Any way to tackle the remaining CAs?(AutoSet for Her)

[ChinaMan]

I am a 36 year old thin Chinese male and have been using AutoSet for her for the past two nights. Last night I had vivid nightmares which may have been caused by hypoxia caused by CAs.

I have been using APAP for a year; previously I had used Dreamstaion APAP for a year.

Attached are the charts for the last three nights.

[Gideon]

I see evidence of Flow Limits is all 3 charts. It is more evident in the ResMed charts. Is there a reason you didn't show the Flow Limit charts on ResMed?

It is more likely that the flow limits are causing your issues and you are not significantly DeSatting.

I suggest that you get a pulse oximeter compatible with OSCAR and prove it either way.

[ChinaMan]

Attached are past two nights' charts including FLs. Wasn't AutoSet For Her designed to tackle Flow Limitations; I have used the AirSense AutoSet For Her for only two nights.

[Sleeprider]

Flow limitation is treated by increasing EPR. Set EPR to full time at 1 and it may help stabilize pressure. The Autoset For Her does increase pressure for flow limitations, and what we're seeing is that higher pressure may be increasing CA events. I think a maximum pressure of 10.0 may actually help.

[Gideon]

Tackling flow limitations is a long way from optimizing the treatment of them.
Starting includes displaying the flow limits chart and will likely include seeing some zoomed views, 2-minute views so we can see them in detail.
EPR is your biggest weapon and you have it off. At this point we don't know the impact that EPR will have with your Central Apneas.
Much needs to be learned.

Step 1 is to look at all the data so we can see where you are at
Step 2 likely will be to raise EPR.

[ChinaMan]

Flow limitation is treated by increasing EPR.  Set EPR to full time at 1 and it may help stabilize pressure.  The Autoset For Her does increase pressure for flow limitations, and what we're seeing is that higher pressure may be increasing CA events.  I think a maximum pressure of 10.0 may actually help.

So I should set the EPR at 1 tonight to tackle the FLs? How terrible is my FLs? Or should I set EPR to max 3 to more aggressively tackle Fls?

[ChinaMan]

Tackling flow limitations is a long way from optimizing the treatment of them.  
Starting includes displaying the  flow limits chart and will likely include seeing some zoomed views, 2-minute views so we can see them in detail.  
EPR is your biggest weapon and you have it off.  At this point we don't know the impact that EPR will have with your Central Apneas.
Much needs to be learned.  

Step 1 is to look at all the data so we can see where you are at
Step 2 likely will be to raise EPR.

Attached are two zoomed FL charts. And what do the two FL values(0.72 and 0.87) really mean?

[Sleeprider]

I think Bonjour and I are on the same page. Your flow limitations are very noticeable in your zoomed charts as indicated by the flattened and downward sloping inspiratory peaks. It is the flow limitations that are causing pressure to rapidly increase, and leads to the RERA events. EPR is a great way to help minimize flow limits. The complication is that increasing EPR can increase CA events. We won't know until we try it. I was going to introduce EPR gradually at 1, but I think 2 might be better. My suggestion is change mode to Autoset Standard, EPR full time at 2 and pressure 8.0 to 12.0. I'll be interested to hear if Bonjour concurs or has some additional ideas.

[ChinaMan]

I think Bonjour and I are on the same page. Your flow limitations are very noticeable in your zoomed charts as indicated by the flattened and downward sloping inspiratory peaks. It is the flow limitations that are causing pressure to rapidly increase, and leads to the RERA events.   EPR is a great way to help minimize flow limits.  The complication is that increasing EPR can increase CA events.  We won't know until we try it.   I was going to introduce EPR gradually at 1, but I think 2 might be better.  My suggestion is change mode to Autoset Standard, EPR full time at 2 and pressure 8.0 to 12.0.  I'll be interested to hear if Bonjour concurs or has some additional ideas.

I am confused. AutoSet For Her was specially designed to aggressively tackle flow limits, but now you tell me to switch to the AutoSet Standard–––BTW, there was only 1 RERA event; and the AutoSet For Her did a great job eliminating all OAs, HAs, UAs.

[Gideon]

Sleeprider and I are on the same page. The zoomed views validate that you have fairly extensive flow limitations and once again flow limits are much more extensive than the stats indicate. I was going to suggest starting at EPR=2 because the flow limits are so extensive. Follow SR's settings and let's see what happens. Expected is a decrease in flow limits and an increase in Central Apneas, what we don't know is how much, CAI may not increase.

ResMed measures the 'flatness' of the breath and presents an index of 0 to 1 with higher being the more significant.