Your Doctor doesn't know THIS about UARS! Truth about Upper Airway Resistance Syndrome.

[@Freecpapadvice]

So many people that you wouldn't think have sleep apnea DO have UARS. These are some of the most frustrated and tired people you will ever meet. This one is for you as well as your physician. Hopefully this gets you the sleep you do desperately need. Thank you for watching! All comments welcome.
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[@cebruthius]

Meanwhile in the Netherlands, doctors are celebrating "great scientific advances" such as medication to "raise arousal threshold" and to "promote daytime wakefulness without the side effects of stimulants" 😆

[@cebruthius]

Btw, my offer to discuss how ASV is providing the required "secret sauce" to treat my UARS is still stands. Any time you like :)

[@KPHVAC]

Jason - Your videos are what made CPAP work for me. My doctor sent me home with a pressure range of 5 to 15. On my follow up visit the doctor was mad that I had slowly raised my starting pressure over my first 3 months of CPAP. I tried to have a conversation with them about finding the right pressure. They didn't want to help, they just wanted me to stay on the Auto setting of 5 to 15.

[@gustc765]

Does that ever sound familiar!

[@nicklasmillner101]

I changed mine totally, doctor looked at my number, Said, " don't change a thing" , they aren't invested anymore, your on your own .

[@deepderp9957]

This might be your masterpiece. Thanks for the clarity.

[@Jason-Pez]

Jason is 100% correct, I did a home sleep test which really only showed I had an issue and I needed to do a complete sleep study. Thanks to insurance, it wasn't covered. Come to find out neither was the home test or the resmed I ended up with. After watching Lanky's channel and learning independently, I realized this could have gone far better. Yep, they gave me an APAP with the wide range. I saw my dr years later and she asked why I changed my settings. It seemed she wasn't quite used to people doing it. I've been going through many life changes, and once I get some stable, consistent numbers, I will get Jason to look at my data. I don't think I'm too bad, but I'm sure it's not where it could be.
Thanks for sharing all your education!

[@animipower4246]

"I bought a CPAP machine after losing hope with doctors. I bought this device because I didn't have enough money to buy a BiPAP machine. The problem with doctors is that they don't listen at all. I give them evidence, like when I sleep sitting up, my condition improves, but when I sleep on my back, my condition worsens. When I use the CPAP machine, my condition improves slightly, but not to the extent required. So, I invented something like a plastic piece that I place between my teeth to advance the lower jaw slightly, creating more space for breathing, which improves my condition even more, but not to the ideal level. Still, I thank God for this."

[@nicklasmillner101]

Try Craig's list , you absolutely need a BiPap ? Are you in a state w terrible health care? Like Florida?

[@michelem226]

I was able to get a sleep apnea mandibular device using my insurance. I'm pretty sure you can use it with a CPAP. If you make your own device, you might end up messing up your teeth in the long run.

[@xLaniex]

Doctors are also only interested in giving you a quick band aid for ur symptoms instead of finding out what's actually wrong and dealing with it

[@user-qt4jf5oz1u]

I have had crap sleep for 35+ years. I wake almost every hour. In Australia I don't have any insurance that covers any of this, so it has all been out of pocket and I'm on a disability pension. I was given a trial of APAP even though my AHI is only 4.7 because of the relentless lethargy I suffer daily and waking with headaches every single morning. My range is 4-20. It hasn't helped.. OBVIOUSLY. My AHI is way down to 1 or under but still feel like crap. I'm going to send this video to my sleep doctor, although I don't imagine it will go well. I could see she was already annoyed that I seemed to have a lot of knowledge just from watching RUclips. But I can't go on like this. I'm so tired of being tired and waking up all night long. I can't even find any info on BiPap here in Oz but will keep searching. I''m desperate for a decent nights sleep.

[@nicklasmillner101]

But a 200 $ Bipap , put it on high levels w some insight by a doctor, don't use auto , go bi level! It's less erratic . A rebuilt dream station is probably cheap , or possibly a Resmed 10 used . You sound desperate! Doctor needs to be replaced! CPAP is almost useless after years, w high pressure! For now increase pressure at one setting, that's what I'd do , maybe 16 !

[@Dan-dg9pi]

Jason, this was an excellent and informative video. I hope the "sleep doctors" will listen.

[@seanthornton3741]

All doctors should have to take a course at AXG Sleep Diagnostics as part of their Continuing Education credits, and the specific doctors that failed us should be mandated by their patients to attend in person and write a 5000 word essay on how they will change the way they practice medicine or face life in prison

[@MF-lb3iy]

This is great work. I have this issue on cpap .low AHI high leak rate and arousals 2 to 4 times a night. How do you set the machine to adjust for UARS?

