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+--- Thread: Narrowing airway needs increased pressure? (/Thread-Narrowing-airway-needs-increased-pressure)
Narrowing airway needs increased pressure? - THEVGE - 09-25-2024
Theory on treating OSA/UARS with bi-level is pretty simple, implementation is not.....
Question: Am I seeing "airway narrowing" here and should I increase my EPAP?
In my case (UARS) I have been on bi-level for almost a year now and therapy is still not great. I analyzed all my old data and I am currently trying (again) to find optimal settings with iterations and logging everything. In general I think I am doing the right things (basically increasing both EPAP and PS independently with small 0.2 steps) as my sleep is getting better (longer, less aware awakenings) but energy during the day is still lacking and I wake up every day feeling tired, needing a daily nap. I can't remember waking up refreshed. Another indication, I think, that I am doing the right things is that I sometimes have "morning wood" with these higher pressures (actually, it seems PS is causing this) and when that happened I realized that has not happened for years. Body seems to be happy, LOL. And my flow rate also significantly improved, although I do still see room for improvement. Issues seem to be during REM phase (besides a daily OSCAR session, I also track with fingertip oximeter (SpO2/HR) and a Pixel Watch 3 (sleep)).
In theory you should set EPAP to the level where you have no obstructive/hypopnea events. Well, any pressure will do that for me. But.....if I set it too low (pressure range 4 - 7 or so with PS => 4) I will get Afib attacks. I can only assume I have apnea-like events (RERA/FL) not picked up by my Resmed 10 VAuto resulting in Afib (if I set a wide EPAP range, not much will happen, the VAuto does not really see events to act upon). Experimentally I am trying to find the trade off EPAP where I have no Afib attacks and I am now at EPAP 7.6 that seems safe. I might be able to go a bit lower, but for now I will stick here (Afib is zero fun and sometimes I need a full week to recover), unless ..... I need to go to higher EPAP? Hence my question.
Shown below is data from last night. My estimation is, from a helicopter view, that my data looks jealous making (0 AHI, minimal leaks (collar + mouth taping), proper breathing KPI's) but I always wake up like crap. I do see 2 things that I do not like; a bunch of self-identified RERA's (my Dutch bi-level does not flag RERA) and what I would call "airway narrowing", see for example around 00:25-00:45, 01:50-02:10 and 03:00-03:30.
This airway narrowing made me wonder......do I need higher EPAP to keep my airway more open or am I looking at something else? Really appreciate some feedback.
Note: my OSCAR view slightly deviates from preferred on this forum; and VAuto S-mode does not show FL hence not plotted.
Full night showing great KPI's:
[attachment=69912]
Zoom of an "open airway" part (flow rate still room for improvement):
[attachment=69913]
Zoom of a "narrowed airway" part:
[attachment=69914]