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+--- Thread: UARS (/Thread-UARS--26783)
UARS - tarah - 10-18-2019
Hi everyone,
I was dx'd with probably UARS 2 years ago from a home sleep study. I have been using APAP since then, first a nasal mask, now a full face mask. I have alot of nasal congestion, and the ENT said there was no obvious obstruction and gave me azalastine to use nightly, plus I use the Neti pot. I don't really feel like it's doing much. I can't get any air through my nose within 5 minutes of lying down.
It look a long time for the hours of gasping as I was falling asleep to stop when I started APAP, but eventually I started sleeping pretty well. That lasted for maybe a year and now I feel like I'm sleeping horribly again. Waking up ALL the time, waking for the day at 4 am (which does to be helped by an increase in my antidepressant, doxepin, and hormone replacement therapy). I'm just not sure where to go from here. I want to address the breathing issues, if they exist.
Here's a typical night for me. Is this what I should be seeing?
RE: UARS - slowriter - 10-18-2019
Looks like, despite your perfect AHI, you may have some RERAs that could be disrupting your sleep.
There's some missing data in the screenshots you posted, that should be fixed if you elimate the calendar and the pie chart and repost.
RE: UARS - Sleeprider - 10-18-2019
The next step is more pressure support from a Resmed Aircurve 10 Vauto. You're already at EPR 3, and you can probably continue to use an EPAP min of 5.0 and just add pressure support at 4, 5 or 6 or whatever works. Keep an eye out for a used one or just figure on buying the better machine.
RE: UARS - tarah - 10-18-2019
Thank you for replying.
When you say pressure support, do you mean the difference between the pressure on inhalation versus exhalation?
What about my data leads you to believe that a bilevel machine is required? Why doesn't it work for the inhalation pressure to just keep going up on the APAP?
I'm trying hard to understand my condition but just don't understand the fundamentals.
RE: UARS - slowriter - 10-18-2019
My thread is pretty long at this point, but you might want to take a look to see the evolution as I (like you, with UARS) transitioned from CPAP to bilevel.
In short, yes, pressure support is gap between the two. This is how you reduce the more subtle breathing restrictions that lead to sleep disruptions.
Not only does a VAuto allow a much wider gap, it also allows finer-grained control, which can make a difference.
PS - if you do look at my thread pay attention to the evolution of the flow limitations numbers and graphs over time, and compare to your's.
RE: UARS - tarah - 10-18-2019
OK, I will start reading it!
Is there any role in having a drug-induced endoscopy to identify the sites of collapse? Or does it not really matter because the CPAP is supposed to be opening those up?
Do you have nasal congestion as well?
RE: UARS - slowriter - 10-18-2019
(10-18-2019, 05:19 PM)tarah Wrote: OK, I will start reading it!
Is there any role in having a drug-induced endoscopy to identify the sites of collapse? Or does it not really matter because the CPAP is supposed to be opening those up?
Do you have nasal congestion as well?
I don't know on your first question. I don't really have any problem with nasal congestion.
RE: UARS - tarah - 10-18-2019
There's no way my sleep doctor is going to go for a different machine. The last time I saw her, she said everything was being treated as good as we could possibly expect and hopefully an ENT would do surgery on my nose....
So, how do I buy a used machine myself??
RE: UARS - slowriter - 10-18-2019
(10-18-2019, 05:34 PM)tarah Wrote: There's no way my sleep doctor is going to go for a different machine. The last time I saw her, she said everything was being treated as good as we could possibly expect and hopefully an ENT would do surgery on my nose....
So, how do I buy a used machine myself??
Craigslist/OfferUp/Facebook Marketplace is the cheapest option.
Supplier #2 on the supplier list is the quickest and easiest.
RE: UARS - Sleeprider - 10-18-2019
(10-18-2019, 05:39 PM)slowriter Wrote:(10-18-2019, 05:34 PM)tarah Wrote: There's no way my sleep doctor is going to go for a different machine. The last time I saw her, she said everything was being treated as good as we could possibly expect and hopefully an ENT would do surgery on my nose....
So, how do I buy a used machine myself??
Craigslist/OfferUp/Facebook Marketplace is the cheapest option.
Supplier #2 on the supplier list is the quickest and easiest.
First, let me link to one of our wiki articles so you know why bilevel is THE gold standard for UARS: http://www.apneaboard.com/wiki/index.php/Flow_Limitation/UARS_and_BiPAP UARS is upper airway resistannce or what we often call flow limitation. Using higher inhale pressure than exhale pressure makes inspiration easier and cancels out UARS.
The suggestions by Slowriter for used machines is excellent and if I knew your general geographic location I would make specific suggestions. You would be amazed at how many members have done this, including myself. Doctors seem to take the path of least resistance and the entity that really runs this show is insurance. There is no medical reason you should not have bilevel, but the work to demonstrate a medical need for insurance to pay for it, is hard. In your case, it is much harder because you have no events that your insuance recognizes as medically necessary. If your doctor really understood this issue and the basic principles of treatment, he could defend getting bilevel and appeal any denial by your insurance I think you know exactly why he is not one of those doctors. Hopefully someday you will have one that does support your best treatment. Meanwhile, like me, you may have to buy your first bilevel to prove it works. I would guess nearly half of all members you see on this forum with bilevel, had to procure their first BiPAP machine without their doctor's or insurance support. I still have my Philips System One 760 as a backup, but insurance bought my Aircurve 10 Vauto. It takes a lot of self-advocacy to move up to bilevel, and even more in your case where it appears you have perfect treatment based on the criteria used to measure efficacy.