[@davidpeterzell789]

Another great video. Seriously, this BiPAP/UARS/OSCAR-SleepHQ/anti-APAP/data-driven manifesto is both practical and scholarly. It encapsulates why I keep an eye on this channel, regularly; why I consult LL27 regularly to optimize my PAP therapy; and why I suggest to my (clinical psychologist/cognitive neuroscientist) clients and anyone who will listen to consult AXG Sleep Diagnostics or similar to optimize their PAP therapy.

[@FlippinFruitFly]

Best. Video. Ever. Thanks Jason!!

[@alfreddiaz9610]

Jason you are the man You've helped me out and I'm sure as well as others keep up the good work maybe doing another Oscar sometime soon God bless

[@davidpeterzell789]

"Incroyable, prodigieux, génial, merveilleux, fantastique ! BiPap machine? We've already got one." Sincerely, The French

[@susanwohlfarth3774]

Thank you for making my CPAP journey so much easier.

[@Holexification]

Oh my this explains so much!. I'm going to purchase a consult from you ASAP!

[@gregblank247]

Thanks Jason for this video. I am pretty sure this my problem. My AHI is great on CPAP but I'm exhausted.

[@j1103conley]

How the heck do I convince the Veterans Administration Sleep Doctors/techs that patient interest in sleep data is good? I have Air sense 11 using a 32gb card. They couldn't read the card. They said it was corrupt. Refused to even look at OSCAR data. “Not medically approved “

[@dcole9589]

Jason, VERY good vlog 2nite. I have been on cpap since May 2021. So much to learn. Appreciate your informing videos.
The sleep clinic I use is WORTHLESS, USELESS. I am getting what I want, though. I download all data on Oscar. Going to take a look at after 2nite session with you. My AHI is very good but now understand how to review the graphs, though. Have Airsense 10, nasal pillows, which I am very happy with.

[@dcole9589]

Well, looking at the graphs did not go well. Should probably book appointment with Lanky.

[@hyctobe7148]

Amazing video. Do you think you could do more videos about how to titrate with bilevel for UARS using OSCAR?

[@cebruthius]

17:15 For ResMed devices it's more or less a glorified EDF+ viewer. Doctors could open up their preferred "Medically Approved" EDF viewer, but of course they don't because it's just an excuse for laziness.

[@VIheavyequipment]

I'm really struggling with using my resmed10 and your videos are helpping

[@ASpectacular3777]

Just watched this and wow, you really know your stuff! The devil is always in the detail and you’ve got the detail down pat.

[@scowell]

Yes! Serious (mostly) Lanky! Will propagate.

[@cebruthius]

1:55 Sooooo true!

[@tompulmcritsleep8975]

Nice video. I think the advice to review the flow tracings is awesome, though I'm guessing it might be a little difficult to implement in a busy clinical setting with patients sometimes having limited technical facility.
One question: How are you sure that the apparently "corrected" inspiratory flow profile is truly representative of corrected flow, and not just representative of the nature of BPAP? I'm skeptical you can detect flow limitation on BPAP given that the shape of the BPAP applied pressure curve will naturally eliminate the ability to detect flow limitation. That is, you'll see an apparently "normal" breath whether there's flow limitation or not because BPAP "draws" a normal breath.
To get a little technical, flow limitation "works" because it's a sign that linear relationship of flow to effort has broken down, and the effort to breathe in proportionally exceeds the actual breath drawn. Flow and effort are *mismatched*. This works because "effort" (or negative thoracic pressure) is upstream of the flow, and the flattened breath implies a large differential in pressure between the airway opening and the thoracic cavity. If you apply a pressure-controlled breath triggered by detected patient effort, you're applying a positive pressure downstream of the flow, and therefore inspiratory curve flattening is no longer a reliable marker of flow not matching effort.

[@gustc765]

thank you thank you THANK YOU!!!

[@lucjulien7989]

Last night, AHI 0.00 with flat inhalation curve and palatal prolapse at expiration. These cpap machine AHI counts are ridiculous

[@livingforhim]

I am brand new to all of this, with an AHI of 20, I did a 2 week cpap trial and didn't really feel anymore awake. I am now at the point of purchasing a machine, but the clinician wants to do CPAP right off the get go. Kind of a big investment for a CPAP just to find that it is not what I need :(

[@hubertj041]

So how does one go about getting a prescription for a bilevel machine if one’s sleep doctor is one who refuses to look at any data beyond MyAir or the AHI in Sleep HQ? I have constant issues with flow limitations even with EPR on CPAP and wake up multiple times each night. I do have a mildly deviated septum and use a nasal emollient each night but don’t know for sure where my limitations are generated, my nose or my throat or lower. My doctor insisted it’s my “anxiety” and obsession with sleep data and gave me a book on anxiety. I’ve been on CPAP for 2 years now with a set pressure of 9 and EPR 2. I’m betting I’d do better on Bi-level. Thanks!

