[CPAP] Need help, crazy amount of flow limitations events on pressure increase

[testetst2212]

Hey there. I was sleeping on the lower pressure settings for a couple of nights (average on 5 AHI) and then decided to increase my pressure last night using 95 percent rule to prevent some events. After updating pressure settings I went to sleep and woke up in the middle of the night and decided that I can't sleep with CPAP machine when I opened report this morning I am shocked because I have a lot of flow limitation events right before waking up. Can somebody help me understand if I did something wrong, thanks!

My settings before:

 
Mode APAP (std)
Pressure Min 6.00 cmH2O
Pressure Max 10.00 cmH2O
Auto start Off
PMaxOA 13.00 cmH2O
PSoft 4.00 cmH2O
PSoftMin 4.00 cmH2O
Soft start max. time 10 Minutes
SoftPAP Mode Standard
Softstart time 0 Minutes

My settings after:

Mode APAP (std)
Pressure Min 7.50 cmH2O
Pressure Max 7.50 cmH2O
Auto start Off
PMaxOA 21.00 cmH2O
PSoft 4.00 cmH2O
PSoftMin 4.00 cmH2O
Soft start max. time 10 Minutes
SoftPAP Mode Off
Softstart time 10 Minutes

[testetst2212]

I did some research, and it seems that pressure on exhale might be to high for me. I will try to reduce it and see how it goes, but would like to hear your opinion

[testetst2212]

The problem is I can't reduce pressure on the exhale on this machine because I already have max setting. Seems like during this event machine was pushing the air on 10cmH20

[staceyburke]

As you know this is not typical.  I would look at positional apnea.  Unless this is a real concern I would just monitor it and make sure they are not happening in large groups as your chart shows.  If it continues, Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two. 
Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[Jay51]

Great points about positional apnea by Stacey. 

Your close ups are interesting.  I recently received the Lowenstein Luisa ventilator.  My close up waves looked like yours (almost square waveish with a double peak and the last peak a bit higher than the 1st.  

This could be the way the Lowenstein machine's algorithms work.  I also felt like you - wanting to exhale, but the pressure was too high.  

I tried to copy the link here, but am not able.  Click on the "Wiki" tab at the top of the page.  Type in, "Lowenstein PrismaLine Optimization." in the search bar.  It should take you to the correct place.  I will try to read this also to help you figure out your settings.

[quiescence at last]

what i see when i look at your close-ups is evidence that you start to breathe in just when you have completed your exhale. This suggests that you are either awake, or in REM sleep.

during non-REM sleep, your breathing would generally be inhale-exhale-pause.

the close-ups also show the flow limitations are on the inhale part, not exhale. you are working on inhaling to bring enough air in, and the exhale is unrestricted.

the suggestion that the pressure is too high to exhale well is not supported by the charts you have posted.

Good luck as you continue the journey.

QAL

[Jay51]

Excellent points here QAL.  I am a rookie at these Lowenstein machines for sure.  Instead of describing the feeling as the pressure being too high on exhale, I should have said that the IPAP pressure lasted too long.   It seems to be trying to use a lower IPAP pressure, but stay at that IPAP pressure for a longer length of time than any machine I have personally ever used (ST (A), ASV, Astral ventilator, and Trilogy Evo ventilator.  

testetst2212, Possibly raising the Min EPAP might help.  Just wondering if raising the min EPAP would help the flow limitations on the inhalation phase (and possibly shorten the inhalation phase also - it would let go of IPAP quicker and transition back to EPAP faster?)  And of course working on the positional apnea like Stacey suggested.