Flow Rate wave form has sharp peaks

[Sleeprider]

Lots of members have done this after finding the residual flow limitation resulted in poor sleep, arousals and fatigue. One of the best threads on this is by Debororah K, and has a lot of information about how to make the change as well as the benefits of doing so. The Aircurve 10/11 Vauto has many other benefits in addition to more pressure support. https://www.apneaboard.com/forums/Thread...to-Bilevel

[dloomis]

Lots of members have done this after finding the residual flow limitation resulted in poor sleep, arousals and fatigue. One of the best threads on this is by Debororah K, and has a lot of information about how to make the change as well as the benefits of doing so.  The Aircurve 10/11 Vauto has many other benefits in addition to more pressure support. https://www.apneaboard.com/forums/Thread...to-Bilevel

That was a super insightful thread, thanks!

Last night was the best one yet, btw.   No noticeable mouth leak and the wave forms looks *almost* perfect. More importantly I feel way better this morning. I can't tell what's triggering the Clear Airway events. Am I just taking a deep breath and rolling over? Are the flow restrictions triggering it? Either way, it looks like I'm in the market for a used bi-level machine since I've hit the limit on what EPR can do.

Thanks again! You've been *so* helpful.

   
   

[dloomis]

I guess what I really want to know is, do the Clear Airway events indicate that I need higher expiratory support? Or can I continue to titrate lower (with EPR remaining at 3) since I'm not getting OAs or Hs? I suppose I can try tonight to find out, but I'm not even sure if 4cm expiratory support (7 CPAP + EPR 3) is even doing anything for my airway.

[Sleeprider]

Your CA events are random and at low frequency. We would need to look at some zoomed flow shots to identify how they evolve, but we often find these are pauses caused by anything from rolling over in bed, to breath-holds, swallowing, change in sleep stage or a pause in breathing related to a prior large breath. It's nothing to worry about and it's not worth chasing at this level. I'm most impressed with how you have beaten back the flow limits and sleep distrubances.

[dloomis]

Your CA events are random and at low frequency. We would need to look at some zoomed flow shots to identify how they evolve, but we often find these are pauses caused by anything from rolling over in bed, to breath-holds, swallowing, change in sleep stage or a pause in breathing related to a prior large breath.  It's nothing to worry about and it's not worth chasing at this level.  I'm most impressed with how you have beaten back the flow limits and sleep distrubances.

In your experience do you think that EPAP=4 IPAP=8 would be an effective pressure for some people with UARS? As you know that’s where ResMed’s titration bi-level guidelines start but I keep reading here that a starting EPAP 4 is too low.

Thanks for the continued feedback and support.

[Sleeprider]

I do, and have seen that work. Those are bilevel settings because IPAP is 4-cm greater than EPAP, so the with EPR, we start at 7/4 pressure (inhale/exhale).

[dloomis]

Quick update. I was able to get a used AirCurve 10 with super low run time hours (2) on FB Marketplace for $260.   Started titrating at PS 4, starting at EPAP 4 two nights ago and EPAP 5 last night. There's definitive improvement although I'm bumping to PS 4.4 tonight as there still appears to be some slight restrictions with awakenings from time to time. Not too many though. Screenshots attached.

I'm still waking up consistently after 6 hours. Hopefully that will go away over time once I get used to PAP therapy.

   
   
   

[Sleeprider]

That looks fantastic. If you want to clean up some of the CA events, try moving trigger sensitivity to high or very-high as needed.

[dloomis]

Most of the CA events are Clear Airway triggered by a deep breath, then minimal breathing for 10 seconds, then a normal wave form after that. I'm guessing because the deep breath over oxygenates the system. Would the trigger sensitivity do anything for that?

EDIT: sample Oscar graph attached.

   

[Sleeprider]

Try the high trigger and see what you think. You don't have to keep it if it doesn't work for you. The deep breath followed by a pause is a pretty common pattern, but I see a couple rises in that CA event that might trigger IPAP and shorten it if you have more sensitive trigger.