Flow Limitations?

[gr3gg0]

Hi All,

Can anyhow help me understand what my flow chart close-up is indicating?  While my breaths are not perfectly rounded, there is definitely a plateau shape that forms once I'm asleep (when awake they are very rounded).  From the OSCAR guide it looks like a Class 4 which says Yes/No under Flow Limitation which is somewhat confusing.  Is it or isn't it?  And if it is what might be the explanation?  

Much of my breathing during the night looks like this with some increased flattening at times but usually part of the downward flow, and while sometimes dips then flat, never peaks again then continues down.  When an actual obstruction is approaching it becomes much flatter at the top and generally looks more "chaotic".

I've also included my OSCAR settings which show very little flow limitations or leaks overall.

Any help explaining what this means, and any ideas on how I can reduce them (if in fact they are FL's) is much appreciated.

Thank you!

[PeaceLoveAndPizza]

To my eyes those are flow limited breaths, just not enough to trigger the FL counter. 

You could try increasing EPR to see if it rounds out the peaks or increase pressure from 10-14 to 11-15 to see what it does. The fine-tuning requires experimentation at this point in your therapy.

[gr3gg0]

I would agree, thanks for the input.

What I've noticed is raising the EPR (I had it at 3) didn't seem to help and only served to further reduce the flow limitations on the chart hence the algorithm for the AirSense would never increase pressure even though these limitations were visible on the flow chart.

I dropped it back to 2 hoping it would be more reactive, as you said there are limitations but my AirSense isn't acknowledging them as such.  I had read that adding EPR can make the AirSense less sensitive to FL's so while the FL chart looks great the flow chart still shows the plateaus and there is never any pressure increase when they happen.  Also noticing the AirSense in APAP mode seems to react late or reduce pressure (after an increase) at times where it seems it shouldn't.  

Am I wrong in my thinking here?  Maybe CPAP mode is a better option?  Curious what others using the AirSense 11 have experienced as it's algorithm in APAP sometimes doesn't seem to make sense. 

I also have Sarcoidosis with some pulmonary fibrosis so obviously that isn't helping matters.

Any other input, thoughts or ideas are welcomed!