Fixed mask leak, but flow limit seems to be increasing AHI

[emile.leplattenier]

Hi all, new to the forum and on my third week of CPAP and having a very hard time adjusting. 

I've managed to get my AHI down to ~6 per hour, but I am still waking you feeling like I got hit by a truck and the exhaustion never really lets up throughout the day. 

For the first few weeks I had trouble getting my mask to seal properly, and as a result kept waking up and had some nights where my AHI was 10+. I've now managed to get that under control, but my AHI is unchanged even with a mask lead rate close to zero. 

One potential culprit might be my "flow limit" which to be clear I am not sure I fully understand, but seems like the only red flag in my charts. (attached). 

Can anyone offer some clues here? How can I reduce this elusive flow limit" and finally get some rest?

Also, I noticed that my pressure is at maximum for most of the night which is giving me some serious aerophagia and I am also assuming not allowing me to get deep sleep since it's so intense. 

As a side note, I also have a slightly deviated septum so even though I can fall asleep breathing through my nose, chances are 100% I open my mouth when I sleep. 

Any ideas here? Really want to have a day where I feel even slightly rested!

[staceyburke]

I would really suggest you use OSCAR for your data.  It is totally free to download and use.  Almost all of use use it and know how to read the charts.

BUT a couple of things.  Your flow limits are very high.  Flow Limits drive up the pressure of a Resmed machine.  FL are apnea just like OA and H events.  When a Resmed machine encounters a FL pressure is increased to stop it from getting to become a larger H or OA event.

We help the severity for flow limits using EPR.  To do that you have a couple of things to check on and change if needed

Settings
Min 8
EPR set to Full Time
EPR set to 3

Also I see some positional apnea.    You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[emile.leplattenier]

Thanks for the advice. I already have EPR set to full time, but will bump it up to 3 from 2 where I have it set and also look into getting a flatter pillow to try and reduce positional flow limits.

[staceyburke]

Again, the min needs to be raised - where you have it set will not do anything.  Set Min 8