[CPAP] Double top flow rate

[ohno]

Hi everyone!
It is my first time here.

My problem is: I never wake feeling rested or good.
And wondering if these double tops is the cause.

How could I improve my sleep?

[Nightynite]

Hello, I’m no expert, but if I had flow limits like yours I would be on zombie mode.

Put your EPR on 3 and see if that helps. On your Flow limit 95% your at 0.15 Some people it may or may not mean much , but when I was that high I felt awful. You may be sensitive like me.

Higher EPR is what helps lower flow limits. If you get centrals , back off to 2.

[Deborah K.]

Your flow rate looks perfectly normal.  Your flow limits are high though.  We use EPR to help with these.  I suggest that you turn EPR on full-time, set at 3.  This should improve your treatment and comfort.  Also, most people are more comfortable with a range of pressure than using Cpap mode.  I suggest you switch to Apap mode and set your pressure range to 7-12.  Try those changes tonight, then post another chart tomorrow and tell us how you feel.  

P.S. Unless you had lots of CAs in your sleep study you don't need to worry about them at all. Use the EPR 3 setting.

[ohno]

Thank you, Nightynite and Deborah K, for your invaluable assistance. The EPR has indeed made a significant difference, resulting in my breaths appearing more rounded and free from double tops.

Initially, I began with an EPR setting of 3. Upon waking up in the middle of the night, I decided to check my AHI, which was at 3.8. Subsequently, I adjusted the EPR to 2 and concluded the night with a lowered AHI of 2.63.

Although I initially started CPAP therapy with EPR to ease into the process, it unfortunately led to CA.

It seems that I have a sensitivity to flow limitation and CO2.
What the next step should be? Any insights or recommendations would be greatly appreciated.

[Sleeprider]

I don't get particularly alarmed at CA events less than 4/hour with new users. The mechanism of an open airway is simply a momentary cessation of breathing. There is no obstruction or chest pressure created by this type of event, and breathing often resumes without arousal. This is preferable to seeing obstructive events or high flow limitation which increases respiratory effort, arousals and fatigue. As the use becomes more accustomed to the improved ventilation, the CA events eventually subside and go away. Thee are ways you can stabilize CO2 with EPR, but it's probably not worth it in this case. We can conserved exhaled CO2 by using Enhanced Expiratory Rebreathing Space (EERS). This is simply modifying the exhaust vent in the mask, and adding space where exhaled air does not get vented. Wiki here: https://www.apneaboard.com/wiki/index.ph...ace_(EERS) As I said, I would not bother doing this modification unless your problem is much worse.

[Deborah K.]

I think Sleeprider means you should set EPR at 3 again, and leave it there.  

[ohno]

Thank you Deborah and Sleeprider for their invaluable advice that proved to be effective. Enabling the EPR in 3 indeed did the trick.
Discovering that EPR is a form of BiLevel led me to purchase an AirCurve 10. Adjusting the trigger sensitivity proved to be a game-changer as it helped me get rid of the CA events.

I recently learned that flow limit is almost like hypopnea, and increasing the pressure is expected to resolve it. I've embarked on a journey to validate this thesis. I've set my pressure at 8 cmH2O with 0 EPR and plan to gradually increase it every 1/2 days to see if it results in fewer flow limits.

The reason for this journey is because I still feel tired and may need even more pressure.
After watching a webinar that claimed IPAP > EPAP is questionable (in most cases), I decided to go for IPAP = EPAP, and in the future, I plan to try IPAP < EPAP with one or more V-com devices. Webinar: KairosPAP (KPAP): The Future of Sleep Apnea Treatment

Does anyone have any thoughts or advice?

[ohno]

Thank you Deborah and Sleeprider for their invaluable advice that proved to be effective. Enabling the EPR in 3 indeed did the trick.
Discovering that EPR is a form of BiLevel led me to purchase an AirCurve 10. Adjusting the trigger sensitivity proved to be a game-changer as it helped me get rid of the CA events.

I recently learned that flow limit is almost like hypopnea, and increasing the pressure is expected to resolve it. I've embarked on a journey to validate this thesis. I've set my pressure at 8 cmH2O with 0 EPR and plan to gradually increase it every 1/2 days to see if it results in fewer flow limits.

The reason for this journey is because I still feel tired and may need even more pressure.
After watching a webinar that claimed IPAP > EPAP is questionable  (in most cases), I decided to go for IPAP = EPAP, and in the future, I plan to try IPAP < EPAP with one or more V-com devices. Webinar: KairosPAP (KPAP): The Future of Sleep Apnea Treatment

Does anyone have any thoughts or advice?

I ask this because I don't know anything and I might be misunderstanding everything. Until recently, I didn't know about the events that the machine didn't mark, and I thought that having an AHI below 1 was all right. However, I'm still tired, and this is the only direction I see.

And this thing scared me:
   

[SarcasticDave94]

If it were me, I would edit PS back to 3 and then increase minimum pressure probably to 6 or 7. This may also make your max pressure need to go up a bit as well.

PS 5 may be inducing those purple Central Apnea flags. Do you get them frequently like this or not? And what did your sleep study report?

I still think PS 5 is your guilty culprit. But let's see what goes on tomorrow.

[Sleeprider]

Nothing to be scared of. With trigger at very-high, the machine changes from EPAP to IPAP with the minimal spontaneous effort and flow. It is the stimulation of that transition (trigger) that reminds the subconscious to breathe. You are still breathing spontaneously. The Vauto is incapable of a timed or backup breath, but by triggering IPAP at very low flow levels, it supports your spontaneous effort and "reminds" you to breathe now. It makes a world of difference to many individuals here and it's why we want to use this tool as the first resort, rather than go to ASV or higher levels of intervention. Your graph is a great representation of the difference many here have experienced. As Dave suggested, you may want to dial back to PS 4 or PS 3 and see how that affects your therapy. I'm kind of thinking PS 4 might be where you want to be. Nothing in this graph suggests there is any obstructive element at EPAP 4.0, so fine-tuning PS with very-high trigger should be an easy task.