Flow Rate and Flow Limit Graphs

[ovmeadows]

Still puzzled by flow rate. If the attached is an example of restricted flow rate what action is needed?
   

[Sleeprider]

This particular segment has very little if any flow limitation apparent. I think we need to back-out and get a look a the whole night to see how prevalent or episodic your flow limitation is. Overall, you have normal respiratory statistics, and all of the images in this thread are short segments where FL is present, but it may not be reflective of your therapy overall.

[ovmeadows]

First off I want to thank you for your great help.  I was about to give up on PAP treatment when you gave me good advice about settings.  Literally complained for years that my air was not right, finally fired 3 doctors at once over the issue.  My currect doctor doesn't pay any attention to my settings (?) but trust me to figure it out.  She is treating me with Zaleplon for Rapid eye movement sleep behavior disorder or REM behavior disorder (RBD).   Not perfect solution but Zaleplon 5mg very helpful when I take it; my wife is thankful.  Most of my adult I existed on 5 hours sleep per night more or less.  At 75 its caught up with me. 

Here is a full nights screen shot.

   

[ovmeadows]

Getting more hours of sleep but not as rested as number of hours indicate.
Wondering about saw tooth patterns on flow rate graph.

Timax 2.0s, Tmin 1.0s, Trigger very high and Cycle med; my best shot at using Resmed Clinical guide. 

Thanks again for your help.

   

[Sleeprider]

This is classic RERA (respiratory effort related arousal) and it is defined by the increasing obstructive inspiratory flow limitation followed by arousal, indicated by the higher flow rate of recovery breathing. This may be positional, or it might be resolved with a 1-cm increase in EPAP pressure. This seems to be an isolated incident and did not really register in your AHI or even the flow limit statistics. I don't know if you need to change anything, but your therapy seems otherwise good.

[ovmeadows]

Here is the full night for 25 Mar 2023.
Recently I used a soft cervical collar and noted no difference with or without.  Have began using Azelastine HCI nasal solution. 

   

[Sleeprider]

We can see the brief positional apnea, and with your results, it's just not worth doing a collar. If you're feeling pretty decent with the therapy and your sleep, let it go. The antihistamine spray is fine for allergies or nasal irritation. I use the fluticasone based (Flonase) spray as works as an anti-inflammatory and seems to keep my nose open in allergy season. I have never noticed any side-effects or tolerance issues.

[ovmeadows]

Thought I would explode a segment of my flow rate so that I could get a better view of oscillations which I see frequently night after night.  Have no idea what I'm looking at but does not appear to be regular or normal.   I'm still not feeling rested after a night of sleep.  I think I'm scheduled for a in home sleep study 24 Apr. 

     

[Sleeprider]

It is normal and common to see cardiogenic oscillation or cardio-ballistic effects on a flow rate chart. http://www.apneaboard.com/wiki/index.php...cillations

[Jonkier]

Apologies for bringing this back to life, but I find it fascinating that you can tell what's going on, at least in part, by looking at the flow rate waveform. 

@sleeprider I had a read through the paper you shared on inspiratory flow limitations. Again, fascinating. 

Another apology, I don't have a machine compatible with OSCAR, but am MORE than happy to spend the money on a Resmed if I can see some positive change from PAP therapy. 

From looking at my flow rate data on the software I am able to use with my Luna 2, it's pretty clear there's an inspiratory flattened top, which also seems to oscillate (is this snoring or reverberations in the upper airway?). These breaths commonly seem to be followed up with recovery breaths.

I am a beginner to this so any assistance would be massively appreciated. I have my settings on auto at 6-14cmH20 with EPR 3. I am assuming that the minimum pressure of 6 isn't enough to keep my airway open, but the problem I keep running into is, if I increase the minimum pressure above 6 I experience quite bad aerophagia. Enough to make me rip the mask off and curse the world. 

Last night I kept the mask on for a couple of hours but experienced frequent arousals/wake ups.

Sharing some screenshots of the flow rate data that seems to run through the time I have the mask on. 

Jon