath for a few seconds....I haven't felt that with the BIPAP, unless it's more subtle, and I've almost caught myself waking up out of breath in a similar way I would feel when not using a machine....it feels almost like it's missing a breathing event. I could be wrong about that but currently it feels like the BIPAP is just not doing anything. I'm wondering if there are some other settings I should be altering besides just pressure and PS.
RE: PSG Results: Could this be UARS? - Dormeo - 04-19-2020
Hello, deebob. I didn't see the close-ups. And I'd be curious to see a recent chart. (The one you linked was from last month.)
I would suggest leaving your settings where they are comfortable for you, knowing that your machine has the capacity to provide additional adjustments that you may want down the line. I kind of doubt your Airsense 10 Autoset was prompting you to breathe, but there could well be some subtle difference between the algorithms that you're picking up on.
You are so right: now is a really lousy time for anyone at all inclined toward anxiety or depression. I know it's hard to do, but can you bracket your current reactions? They are what they are; you can acknowledge them. But don't try to forecast using them, or infer anything about your condition from them, or brood about them. (I know from experience that this more detached attitude isn't easy to achieve.)
When things get back to normal, you'll see how you're feeling, and you can go in and talk with your doctor about additional testing, meds, or anything else that might help you be more rested.
How are you doing on exercise, sleep hygiene, etc., while housebound?
RE: PSG Results: Could this be UARS? - Geer1 - 04-19-2020
At EPAP of 8 and EPR of 3 this is pretty much the exact same machine as your original Autoset. Any advantage you think the autoset had is just a belief. For example the autoset will never force you to take a breath, that functionality is called backup rate and neither of these machines have it (nor do you need it).
Like the cpap you need to give the Vauto a significant chance and not just revert to old cpap settings. You dont need higher pressure. The only potential advantage is higher PS so set it at 4 and leave it there unless you are sure it makes things worse. If that doesnt help then you are right that the Vauto isn't helpful to your situation.
This has always been a bit of a long shot as nothing has ever really indicated obvious sleep disordered breathing. Your sleep is obviously disturbed but by what I dont know. This is all similar to my situation which I also do not believe is caused by sleep disordered breathing. That said cpap does help me which I have realized by stopping using it at times.
If I remember right you have IBS symptoms like I also do. That is one of things my doctor now has me focusing on. Stress makes a mess of your digestive system and if it gets out of whack it can create it's own problems. The doctor has me trying a low FODMAP diet. This is an elimination diet that removes types of carbohydrates that our body has trouble digesting(some people more than others). When your body doesnt digest these carbohydrates itself then bacteria in gut does which causes the bloating, discomfort etc. If that bacteria gets out of control it can create other problems (Sibo being one possibility). The goal is to see if I can get control of my digestive symptoms and then see if that has any effect on other symptoms. I have only been on it a bit over a week though so too early to see results. I had started taking polyethylene glycol regularly which has helped the digestive symptoms although they are still present.
The current virus (and work) situation threw my anxiety out of kilter for a little bit. Anxiety and depression definitely affect a persons sleep and a person needs to try their best to control any situational anxiety/depression. Medication may help that (it helps mine a bit so I started back on some to help deal with these times).
I think yourself like many other potential "UARS" people suffer from other health issues. I have noted too much similarity between other "UARS" patients having other symptoms and few of these people seem to respond much to cpap although a number do seem to find it helps to some degree.
RE: PSG Results: Could this be UARS? - deebob - 04-19-2020
Sorry I didn't mean that I thought the Autoset was breathing for me....I just meant it felt like it was responding to my breathing more....like if I held my breath for a few seconds, I could feel it increase pressure or send pressure pulses. I haven't really noticed that sort of thing with the Aircurve....maybe it's just more subtle in how it works, or maybe I just haven't noticed it....but either way, it does feel like the Aircurve functions differently, even when it has essentially the same settings. Which is why I'm a little suspicious that it isn't intervening the same way if I'm experiencing airway resistance.
I was experiencing some IBS symptoms back in January or February, when my anxiety was much worse and I was having a lot more stressful nights, but my anxiety has been mostly under control since the end of February and my stomach symptoms seem to be quite normal. I've maybe been eating more comfort food and sweets lately which could be contributing to inflammation and anxiety a bit, but I'm not sure if that's a huge contributer.
I honestly think there's just a big mental component to my sleep problems...and spending a lot of the day laying around, watching the news, social media etc. and every day being so repetitive is making me go a bit crazy. I'm thinking of experimenting with spending a couple days not looking at my phone or news at all, and spend most of the day outside doing stuff. I bet it will help.
I'm pretty sure there is some SDB, and it's visible in my Oscar data sometimes, or I can feel myself wake up slightly out of breath with my heart racing... but it's without a doubt exacerbated by stress/anxiety/depression. That is one thing I have observed consistently. My sleep always improves when my mental health is in a good place.