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+--- Thread: Appreciate help adjusting settings (UARS) (/Thread-Appreciate-help-adjusting-settings-UARS)
RE: Appreciate help adjusting settings (UARS) - cmcphee - 09-07-2019
Updating with a few screenshots of what I think might be RERAs from last night? Let me know if I'm getting this right and I'll post more.
Ex. RERA 1: https://drive.google.com/open?id=1mTZI-bQk4UWRc-pB32zCIDpV0RIIednB
Ex. RERA 2: https://drive.google.com/open?id=1Z57VYvfg0caeqTTOXRWuT21Q7H0HFUsl
Ex TBD??: https://drive.google.com/open?id=1u-F70hhHwLuN509GMqs35rpT1wbJ9oBF
RE: Appreciate help adjusting settings (UARS) - slowriter - 09-07-2019
One of the things I learned in my own journey is those jagged curves you have indicate some kind of flow problem, which can lead to arousals. If you accept the arguments of people like Barry Krakow, one goal is for more rounded curves, which you get with greater pressure and/or pressure support.
Here's what mine look like these days with a bilevel, though I don't think mine ever looked at jagged as your's ;-).
RE: Appreciate help adjusting settings (UARS) - sheepless - 09-07-2019
slowriter, have you figured out how to self titrate for rounded curves; i.e., to reduce flow limitations? it's been a while since I read any Krakow. as I recall the only thing I read about uars titration was that it involves a lot of back and forth (here's where my memory is really vague) between epap and pressure support, I think. whatever it was I read, it wasn't enough detail for me to understand how to manage it. my understanding is that increasing the difference between epap and ipap is the way to address flow limitations, yet in contrast to much of what I read here, raising my min ps to 4 from the current 3.2 seems to result in more flow limitations.
RE: Appreciate help adjusting settings (UARS) - Gideon - 09-07-2019
Example 1 is Flow Limited, both inspiratory and expiratory, np arousal so not a RERA
Example 2 is Flow limited, ending in slightly more rapid breathing and at the ending of the chart with lengthening period between breaths (to compensate for the few breaths that were more rapid) and these look central which makes sense as your body tries to bring the pCO2 back to normal.
Example 3 is some periodic breathing that looks like it might be flow limited.
Flow limitation means that you would want, preferably, higher pressure support or higher pressure.
I really would like to see your at home results from an overnight oximeter.
RE: Appreciate help adjusting settings (UARS) - slowriter - 09-07-2019
In my experience, and from my reading, raising PS does reduce FLs, and round the curves.
Sorry; was replying to sheepless.
RE: Appreciate help adjusting settings (UARS) - alexp - 09-07-2019
(09-07-2019, 02:25 PM)cmcphee Wrote: Updating with a few screenshots of what I think might be RERAs from last night? Let me know if I'm getting this right and I'll post more.
Ex. RERA 1: https://drive.google.com/open?id=1mTZI-bQk4UWRc-pB32zCIDpV0RIIednB
Ex. RERA 2: https://drive.google.com/open?id=1Z57VYvfg0caeqTTOXRWuT21Q7H0HFUsl
Ex TBD??: https://drive.google.com/open?id=1u-F70hhHwLuN509GMqs35rpT1wbJ9oBF
1. Not a rera but several flow limitations resulting in having your body work harder to breath. You see'll in theses cases that the inspiration is a bit longer and the pause between exhalation and inhalation is shorter. Your body does this in order to keep your tidal volume about the same as if you were breathing normally.
The little spike you see happens from time to time when you work hard to breath. It's probably your lungs succeeding in opening your airways for a split second.
2. Yes that's look like a RERA. Flows limitations followed by an irregular breath.
3. Looks like you are in REM sleep but hard to tell without seeing the entire night. REM sleep breathing is irregular compare to NREM sleep.
There are two ways to fight flow limitations and RERA.
1)Reduce the airways resistance by raising the cpap pressure.
2) Add an external ventilator (what we call pressure support). In simple terms, the ventilator will act like an external lung helping you breath at night. It will increase your flow rate without having your body work harder which results in less RERA.
RE: Appreciate help adjusting settings (UARS) - slowriter - 09-07-2019
(09-07-2019, 02:35 PM)slowriter Wrote: One of the things I learned in my own journey is those jagged curves you have indicate some kind of flow problem, which can lead to arousals ....
Here's one of the academic articles on this:
https://www.sciencedirect.com/science/article/pii/S1984006315000516
See Table 1, Figure 5.
RE: Appreciate help adjusting settings (UARS) - cmcphee - 09-08-2019
Thanks everyone. Last night I didn't change my settings and the median pressure went up to 9.62. I woke up after an hour of sleep in a ton of pain with what I think is aerophagia and couldn't bring myself to put the mask back on for the rest of the night. Should I lower the upper pressure setting tonight? I know that is the opposite of what I need to do to smooth out my curves but I don't know what else to do.
Not sure if this is related, but should I be concerned if tidal volume has been spiking temporarily up to 640 at multiple points throughout the night? My 95% is still within range at 440 but figured I'd ask in case this is an issue.
@slowriter remind me if you had issues with fragmented sleep / waking up at night and whether the bipap helped resolve that? Your curves look awesome - hope I get there myself sometime soon. Have you experienced aerophagia at all when raising the pressure?
@bonjour I have procured an oximeter and will post results tomorrow morning.
Thanks again.
RE: Appreciate help adjusting settings (UARS) - slowriter - 09-09-2019
(09-08-2019, 09:00 PM)cmcphee Wrote: @slowriter remind me if you had issues with fragmented sleep / waking up at night and whether the bipap helped resolve that? Your curves look awesome - hope I get there myself sometime soon. Have you experienced aerophagia at all when raising the pressure?
Hi @cmcphee. I had serious fragmentation issues (during initial sleep study, 18 RERAs/hour), and frequent problems waking up at night.
I think the latter is actually worse under PAP therapy, but I'm still new at this and sorting out what's going on.
One user suggested on my thread in last few days that I need to look into possibility of something like PLM, on top of the UARS.
The tech that did my titration study said that when she put me on the bilevel at 6 and 12 (so, a PS of 6, which is pretty high), that was the only thing that resolved the RERAs.
So long-winded answer to your first question is not yet, but working on it, and expect to solve it in time; but I don't think I would solve it without the bilevel, given what the titration study found.
On aerophagia: thankfully, I have yet to have any issues with that.
RE: Appreciate help adjusting settings (UARS) - mper6794 - 09-09-2019
(09-05-2019, 04:13 PM)cmcphee Wrote: Thanks, @melman. I'm not seeing an option to add RERAs. Uploaded a screenshot of the dropdown - is there a setting I'm missing maybe? Appreciate your help!
Hi, cmcphee
UARS (and PLM's) are my single focuses on this forum; interested on learnings to help myself and others.
Looking through above, and let you know my opinion:
UARS treatment would involves some basic steps, in my experience and scrutinizing this blog. First thing you would need to bring down flagged FL down to p95 = zero, and max some < 0.10. You have not got there yet. As far as I remember, neither me, slowriter, and so many others in this forum have eever suceeded on getting this with Autoset machine, and max PS(EPR) of 3.0, whereas when you move to BPAP, and set PS: 4.0, quite often (or always?) those thresholds, particularly P95:zero , happen almost overnight, as magic!
Then, my suggestion would be go for a BPAP, which hopefuly would bring much more imediate comfort on breahing, as well as at the same time allowing to explore and fine tuning what will remain of FL.
good luck