[CPAP] Jojo07 Therapy: Whats going on with my flow rate?

[jojo07]

Hello! I'm still quite new to therapy - ive been looking at the MyAir app only until now and it gave me great scores. But my sleep doctor isn't the best if i have to be honest. He doesn't really respond when i got problems or questions, nor will he let me try other masks - so i started looking at my sd card myself through OSCAR. I'm going to request to get another sleep doctor. 

The only thing I've done myself is turn my pressure down slowly over time from 12 to 10 while observing if it would affect my AHI - cause at 12 i got horrible air in my stomach to a point where i couldn't walk because of the pain. 

As you can probably see I had my mask off at some point, that was on purpose though. I woke up and couldn't sleep.

Also I've noticed that my respiration rate seem quite high and it worries me... Is it something i should give more attention - its it a cpap thing or something i eventually should see a doctor for?

Anyway... I hope some of you guys will take a look and guide me if something is off - i've yet to learn to navigate all of this. 

Thanks in advance

Jo 

         

[gainerfull]

Hi Jo - overall your results look pretty good. How do you feel most nights after sleeping with your cpap?

Here are some things that stand out to me:

1. Your mask leaks could use some work, ideally you'd want to get your 95% leak to 0
2. Your minimum pressure is likely too low and precludes you from fixing the next item but ideally you'd want to get your 95% flow limits to 0 as well.
3. Your flow limits could use some work but that requires EPR which you are precluded from given your low minimum pressure.

Considering your therapy looks good you might do some experimentation with your mask tightness over the next couple of nights to get your leaks under control. Once that's done you should think about raising your minimum pressure to 7cmH20. Once you get leaks under control and are comfortable with the new minimum pressure you'll want to experiment with EPR - most of the more seasoned posters here recommend EPR at level 3. Good luck

[Sleeprider]

Jo, your AHI is very good, but we can hopefully get you to a lot more comfortable place and resolve most of the problems with hypopnea and hopefully aerophagia using the EPR feature on your machine. EPR is exhale pressure relief and works like a bilevel with up to 3-cm pressure difference between inhale and exhale. Pressure follows your respiration and increases as you inhale, and then cycles back quickly to a lower exhale pressure. This is usually very comfortable, and helps overcome flow limitation or upper airway resistance. You have a smaller than normal tidal volume (volume if each breath cycle) and high respiration rate over 21 bpm. The effect of that is to give you a normal minute vent of 5.25 liters of air per minute. Making it easier to inhale with EPR may facilitate a deeper, slower breath that accomplishes the same thing.

I recommend we change your minimum pressure to 6.0 and maximum to 10.0 and turn EPR on full-time at setting 2. This will give you 2-cm of pressure diffeence between inhale and exhale, so your actual pressure range will be 6/4 to 10/8 (inhale/exhale). This is lower than your current pressure range of 5/5 to 10/10, and with EPR I'm pretty sure you won't hit that maximum pressure. It sounds like you already know how to access settings, but just in case, here are some easy instructions: https://www.apneaboard.com/resmed-airsen...setup-info Good luck with the new settings. I think you will be pleasantly surprised.

[jojo07]

Soooo.. ive attached last nights data. And this part looks faaaar from normal in my opinion - anyone got some ideas to what this could be? 

I'm aware i have some trouble with high resp. rate and i dont know whats causing it. I've tried some EPR, but the max i can do is 1 - over that and ill get alot of CA's. 

Some also pointed out that my tidal volume is low - again i've got no clue if its normal or if its something medical i should see a professional for. 

Other than that my AHI is low - usually under 1.


   

[CPAPfriend]

Flowrate can get pretty weird in REM sleep. How often do your waveforms look like that? And are you sure you weren't awake during this time?

Minute ventilation is the product of tidal volume and respiratory rate, and it has important implications for proper balance of CO2 and O2. So if your tidal volume is low (which it is, but I need your sex and height to be sure and I'll calculate it), then your respiratory rate is going to be high, because you need to breathe more if each breath is smaller. Tidal volume is increased via increasing CPAP/EPAP, as it recruits more alveoli.

[Sleeprider]

JoJo, I have merged your two threads. We request that members keep therapy threads together so that we can see the full history and what has already been recommended.

I stand by my original advise to increase minimum pressure and EPR to 2 or 3. The zoomed flow rate shot shows what appears to be non-sleep respiration, but there is a lot of expiratory and inspiratory artifacts and obstruction. My concern is the consistency of low tidal volume which may be improved by the settings I originally suggested. A tidal volume in the mid-200 mL range is at the low end of what we would expect with a small female and is somewhat compensated by a high respiration rate. Your AHI remains low. Is this chaotic pattern something you observe frequently, or just occasionally?

[Sleeprider]

JoJo, I have merged your two threads. We request that members keep therapy threads together so that we can see the full history and what has already been recommended.

I stand by my original advise to increase minimum pressure and EPR to 2 or 3. The zoomed flow rate shot shows what appears to be non-sleep respiration, but there is a lot of expiratory and inspiratory artifacts and obstruction. My concern is the consistency of low tidal volume which may be improved by the settings I originally suggested. I see you increased EPR to 1, so let's try increasing the minimum pressure to 6 and increasing EPR to 2. It is noteworthy that with EPR 1, your 95% flow limitation has been reduced from 0.07 to 0.02 which is significant progress. A tidal volume in the mid-200 mL range is at the low end of what we would expect with a small female and is somewhat compensated by a high respiration rate. Your AHI remains low. Is this chaotic pattern something you observe frequently, or just occasionally?