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BiPAP Pressure for Possible UARS - bertchintus - 01-24-2024
Hello! Quick background, I have been incredibly tired and had trouble concentrating and thinking clearly for the past year or so. This led me to get a sleep test in which the results indicated I had 0.3 AHI but at the same time I had 88 "spontaneous arousals" throughout the night. I then started using a MAD device purchased off Amazon as well as taking allergy medication before bed, both helped a bit but I still felt like death warmed up. After some research I learned that not all sleep tests are scored the same so I had another one done at a different facility and this time scored with AASM's 1a scoring criteria. The second sleep test showed I had an AHI around 6 which was enough for a sleep apnea diagnosis and a CPAP prescription.
CPAP has helped the most but I felt nowhere near rested. I found my ideal pressure to be somewhere around 5 with an EPR of 3. I am able to sleep an entire night with higher pressure settings, without experiencing any aerophagia, but I feel as if I have slept worse. After researching a bit more into UARS it seemed that BiPAP would be the next step, so I purchased one secondhand. I have been tinkering with the settings for the past two weeks but I still feel tired all the time with the usual brain fog.
Below I'll attach my OSCAR data for when I was on CPAP, as well as Bi-Level using the settings suggested from user PeaceLoveAndPizza. I'd like to mention that for the Bi-Level data I was using a soft cervical collar, nose strips, and mouth tape. All of which have not produced any noticeable results so far.
Does anyone have any suggestions on what pressure to try next or any advice at all? Also, does any of the data seem to indicate UARS?
RE: BiPAP Pressure for Possible UARS - PeaceLoveAndPizza - 01-25-2024
At a fixed pressure of 5 and EPR of 3 you are never getting the full effect of pressure support. My opinion is you do not have enough pressure. You can have excellent AHI at lower pressure if flow limitations are being handled and it is enough to manage OA and H events. But that does not mean you have enough pressure for the arousals.
I do not think a fixed pressure of 5 is enough to give you a good nights sleep. Maybe good AHI, but the arousals will be affecting sleep. Your chart with the bilevel is on the correct course, but the pressure is too low. It needs to be at least:
EPAP min 6
IPAP max 12
PS 4
I think it needs to be even higher, possibly an EPAP min of 8, to handle the arousals. You can work up to that over time if it is uncomfortable at the start. Incrementing pressure by 0.2 a night or every few nights may be more comfortable.
We provide advise, which you are welcome to follow, ignore, or modify as you see fit. It is your therapy, do what is right for you.
RE: BiPAP Pressure for Possible UARS - bertchintus - 01-31-2024
Thank you for your response! I tried out your recommended pressure settings for the past 6 or so days and luckily I had no issue adapting to the higher pressure. The first 2 days I felt worse than usual now I feel about the same, there still seems to be a bunch of arousals on my OSCAR charts. Does any one have advice on where to go from here?
RE: BiPAP Pressure for Possible UARS - PeaceLoveAndPizza - 01-31-2024
Good to hear it is working for you! Funny how proper settings make things feel once used to them.
For now, I would just leave things alone for a bit. I would not even look at OSCAR, just the daily AHI on the CPAP screen. We obsess far too much at times with OSCAR and micro-analyse things that may just work themselves out in the end. If something goes totally bonkers, definitely post a chart. Otherwise, just focus on good sleep hygiene and getting a quality sleep.
RE: BiPAP Pressure for Possible UARS - bertchintus - 03-11-2024
Although I appreciate your advice, you may have misread what I said earlier. Your advised pressure has helped a tad but I am still not sleeping well, even with better sleep hygiene. I'll post some more OSCAR data, this time with a nasal mask. Again if there seems to be any weird discrepancies or if there's any other advise I would love to hear it.
RE: BiPAP Pressure for Possible UARS - Macka - 03-23-2024
I get very similar results as you on these pressures. Also suspecting UARS. For what it is worth, I have a theory. If your restriction is nasal, I believe the pressure and flow rate of changing IPAP pressure becomes an aggravating factor in causing constant arousals. I cannot get any decent sleep on the various machines i have tried in standard form. Multiple Bi-level models also.
I can however, get half decent results by using a Vcom and 19mm hoses. For me this makes so much difference it is crazy. I believe this slowing of the flow rate during inspiration is reducing the aggravation and turbulance trying to get past the narrow nasal cavity. More pressure just makes things worse.
Two negatives to this I am trying to solve are;
I think flow limitation control might be suffering due to losing the rush effect of pressure support ramping up, and also my inhalation times are double my exhalation time. Don't know what the negatives of this might be but it doesn't seem neurologically conducive to relaxing in your sleep. So this could be causing the spontaneous arousals I am still getting, particularly during obvious attempted REM.
RE: BiPAP Pressure for Possible UARS - tcinoz - 03-23-2024
Sorry to butt in, but could someone please explain the term 'arousals' in the context of sleep disorders? I'm relatively new to all this and keen to learn. Does it refer to times you wake up? How are flow limitations significant? Thanks - if you have the time.
RE: BiPAP Pressure for Possible UARS - Crimson Nape - 03-23-2024
Being brought out of (awakened from) a sleep state or elevated from a deeper sleep level. Basically, any condition that disrupts your current level of sleep.
- Red
RE: BiPAP Pressure for Possible UARS - tcinoz - 03-23-2024
Thank you. That would apply to me most of the night every night!
RE: BiPAP Pressure for Possible UARS - PeaceLoveAndPizza - 03-23-2024
The pressure changes have resolved the apnoea's as I noted, but the arousals remain. The dilemma for you, I, and others with UARS is we can handle apnoeic events well with the machine as is shown in our AHI and lack of flow limitations, but still have arousals. It is a continual cycle of tweaking things to try and resolve them, but in the end nothing dramatically changes. The best most of us seem to achieve is a reduction in arousals, not a complete resolution.
From this point you know what to look for and can try different pressure ranges and pressure support numbers trying to reduce the arousals. I am not aware of any magic, pixie dust, or other method to manage UARS directly.
We are all searching for the DaVinci code to handle UARS in a methodical manner. So far nothing I have heard or read contains the key. Lots of chatter, but so far nothing definitive.