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RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct?
I plan to keep trying CPAP with the settings recommended here for the next few weeks, and see if that has any affect on my symptoms and/or flow limitation numbers.
So far is hasn't had any effect for the last few nights, but I'll keep trying/waiting.
Are you asking because you're in a similar camp? Do you have any thoughts or advice for me?
RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct?
Do the attached images looks like flow limited breathing to anyone?
(I took some random snippets of OSCAR data from last night)
Even after upping the min pressure to 8 over the last 10 days, I still haven't seen any improvement to fatigue symptoms, and I'm starting to question whether my breaths are actually just normal and I should be looking into another cause.
I'm also wondering why the breaths all look similar, but Resmed/OSCAR only classifies some of them as flow limitations ?
RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct?
Hey, I briefly looked through your case, and I will do a comprehensive look into it tomorrow and try to provide you with some advice.
From my brief lookover, those zoomed-in flowrate screenshots do look like they have flattened tops, which aren't being picked up very well by the flow limit graph, but that can be expected sometimes, as it's less sensitive.
Given that one study resulted in a RDI of 12.2, it's not a far cry to suspect you have SDB. By definition you do, but whether your symptoms are engendered by it is a separate question. To clarify, I think they more likely are than not, but let's keep an open mind.
Another random piece of input is you could try to control your leaks better. Tape mouth, full-face mask, chinstrap, cervical collar, or some combination thereof.
RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct?
All three screenshots show moderate flow limitation that might respond best to bilevel (NOT ASV), preferably the Vauto. When inspiration starts you get a good increasing rate of flow that becomes decapitated as resistance increases. The flattened tops show us that respiratory effort is being used to complete the breath at a reduced flow rate below what we would expect if the flow limitation was not present. In some cases we see a wavering or double peaks in the flow rate at the peak which suggests some soft tissue involvement. With bilevel, we would use pressure support to replace some of the respiratory effort to smooth that out and increase peak flow. ASV is not as good of a solution for this type of flow limitation which benefits from consistent pressure support to improve flow, rather than adaptive pressure support intended to manage volume. Those two objectives sound similar, but the consistency of your flow limit means you need consistency in the respiratory assistance. This is an obstructive flow limit, not central, so is not appropriate for ASV.
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RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct?
Jwest - Thank you. Any analysis or advice you can provide would be greatly appreciated. I'm happy and willing to try anything.
Is the leak rate that you see in the latest screenshot worrisome? It seems that very few are classified as large leaks?
Mouth taping didn't seem to be very effective for me. It would constantly fall off or perhaps I'd subconsciously remove it.
I have actually been using a cheap chinstrap from Amazon over the past 4 days, and I think it may be helping somewhat with leaks.
I wonder though if part of it is using the nasal pillows mask and them getting dislodged during movement. Perhaps I should consider a full nose or full face mask?
Sleeprider - Got it. Thank you for that detailed explanation!
I'll try to get the VAuto bilevel device for trial then
RE: CPAP isn't helping. Do I actually have SDB, and are my PAP settings correct?
Your leak rate is just all over the place, and in many cases it's going to disturb sleep. It's just good practice to try to eliminate them alongside other therapy adjustments. Your mouth could be opening while you sleep with the nasal mask, thereby breaking the closed loop and causing leaks. Just a consideration.
Yea, I see the same thing. You still have considerable flow limit throughout the night, and that's supported by the zoomed-in screenshots you shared. Basically you're inspiring and then at around 80-90% the breath is getting cut off. Bilevel would deliver a punchy force during inspiration to facilitate getting over that resistance towards the end of inspiration, theoretically. It could be helpful to give it a trial.
Something of note from your sleep study: you slept about half of it on your back and the other half on your sides, but your RDI is much more elevated while sleeping on your back, which is a common occurrence for patients (RDI of 19 versus 6.3, respectively). So, try to only sleep on your side.
