Is my breathing shallow ?

[dwd1249]

Thanks for the suggestions.  
The EPA was on 2 for all charts until the 5th July when I switched it off. I'm willing to try 3 cpap or apap ?

[dwd1249]

Last night

[Gideon]

You should show a detail of your flow rate for a while yet.

[TBMx]

although (or maybe because?) your leak rate increased your resp. rates (slowly) comes down.
14 seems to be not enough - maybe you try some more? (or wait a few more days? - as your resp. rate slowly comes down)

how was your nose the 2 nights? how do you feel in the morning / during the day? (that's what is most important, isn't it?)

Give dymista a try ... maybe even your GP can describe that?

[dwd1249]

My nose was stuffy with right side worst then left. I would say it was like most nights.
I feel good during the day . I know that dymista is only available on  prescription . I'll talk to my gp about it next time I see him.
Some flow rate charts from last night.

[Sleeprider]

It is not being recorded, but most of the above is flow limited breathing. I'm coming around to the idea that bilevel might be a good solution. Based on these images, the respiration rate is about 18 BPM, which is normal; however the wave form is erratic which probably results in the error in the summary reports. If bilevel was available, my best guess would have you at EPAP 10, PS 6, or in auto bilevel EPAP 9-13, PS 5.

[Gideon]

What do you guys think of trying 15 fixed to see if it impacts the flow limit and the apparent respiration rate?

[TBMx]

the first close-up looks "good" - the two after that are due to the leak-rate a bit "worse".

I don't know much about BiPAP, but in the end there determining the breathing phase really gets important. I have my doubts that the bipap devices have that much more capabilities to do that ... I would expect the same results that we saw where you had EPR on.

If your nose gets really stuffy your machine "sees" 2 or 3 inhales (and nearly the same on exhale) - I really can't imagine that it would help anything if during that 1 real inhalation the pressure would fluctuate that much. (If and only IF the machine would be able to keep up with that!)

I'm still pretty convinced, that what we see is mostly the stuffy nose. ... try a FFM^^

The scale on flowlimitations on your device goes from 0 to 1. - what we see (in the phases where your machine thinks you are breathing with a resp. rate in the 50s) needs a NEW SCALE. That would probably be like 3 or 4 on the same flowlimitation scale. (or let's just call it, what it most probably is: a very stuffy nose - blocking your airways partially!)

For short-term "relieve" you need to find the soft-spot in the pressure for you, where the pressure is high enoguh to treat your OSA and high enough to keep the nose open - thus the secretion out of the way.

When you breath through your nose and only have 1 clear nose-hole, all we can see is a bad flowlimitation. In the flow-curve the amplitude directly translates to flow-speed. A normal breath is: increasing flow-speed up to the peak-value, than slowing down and than start the exhale: rapidly increasing flowspeed ... which than slows down ... short pause - cycle repeats.

If one nose-hole is stuffed you simply cannot reach the normal peak-value. Thus your flowrate /-speed stays steady for a while - showing up in the charts as a flat-top curve. (the very definition of a flowlimitation) If you have a lot of secretion in your nose you can't even reach the peak-value of that one nose-hole, because the airflow would drag some secretion with it - thus you need to slow down your breathing a bit more (another very definition for flowlimitations) - these are the "mountains" we see --> that is the very thing, that the machine gets confused with "oh, it's another breath..." (if the flanks of these mountains are high enough)

As long as your nose is not under control and you are still on nasel masks the only thing you can see are: flowlimitations! - you can however treat the origin of that and not just conceal it.

So I would start treating your nose!
Have you ever tried rinsing / douche your nose? I don't like that - can't stand the feeling - but it really helps.
Another thing you can try: change the humidity. Maybe more dry air or more humid air would help a little too? ... or change the temperature if you have a climate- or heated tubing.
If your nose gets better out in the cold, I would try lower humidity with much lower temperature first. If it gets worse outside I would try the opposite.

Do you change the fine-filters often enough? - is there any chance that you are allergic to dust (as you said it is worse in the winter)?

[dwd1249]

Well longer sleep last night. Interesting that after a wee break around 0345 my resp rate dropped down.
I did notice that my nostrils were both open but stuffy when I got up at 0345 and 0639. They are about the same still.

[car54]

I have been following this post and it is very interesting. I also suffer from nasal congestion. I take a daily allergy tablet year round and generic Flonase and Benadryl  before sleeping.  My congestion has always improved when I use cpap. Years ago I had a sinus surgery to correct a deviate septum and had my sinus's scraped. This drastically cut down on nasal infections. If your problems are sinus related have you investigated any surgical options.

car54