[@xLaniex]

Id suggest a new sleep doctor if they arent willing to do their job

[@jeroenvermeersch4875]

I tried to share some of your videos to ENT and sleep doctors, but they all wavered me away. Stubborn and "I know everything and you know nothing" attitude But they are the intermediary to get access to the biPAP devices. So I'm blocked

[@SayCheeseAndDie01]

It truly is a broken system

[@gilrose12345]

Great rundown and education here. Where are the pictures from?

[@RyanWilliams222]

7:03 Can you ask him what kind of scan this was and how he got it done? Or is it just an MRI that was run through a software program? (If so, which one?)

[@Freecpapadvice]

It was through a dentist. Tomography scan.

[@cebruthius]

Also known as CBCT (cone beam computer tomography with X-rays)

[@farisalotaibi9549]

Have any one with uars or expiratory palatal prolapse tried oral cpap mask ?to solve this issue i mean to skip breathing from nasopharyx and just breath through one way from mouth to lungs

[@cris_miko]

Excellent info!

[@camth4]

Jason, you mentioned that bi level helps move the meat out of the way in the lower airway. I'm struggling to see how it does this if the inspiratory pressure is the same or even less than CPAP. In other words, how does bi level magically "give more energy" as you say to dilate the stubborn tissues further down?

[@Freecpapadvice]

Great question! The machine is ramping up to increase the pressure as you are inhaling. You're getting assistance in breathing.
Think of it as jumping off the ground (CPAP), or jumping off a trampoline (bilevel). You're putting out the same effort, but jumping much higher.

[@cebruthius]

Look up "pressure support" it is like power steering for breathing.

[@camth4]

@@cebruthius In so far as I can tell, Pressure support on a BiPAP is no more powerful than on a CPAP. Critically, the IPAPs (Inspitory Postitve Airway Pressure) are the same which begs my original question: How is a BiPap any more effective at dilating lower pharyngeal tissue than CPAP? I get that it may ramp up IPAP faster than a traditional CPAP machine with EPR on but if the CPAP machine is set at CONTINOUS pressure, then this would become a moot point wouldn't it?

[@camth4]

@@Freecpapadvice But CPAP is just constantly set to whatever IPAP you want (say 15 cmH2O), continuously. If IPAP on Bilevel machine is also set to 15 cm, how is it possible that it's more capable of dilating tissues in the airway?

[@cebruthius]

@@camth4 Pressure support is the *difference* between EPAP and IPAP. The greater the difference, the more breathing assistance is given, which in a sense turns a "small opening" into a large opening to breathe through.

[@user-cu1fc1gv3w]

Great Job !!!

[@barbosa62]

@TheLankyLefty27 This all makes a lot of sense. Question about moving to Bipap from CPAP: is it the case that EPR support on CPAP acts basically like a Bipap, but only up to a delta of 3 cm h20? Basically, my question is if the pressure support I end up needing is 3 or less cm h20, does that effectively mean a CPAP is fine for my purposes? Is Bipap needed only for 4 or more cm h20 of pressure support, or is there some other benefit the Bipap provides over CPAP I'm not seeing?

[@Flipperwi715]

Great stuff.

[@jamesf8783]

I need to get with you again soon about plotting out a path to a bipap/asv because although my ahi is 2.x average. Majority comes from centrals. I just feel like it could be improved even with mouth tape/1 set pressure.

[@donaldvough4675]

Great video!!

[@bethover4hu544]

Wow. Doctors have given up on me too. All my flow rate curves are flat and jagged on top every night, all night. I can sleep at cpap 8.0 epr 3 without much aerophagia. If I try to go any higher, my stomach fills up with air. Could bilevel help with that at the higher pressures?

[@LIBERTYVIEWS]

THANK YOU Jason! Hugely helpful! QUESTION: How much detailed data does ResMed send to docs? In other words, are we getting way more data using OSCAR or SleepHQ than the docs get from ResMed?

[@cebruthius]

7:45 #teammeatmovers

[@catallergiccat]

Thank you Jason for bring it up! I have both osa and uars, CPAP helps but CPAP-gas sucks, therefore I cannot use an optimal pressure. I even had a modified U3P after a DISE recently, but mouth leaking got worse (soft palate seal loss). BiLevel seems to give me a lot of CA events and not to help with CPAP-gas much. Would ASV help?

