Are these flow limits my problem?

[Sleeprider]

k888, the inclined sleeping is why you have persistent positional issues in spite of working with collars and other aids. I think you need to find a better solution than pillows and perhaps look at elevating the head of the bed or wedge the mattress in a way your aerophagia and GERD is tolerable without aggravating your positional obstruction.

[k888]

Thank you Sleeprider.  I am working on it. k888

[k888]

Greetings,
Could someone please help me "read" this flow rate pattern?  I don't believe it is quite desirable, although my AHI and flow rate are good.  I seem to have a lot of this pattern, sometimes smoother, but with the same erratic quality when the inspiration starts.  thanks, k888

   

[Sleeprider]

Expiratory flow limitation or partial palatal prolapse. During expiration you are experiencing some partial obstruction from loose tissue that partially closes your airway and reopens. We see the normal expiration reach the initial peak, then sharply decrease and resume. The second peak is where flow reaches zero ahead of inspiration and is normal. Was this a problem with lower PS or different EPAP min? Is this issue occurring at all pressures, or is it confined to a particular range?

[k888]

Thanks Sleeprider.  Will have to do some homework to answer that question, k888

[k888]

So many variables.
Should I look at CPAP and Bipap, or only the new machine?
•  PS:  going back to the CPAP on September 5, I see the same problem w/ EPR 2, pressure 9-12.  The top curve is more jagged, or chopped off than it is now. 
•  pressure range:  looking at 2/21, I see the same problem at EPAP 9 and EPAP 14. 
•  EPAP minimum:  happening now with EPAP min of 9, same earlier w/ EPAP min of 8.  On Jan 5, EPAP min of 7, a similar problem, but the expiration flow line was more jagged or just ran kind of flat for awhile, before inhalation started.  Same on Jan 1 w/ min EPAP  of 6, my first day on the machine.

I hope I am seeing this clearly.  I'm tired, and rather out of my depth, k888

[Sleeprider]

I have to use the analogy of taking an eye exam and ask, "what is better? This? or This?" While differences are subtle, it sounds like expiratory flow limits for you are not influenced much by EPR or PS but may be improved with higher minimum EPAP pressure? You use auto-pressure, is there a pressure in your current range where this pattern turns on or off? The mechanism of this obstruction could probably be identified by an ENT specialist, but it may required sedated endoscopy to visualize it. How disruptive is the expiratory "flutter" for your sleep? Is this the majority of your remaining comfort or efficacy issues?

[k888]

Unfortunately, it does seem to make a difference.  I just had my 4 best nights ever, and in a row, but I am still sleepy this morning by 9AM, and yesterday very much so.  (Last night was zero for both AHI & 95% FL!)  There are other health issues present, but sleepiness early in the morning is, most likely, the sleep disorder, I think.  So I have been reading about PP, and this is my first takeaway.  Please correct me if I’m wrong.
•  PP is not well understood, or at any rate, there is no straightforward fix.
•  Surgery is a possibility, but not simple and not with particularly good outcomes.
•  Best option for improving the situation is to test small changes in pressure and PS to see whether you can find a better spot.
•  Possibly, positional changes can have an impact.  I think SleepyCPAP improved some with a wedge pillow – will have to read that thread a few more times.
•  SleepyCPAP successfully used AlaxoStent, something to think about.

Assuming all that is correct:  since I seem to have stabilized on the AHI front, I need to start testing small changes.  (I resolved the collar issue by wedging the rolled-up edge of my bedspread between the collar and my collarbone.  Low tech, but it’s working.)  I have a question:  I know that how I feel is the bottom line, but are any of the attached waveforms considered technically better than others - Oscarwise?  Unfortunately I did not take a lot of notes over the last 5 months, and mostly the ones I did write are about how I felt sleeping, not about how I felt during the day.  Now it’s hard to go back and use the data to see whether certain choices improved or worsened the PP.  It would be useful to know whether some waveforms look better than others.

Thanks so much for your help Sleeprider.  I appreciate it, k888

  comparison breaths.pdf (Size: 175.32 KB / Downloads: 8)