Can someone help me with these flow rates?

[emos12]

Hi guys,

So I have just been experimenting with my CPAP, and it usually goes to higher pressure's to attack the hypoapneas. I have UARS, sleep study showed RDI 12. I am just using the CPAP and actually I can adapt to it quite easy. Except for some moments where I wake up in the night and just cant get back to sleep with the mask on. Seems like this is a general problem for most beginners... 

I will show my results with CPAP in the following pictures I hope they work:

https://imgur.com/coAWo4f

https://imgur.com/v8odlmw

I have checked my breathing patterns and I am doing this because I have UARS with mild apnea and I was wondering if anyone could help me with the flow rate. and look at if its normal that I have these paterns? My inhale is very short followed by a significantly larger exhale. I thought it is important because My AHI is low most nights, but I still feel like crap. Even writing this my brain fog is so inmensely, it makes it hard to even write this thread. I thought it is important to look at the flow rate beceause the machine doesnt always understand the flow limitations and I was wondering if someone on the forum could help me with this. 

Also in almost all nights, I eventually have very shallow breathing that wakes me up, as if my body knows an apnea is coming and then I wake up

https://imgur.com/uZwrDal

You can see it here, and here:

https://imgur.com/E1uztyZ

https://imgur.com/YUEJCpY

If you need better pictures or more specific imagery let me know, this is what I thought initially would be helpfull. I saw another post of someone where he was being helped for his UARS with similair pictures. So I hope it is alright! 

I am just not sure what to do beceause my AHI is low but I just feel very tired everyday, it is literaly killing me and driving me into depression. My brain fog is out of control and my body just feels very weak where it is even hard to walk anywhere. Is that normal for my RDI?  Any advice someone? Thank you very much !

[Sleeprider]

Your images did not work out for me. You can use attachments as shown in my signature, otherwise, the links are improperly formatted.

[Sleeprider]

https://imgur.com/a/XRR2U

[Sleeprider]

You need a BiPAP with enough pressure support to overcome the extreme inspiratory flow limitation in the flow charts above. CPAP will probably not resolve this problem. Note the flow limit gets worse with higher pressure. I recommend you try a lower pressure and see if it helps. Set the minimum to 8.0 and maximum to 12.0.

[emos12]

Thanks sleeprider for your advice! 

I already thought something was wrong with my inhalation. Should my inhalations be longer?  Why is it not possible to resolve it with CPAP if I may ask? Beceause it will be difficult for me to get a BIPAP. The doctors here first give you a Mandibular device, then if that does not work CPAP and then BIPAP. They are very strict to their protocol here unfortuantly. So before I am there will take some time and I really want to feel better of course.

Edit: I see t, I will try the pressure range 8-12 then. Also on a quick note: I have nasal pillows and thought maybe it would be effectful to tape or chinstrap beceause it may allow for lower pressures.

[Sleeprider]

Emos, with a bilevel, the machine can provide higher inhalation pressure and back-off on exhale. What this means is you can probably tolerate an exhale pressure(EPAP) as low as 4-5 cm without causing obstructive apnea, but when it's time to inhale, you could benefit from an increase in pressure support of 6 (or more) making hour inhale pressure 10+ cm. What that does is relieve the flow restriction in your upper airway, and supplement the respiratory effort. This would get rid of those start/stop inhales and greatly improve your volume.

The CPAP cannot do that, and as a result, of a lack of pressure support your airway restricts flow almost to apnea during inhale. Your respiration is extremely disrupted as evidenced by the wavering inhale flow and that you practically blow out your exhale. Your time in inhale is taking 2.54 seconds, and you blow the air out in 1.4 seconds in order to get another breath started. This is what your doctors need to see to justify bilevel. Most importantly I suspect you feel like crap. That is a lot of work you're doing just to get your next breath, and that lack of efficacy is what your doctor needs to be aware of to justify bilevel. They may try higher pressure, and once we see if lower pressure is helpful, we may experiment with other pressure settings as well to see if the restriction can be overcome. Normally that is the direction we would go for flow limitation, but you seemed to have more difficulty with higher pressure. It may take some time to work out your best CPAP solution, but for this severe flow limit, I think bilevel is a more appropriate and comfortable option.

[emos12]

Sleepyrider I really appreciate your support !

OK, it is very clear now for me. For me there is a clear problem with my inhalation, which is the severe flow limitation. Bipap could supplement the respiratory effort and help me with the flow restrictions. I hope I will be able to resolve this problem with the APAP, because my doctor did not prescribe it, I bought it myself. I may try sleeping with the Mandibular device AND APAP. I think the biggest problem lies in my nose getting stuffed during the night, which forces me to breath through my mourh. I tried nasal strips etc but nothing works.

I thought maybe I can use my airfit p10 nasal pillows and tape my mouth. Because I believe it will give me more room as my tongue blocks the airway and decreases flow in my Larynx. What do you think about this solution? I am asking this, because I have tried different pressures with my FFM and nothing seems to help, I feel no difference. Every single night my mouth is all dried up, my teeth even get a horrible yellow colour.

By the way, I am from the Netherlands and the apnea world, so to  say, is very different. First of all I am very lucky to be even diagnosed with SDB because most hospitals do not have the expertise to identify UARS while they do have PSG's. My pulmonlogist/sleep doctor had to revise my sleep study to show I had SDB. Even he said that in the lab they tend to miss it ! Secondly, there is a lot of controversy about UARS, my doctor thinks it is an old term and should not be separated from OSAS. And for mild OSA they have the standard protocol where you first try a MAD with a sleep study. If that is not effective enough you get assigned a CPAP/APAP, if your lucky. So for me to get the BIPAP while I am in the beginning phase of my treatment will be extremely difficult. 

I hope there will be different ways to treat my horrible illness, may it be the nasal pillows or sleep with the MAD and APAP. I will try anything as I am very dedicated to treating this. I will update my results because I am learning a lot already here. Like the inspiration/expiration flow I see how it works now and for that I am very grateful

[Sleeprider]

Let's take this one step at a time. I think a trial at lower pressure will tell us something. If it doesn't work, I'd also like to see what a higher pressure does. It should open your airway without the mandibular device. Let's give the CPAP a chance to do the job, then we can evaluate other options.

I wish I had the magic solution, but with UARS we sometimes do some trial and error, then look at what works best. The flow rate close-ups you posted seem to be at the beginning or end of your sleep sessions, and I want to be sure what we are looking at is typical for sleep. If everything looked like that flow at 06:22 (last graph) just before you woke up there would be no problem.

[emos12]

Yes you are right patience is important in resolving this otherwise I will be jumping from one solution to the other. I will start with the lower pressure's from here on. I think I will try the nasal pillow because it just feels better. 

So that flow rate at 6:22 is good if I understand correctly. Yes well the graph with the disruptive breathing is somewhere in the middle and I tend to wake up a couple of times each night. Should I post the sleepyhead info on this thread or make a new one, what would be most convenient for you?

Again, I am very grateful for the help on this forum !

[Sleeprider]

It's always best to keep the data together. I am forgetful and if you spread it out, I'm likely to lose track of what we've said or tried.