Flat Topped Flow; Help With Chart Please

[Geer1]

If you have some good data from default settings (for timing etc) and ps of 3 or 4 then post some of those graphs.

Centrals are caused more by PS then EPAP (which is what ramp affects). This is part of the reason I want to see lower PS to see if it reduces centrals and what effect it has on flow limitations.

The reason to turn ramp off is because your EPAP is low so ramp is doing very little other than not recording data. Your breathing is the same whether you use ramp or not, the machine just isn't recording the centrals during ramp time. That is why we dont like ramp because it both delays treatment and also doesnt report what is actually happening. It is only necessary for higher EPAPs.

Part of the reason your flow rates may have looked bad is what was noticed about your IPAP not triggering. The machine a lot of time was acting like a basic CPAP. This is something to keep an eye on, the easiest way is to monitor the mask pressure graph. It should show a wave shape for each breath shown. If you continue to have sections lack of pressure your machine might be faulty as Sleeprider had mentioned earlier.

[Geer1]

Oh yeah and if you want to try a FFM I recommend the F20. If you are a mouth breather at times (especially if you have nasal congestion etc) then trying to force yourself to nose breathe isn't necessarily the best answer. I switched to FFM and it was way better and allows me to mouth breath when my body wants to. My leaks went down substantially and treatment and sleep improved.

[suzdream]

My motivation in having ramp was just so the pressure wasn't as high when I was falling asleep. I did notice the machine doesn't record data during that time, which is a bummer. Thanks for explaining that to me  

I did not have much for FL during these first two nights with my vauto, but even on my month with the autoset I would have days where FL went up (some 95% at 50 or so), and then I would have stretches where the 95% value was low. 

I think I forgot to tape my mouth the one night, because there are some large leaks. Not ideal but it happens.

I was looking at the quattro air over the f20 simply because I thought the forehead bit might stabilize the mask more, so less waking up due to a fussy and leaky mask. 

It's too bad the liberty was way too wide for the mouth part, because after I taped the whole mouth piece to my face I had zero leaks    (Oh the things we do when tired and don't want to get out of bed to change masks and have lots of mouth tape handy on the nightstand lol )

Oh the time was also wrong for these nights, but I fixed after.

[Geer1]

You can see in those images how your spontaneous inhalation time was just over 1.1, that is why having Timin set at 1.5 was an issue. You were trying to force yourself to inhale 30% longer with that setting.

Ramp starts at EPAP of 4. In the first image in this thread your EPAP was set at 4.8, the difference between 4 and even 6 EPAP is barely noticeable. Ramp is mostly useful for people requiring 10+ minimum EPAP.

I have an F20 and F30. F20 has been best for me, I have to tighten the mask a fair bit but got used to that quickly. It seals well when tight and I can move around, sleep on side etc with no issues. The straps allow you to tighten top and bottom independently to fix leaks in certain areas. The F20 is one of the most recommended FFMs and I don't think forehead piece is necessary.

Your flow limitations on at least the examples you have posted occur when you also have leaks present. Your treatment quality during these periods is affected and it is important to find a way to minimize these leaks. I think you might be having mouth leaks because your settings aren't comfortable (with high Timin and definitely when very low trigger sensitivity was stopping IPAP from occurring) and your body is trying to mouth breath to avoid the uncomfortable PAP settings.

[suzdream]

In some previous days my inspiration times had been longer, that was partly why I was wondering. I did switch it all back for last night though :

I think the reason I didn't mentally go for the f20 was that it didn't come in extra small. I also read that the quattro air was smaller or narrow than other full face masks. And after seeing just how too wide the liberty in a small mouth cushion was on me, I thought I should try something else that had a smaller size than small. (Since I now have 2 too big "small" resmed masks, lol)

[suzdream]

Here are a few screenshots from last night... They seem to have the rera type of events. 

I picked examples where I didn't have flow limits or leaks (the one had a leak of 1.2 L/min, so pretty low). 

I did order the quattro air in an XS so next week I can try it and see if that helps, but I have been making sure to really push the tape on my lips for now.  I don't think a full face mask with no leaks would change much on last night though.

I haven't been able to find a soft neck collar small enough yet. I am not sure I would love sleeping on too much overlapping foam.

Settings for cycle/trigger/ti are default, except tmax is 3.

I am not sure if there are any settings that can be tweaked or if it is likely positional.

Thanks!!

[suzdream]

A couple spots from last night, but maybe this is as good as it gets? /shrug 

No headache today at least, but I'm still super tired.

I might bump up EPAP and see if that helps? Since I think I have more events like this when the pressure is low at the beginning of the night. 

[Sleeprider]

I think you want to track the median and 95% pressures as directions to take on therapy. Based on those results, an EPAP min of 7.6 might be beneficial. I think it's worth a try, and if you still feel something is missing, we can play with small increments of pressure support and see what effect that has.