Flow curve shape - what does it say?

[CPAPfriend]

Glad to help. Let us know how it goes

[PeaceLoveAndPizza]

FWIW I spent some time reading up on previous posts with similar waveforms. Generally speaking the inspiration peaks are slightly flow limited (peak above the zero line), but the rest is normal. Remember the waveform above the zero line is an inhale and below is exhale. 

The first rise is getting back to zero after the exhale and the second rise is the actual inhale. The slight ripple when at the zero line is possibly a cardiogenic oscillation. 

In general nothing stands out as being an issue.

[CPAPfriend]

Yeah, good point by pizza, in case you were wondering how to read it. The flat at zero is a pause between inhale and exhale.

[pezhead99]

I spoke to my sleep doc and here’s a recap…

Overall treatment is excellent - nothing really more to do objectively to provide long term health benefits. The waveforms show some flow limitation (plateauing at peaks) but nothing too concerning. My big issue is daytime fatigue so am trying a fixed pressure to see if that helps sleep fragmentation at all. Too soon to tell. I may be within the unlucky 5% of people who have “residual sleepiness in sleep apnea” (what a terrible name). This is due to untreated sleep apnea over a long period and modafinil is the primary treatment. I am also pursuing full neurological testing and various blood tests to determine if anything else is a factor. I have already learned than I have a vitamin D deficiency which is not helping. The journey continues…

[CPAPfriend]

What we do know is that increasing arousals correlates with increased sleepiness. Either by the machine or by resistance / flow limitation, you could be experiencing arousals, which in turn are making you feel unrested. Of course, too, your sleep physician's theory could be true. I just want to emphasize that once upon a time RERAs were ridiculed and ignored, and that there's a chance you're still being aroused via SDB or your therapy.

[pezhead99]

That’s a good point. Is there anything I can investigate to determine if arousals are a factor? I don’t usually see a lot of RERA events in Oscar. Would an ENT or DISE be helpful? Thanks again for all the insight.

[CPAPfriend]

EEG is the best tool, but you could use a pulse oximeter to elucidate some of what might be going on. Pulse spikes are highly correlated with arousals, along with movement. You could line that up with the OSCAR data too, to see if leaks or flow limitation coincides.

DISE is used to see where obstruction might be taking place while in a sleep-mimiced state, typically a precursor to surgery. It won't hurt seeing an ENT, but my experience is most aren't well-versed with sleep-disordered breathing.

[pezhead99]

Thanks! I just got an EEG … no results yet. I have the Wellue ring and will take a look!