Can someone help me with these flow rates?

[Sleeprider]

Ask your doctor for a BiPAP trial. The flow limits are going nowhere without pressure support, and PS should also resolve hypopnea. You're pretty new at therapy, but I can't suggest pressure changes that will resolve this without bilevel. The big question is how are you feeling and sleeping?

[ajack]

Thanks everyone for the replies and insights ! 

These are my results from yesterday, As you can see the AHI is controlled but I keep having these wave forms which I assume are flow limitations. Most importantly, I feel like crap still. should I bump up the pressure to 14-15?

If you need anymore info please let me know as I am very determined to make this work.

When you get back to your doctor.  The question I would ask is, is this obstructive or a a quirk in my breathing pattern?
Can you post the whole sleeepyhead page, the stats on the left hand side are useful.  I would look also at the snore, flow limitation, tidal volume and minute vent. to see if they look obstructive and you are getting enough air during these episodes.  The FL flag is clear in the events chart
Till you see the doctor, I'd do trial raising the pressure, to see if these are obstructive events and they clear. If you just have a crazy breathing pattern and good o2 readings without arousal, they may leave it. perhaps not the best thing. They will find out in a titration, they may see a need to go to a bpap machine with back up to fill in the gaps. either asv, st or vaps

has there been any med changes, that could impact on the central nervous system?

[Sleeprider]

Thanks everyone for the replies and insights ! 

These are my results from yesterday, As you can see the AHI is controlled but I keep having these wave forms which I assume are flow limitations. Most importantly, I feel like crap still. should I bump up the pressure to 14-15?

If you need anymore info please let me know as I am very determined to make this work.

Emos12 PM
I have found a resmed vpap STfor 400 euro’s . Ita a lot of money me and I know you advice me to buy a Bipap. Do you think it’s a good machine and good deal. And mostly a good option for my treatment. I just wanted to say that’s I really appreciate your time and advice beceause It is more than my doctors at the moment ! 

Hi Emos12,  I got your PM and prefer to reply to you in the Apnea Forum where other opinions can be offered in addition to my own.  A VPAP ST will provide very good fixed bilevel pressure to help resolve your very disrupted, flow-limited breathing.  The ST stands for "spontaneous/timed", which means this machine can provide a timed backup rate for IPAP, in addition to the mode that responds to spontaneous breathing effort.  You don't have any apparent need for the Timed backup function, so we will recommend a setup using S-mode.  The VPAP ST is capable of functions you don't need, but is also a capable S mode bilevel.  You could also consider a VPAP S or VPAP auto machine.  400 Euros is probably a very good value for a ST bilevel, depending on the number of run hours on the unit.  You can access run hours by pressing the control knob and home button at the same time, then entering settings, and scroll to "About".  The run hours and machine serial number will be available on-screen. 

In this thread we have seen a wide variety of pressures used on your Philips Respironics Dreamstation Auto.  Even at low pressures, obstructive apnea has been rare, but you have abundant hypopnea at lower pressures along with the odd looking flow limited respiration.  So if you are going to treat this with fixed bilevel pressure, my suggestion is that we start with fairly low EPAP pressure in spontaneous mode with a pressure support (PS) of 5.0 cm.  We will need to look at your results to ensure the OA events remain controlled, and hypopnea and flow limit is addressed.  To set this up, you  enter clinician settings, and set Mode to VPAP S, EPAP to 5.0 or 6.0 as comfortable, and IPAP to EPAP + 5.0 cm.

Other members may have additional or alternative ideas, and I'm certainly open to other suggestions.

[emos12]

Hello, its me again. 

So I just received my Resmed 9 ST VPAP. I figured out how I can change the settings what do you think would be a good starting setting?

And I can set it at ST and S. What should I do? ]

[Sleeprider]

Set Mode to VPAP S,
EPAP to 5.0 or 6.0 as comfortable, and
IPAP to 10-11 depending on EPAP pressure. Just add 5 cm to your EPAP pressure.

Once we have some baseline data, we can refine this.

[emredogan]

Thank you sleeprider!

Will the difference in IPAP and EPAP of 5 eliminate the flow limitation?

[Sleeprider]

We don't know! There have been a lot of people on the forum that this strategy helped. We are doing a big change in your therapy, and don't be surprised if it requires some fine tuning.

[emos12]

Hi all,

So I have been experimenting by slowly upping my pressure to the point that it eliminates my flow limitation and I think I have reached the point ! I only slept with this pressure for 2-3 hours but if I look at my sleepyhead rates I dont have the short inspiratory waves, but deep inhales followed by full exhales. an it looks more rythmic instead of constant changes in waves and the extreme effort that comes with it for my bode. However, there are some m shapes before I inhale is that anything to worry about? 

I hope I will be able to sleep longer with this pressure and hopefully it will be for the good :0

Looking forward to your advice

[Crimson Nape]

I am curious as to why you only have hypopneas and obstructive events turned on and not the other event flags. Also, your I:E Ratio is rather large. I would be very interested in what the basis is to cause it to be that large.

[emos12]

hee Crimson, what do you mean with I:E ratio? I am also very short of breath during the day could this have to do anything with it ?