Flow Rate/Limitation Question

[gr3gg0]

Hi,

Hoping someone can help describe the flow rate capture I've attached, is this a flow limitation?  This is often how my breathing looks in OSCAR.

The CPAP did not show any flow limitations during this specific period but the flow still lacks the usual roundness.

I've also included my OSCAR for this night.

Any thoughts?  Ideas on my settings?

Thank you!

[THEVGE]

Yes, clearly inspiratory flow limitation. Advise would be to increase EPR to 2 or 3 and see if you can tolerate that (without long term therapy induced CA's) with improved flow rate.

[gr3gg0]

Thank you, helps explain that while my AHI is low I still feel like a zombie during the day.

I did try EPR at 3 for a night or two and started getting a few (2-3) CA's per night so turned it back off.  Should I leave it on for longer?  

I've heard that therapy induced CA's can subside in time.  Any idea how long this usually takes?

[THEVGE]

I always got used to it within a few days tops and typically have 0 CA's even with PS 5.4 but that is personal. And a few CA's (especially therapy induced) probably are much less of an issue than the positive effect it will give you.

Make sure you increase EPAP with every EPR increase with the same value.

Good luck and let us know!

[gr3gg0]

So just to clarify if I turn on EPR to 3 with current APAP settings at 8-14 I should raise this to 11-17?

[SeePak]

Yes grego

increase both by 3

Now as far as getting CA events, i have had that for a long long time!
It is not really going away either, it can come up out of the blue sometimes.

Nothing to worry when once in a while, but i have had 100+ CA in one night, more than a few times!

Increasing min. pressure will help with the 'bottlenecking' you see in the flow pattern.

That is a sign that an airway is closing off, and needs a little more pressure to help keep it open.

You have a low amount of pressure output change from your machine, only going from 8 to 9 which is a sign , to me, that your airway collapse is repeatable, and controllable with min. pressure changes.
I have read, to envision this, that the airway is like memory foam, i takes awhile to open.
Sometimes this happens no problem by your body normally, but the machine overshoots pressure causing all kinds of extra issues, seriously, this happens.

There are many of us out here who use constant pressure cause it works!

Your charts suggest

Min pressure 9   Max pressure 10

EPR 0

You should be pretty close with that.

Interested to see how you make out either way!?

[gr3gg0]

Thanks SeePak, that was just last night, I've seen higher pressure changes more often, usually somewhere around 11 sometimes as high as 14.

Interesting you don't think EPR isn't needed.  I've raised pressure to 10 with EPR off and had a bad night so wonder if EPR might make a difference here.  I tried using EPR but only got a few CA's the whole night, I forget offhand the results (not in front of my OSCAR data) so doesn't sound like a big problem.

I will have to try a few different options and see what works best but hopefully can get to a good place, it's been a few years wondering what was wrong with me before anyone even mentioned I might have apnea!!!  I also have Sarcoidosis with nodules in my lungs and some fibrosis which doesn't help matters.

[gr3gg0]

If anyone else has any thoughts on settings or any other input please feel free to add to this thread, I need as much advice as I can get!

Thanks!

[SeePak]

greggo

checked out Sarcoidosis.

Sorry to hear about that.

You do have a bit of a high respiratory rate.

Check out Patrick McKeown, Oxygen Advantage.
Breathwork.

Everyone usually thinks we know how to breathe, i certainly did NOT !

In order for air to get efficiently to the alveoli at the end of the lungs, breaths need to be slower, lighter and longer than what we tend to do.
Shorter breaths end up filling mostly the upper airways type of thing.

I really enjoy the exercises, especially the 'air hunger' which is part of CO2 production.

Definitely a lot to help here, hope you check it out!

Also, my thoughts may change if i saw more of your chart, as you suggest differences there.

Keep us all informed with your progress and charts as well.

[gr3gg0]

Here is the night I set EPR to 3 and 8-16 pressure, with a snip of a random flow rate.  Had not noticed that up close it seems much more rounded.

Also a night set at 10-14 with EPR off.  Much smoother but I do see extended areas with flow limitations similar to my initial post.

I think I will try 10-14 EPR 3 and see how that goes.  I'll post results.

Thank you!