[@cebruthius]

Yes, ASV can be adjusted to avoid inducing CAs.

[@amandasaunders9947]

Thanks sent the video to my sleep doctor.
Question: why can uars require higher pressures?

[@airyeric]

How does the varying pressure of the bipap move tissue the APaP can't?

[@jeroenvermeersch4875]

So an MRA device (to treat blockage caused by tongue by pulling under jaw to the front) is not effective at all to treat UARS? I have an appointment in clinic to make such a device. I was begging to jaw surgeon to do something for my sleep problem and he proposed to do that, but I'll cost me 1000 euros. If this is wasted money I will try to cancel the appointment obviously, but will have to act fast...

[@VIheavyequipment]

awesome vid

[@narus1234]

How did you get those heat map style graph in this video?

[@gregblank247]

I'm confused by something you said in here... You said bipap is not for comfort? But if you are struggling with the discomfort of pressure against your exhales like in cpap, won't that feel more comfortable with bipap?

[@Freecpapadvice]

You're right, that is confusing. I really shouldn't have phrased it that way.
I was trying to contrast EPR and Bilevel. EPR is solely meant for comfort. While bilevel can also make therapy more comfortable, it has a much greater therapeutic value than EPR.

[@JH-lz4dh]

Yup. Sleep "medicine" is a joke!!

[@user-px2sn8pr5t]

solution for Upper Airway Resistance Syndrome?

[@Freecpapadvice]

More often than not, bilevel.

[@user-px2sn8pr5t]

@@Freecpapadvice ???

[@churchhymnsandpsalms]

Hey Jason. This is totally unrelated. Does insurance really not cover your machine for the 5 years you have to use it before getting a new one? I’m at the end of year 3 and my humidifier and heated tube stopped working. So something’s wrong with the unit. But insurance says they won’t do anything. Is this common? I thought, for a medically necessary treatment, they would cover the machine for the 5 years you have to use it…

[@cebruthius]

Is your machine provided by a DME company? Have you contacted them?

[@churchhymnsandpsalms]

@@cebruthius I don’t know what that is. It’s a cpap service company that takes my insurance. They said it’s out of warranty. It’s almost 4 years old.

[@cebruthius]

​@@churchhymnsandpsalms Check the billing with your insurance, if this company is still billing your insurance, they are required to provide new equipment. If not, you'd be better off skipping the whole corrupt system and getting a low-hour used unit from e.g. Craiglist.

[@Dan-dg9pi]

Did you scramble the letters in the word "this" in the title?

[@Freecpapadvice]

🤣

[@trannga2625]

sleep doctor does not have much time to invest in those data.,

[@uragirichannel]

Hey Jason, thank you for the video. If you don't mind me asking two little questions because I'm getting desperate: 1 - I don't feel rested with CPAP either (current pressure is 7cm and EPR 1 and AHI often less than 1) and the tops of my breathing aren't often round, they're often flat and/or having weird double spikes like shown in the video.. is the only explanation for this that I may have UARS? I do have respiratory issues during the day so it could explain that too. 2 - I suffer from terrible aerophagia, even on a pressure as low as 4cm. It's most likely positional because sometimes I'm fine sleeping 8 hours and sometimes my belly hurts after just an hour or two and I have to stop the therapy. Do you have any suggestions for this? I don't know what to do, I tried cervical collar/wedge pillow but to no avail. Sleeping on my back is the only position I know for sure that doesn't give me aerophagia, but I hate it and can't sleep well in that position. Any help would be appreciated, thanks!

[@Freecpapadvice]

Don’t know without looking at data, but too little pressure (especially with full face mask) very often leads to aerophagia. Assuming FFM….if you’re using nasal/pillows you probably have a massive mouth leak as well.

[@uragirichannel]

@@Freecpapadvice Thank you for responding! FFM, yes. The highest pressure I've tried is 8, and I immediately set it back to 7 because I felt like this was the threshold before I got guaranteed aerophagia. I could try bumping it up even more and see how it goes then. I don't think I even get aerophagia when I'm just chilling with the CPAP (awake), only when I fall asleep.

[@jamesf8783]

I highly recommend a data session with Jason to see what's going on. I did and a few changes helped a lot although i think i might need a different machine type.

[@catallergiccat]

Btw, what kind of imaging of the two clients you show us here?

[@cebruthius]

It's a CBCT (cone beam computed tomography with X-rays)

[@catallergiccat]

@@cebruthiusthank you!

[@snospmoht3252]

👏💐