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I saw a peculiar pattern in my flowrate data last night and I'm wondering if anyone knows what might be going on and whether it is something to be concerned about.
In particular, it seems that there was a significant period of time (from about 3:40am to 4:50am) where the expiratory part of the curve is very shallow.
Also, separate question, but does anyone know how the inspiration and expiration times are calculated. I assumed the inspiration time was when the flow rate was positive and the expiration time was when the flow rate was negative. But it doesn't seem like that would line up with what I'm seeing in those charts.
Machine: Resmed Airsense Autoset 10 Mask Type: Full face mask Mask Make & Model: BMC F5 Humidifier: HumidAir CPAP Pressure: 9-11 cm CPAP Software: OSCAR
I think this is just expiratory mouth breathing. If so, I don't think there is anything to worry about. I'd wait for the opinion of more experienced users though.
Machine: Resmed Airsense Autoset 10 Mask Type: Full face mask Mask Make & Model: BMC F5 Humidifier: HumidAir CPAP Pressure: 9-11 cm CPAP Software: OSCAR
No issues. How are you feeling with your therapy though? Do you feel satisfied? Your pressure changes seem to suggest that your machine is responding to flow limits. The inspiration and expiration time is almost equal, which I believe also suggests flow limitation (normally the exhale time should be about twice as long as the inhale time during sleep). What helps in reducing flow limitation is pressure support (the difference between the inhale pressure and exhale pressure), which your machine offers under the EPR option (to a limited extent, though, since EPR can only go till 3 - i.e. your machine can create a maximum gap of 3 cm between your inhale and exhale pressure. For higher gaps bilevel machines are used). So, if you are looking to improve your therapy, I would recommend increasing your minimum pressure to 7 or 8 and setting EPR to 3. I recommend increasing the minimum pressure since that will give the EPR of 3 room to work; if you use an EPR of 3 with a minimum pressure of 6 you won't get the full benefit of the EPR since the machine doesn't go below 4 cm of pressure.
I still have quite a bit of daytime sleepiness, particularly in the afternoon. So I’m not sure if I’m getting the best result from treatment. I will try the EPR on 3 with min pressure at 8 tonight and see how things go. Thanks again for the helpful suggestions.
I tried the suggestion of ERP 3 and min pressure of 8 last night. Very helpful! Flow limitation looks to be quite a bit better.
The apneas I had seem like they might be related to position changes since they have irregular breathing ahead of the apnea. I'm wondering if I should try a bit higher min pressure or if those are just inevitable and not problematic.
If they're preceded by breathing that looks like it's irregular and associated with arousal, then just ignore them. These (and the odd ones that occur right at the moment of dropping off or waking up, we call "sleep wake junk". And to me, that's exactly what this looks like. Nothing to worry about.
Thanks Ratchick. That makes a lot of sense. If all my apneas look like sleep-wake junk, could I lower the pressure on my machine further until I see some true events? I'm not sure how to find the right pressure. Thanks!
I recently upgraded to a AirCurve Vauto Bi-pap and have been working to dial in the settings over the past few nights. Currently my settings are:
- EPAP Min: 6.0
- IPAP Max: 14.0
- Pressure Support: 4.0
- Ti Min: 0.7
- Ti Max: 2.0
- Trigger: High
- Cycle: Med
Are there any suggestions on how I can optimize this? I'm still feeling some residual fatigue. I'm thinking I may be still having too many arousals. I know Dr. Rapoport mentions that arousals should be less than every 20 minutes to minimize fatigue. It looks like I had about 32 over 8 hours (~ every 15 mins).
Also, I intermittently have a weird waveform which I've seen described as either expiratory mouth breathing or palatal prolapse. Are there any settings that might be able to address this?
Any help would be tremendously appreciated. Thanks!
Those OAs are all not real and occuring post arousal. Your arousals may or may not be related to symptoms and from those examples there is nothing that makes me think they were caused by breathing issues.
That is either mouth breathing or possibly palatal prolapse. If palatal prolapse the only thing I believe can help is lower PS which reduces the exhalation flow rate reducing chance of palatal prolapse.
