Need help understanding data with so much flow limitation

[melody]

I have been struggling with CPAP for months, trying lots of nasal masks, chin straps, mouth tape and finally a collar.  I've changed the pressure and EPR and struggle with aerophagia. I'm awake often 90 minutes during the night. I have the fewest leaks (by far) with the Phillips Dreamwear even though it is hard to sleep because it's so loud.

Two things are consistent - 
* the flow limitation looks high. Is this a level I should be concerned with?
* I almost never get a good night of sleep with CPAP, even when I have a very low AHI, as shown in the attached graphs.


Can anyone help me understand if this flow limitation is concerning and what I can do about it? I can post additional screenshots if helpful.
   

   

Here is a look at the previous night before I adjusted my pressure settings:
   

Thanks!

[SarcasticDave94]

Flow limits are not quite apnea, and it literally means a limitation on flow. Sounds like a Webster's definition.

The prior settings weren't ideal, as the starting pressure of 4 and EPR 2 combo didn't gain you any pressure relief until the algorithm moved pressure to 6 and above. EPR will not reduce below 4, the hard stop for how low pressure can go. Saying this to indicate the edited settings are likely closer to ideal.

OK now with flow limits still being present, and EPR at 3 the max, the only thing left setting wise is slowly increasing the min pressure. You can bump it in .2 steps if you want.

[Expat31]

I had a similar problem quite a while ago; really low AHI,  - well under one, but still poorish sleep. 

FLs were a tad high, but comparing the FL graph to the pressure graph, it was clear flow limitations were  not really pushing up pressures to any degree..

 EPR was already on maximum 3, so nothing to do there.

I though changing pressures further would not help, as AHI was as good it will get,

But I had one more try, pushing up minimum pressure +1, and maximum +2. Surprise, problem solved.

Pure guesswork on my part, without any logical foundation.

I can only speculate that they were "latent" obstructions waiting to fully appear causing some kind of arousals and sleep disturbance. 

Perhaps this marginal  increase in pressure was just enough.

Maybe something to test in your case, you never know...

[quiescence at last]

yes. I looked at both charts, before and after changes.  If this were my chart, I would want my RAMP pressure set to something just below the lowest pressure needed in sleep. From EPR=3 night that is about 9.2; from EPR=2 night that is about 8.2.  This is actually consistent settings. Both result in an EPAP of 6.2.

If I liked EPR=3, then I would try setting RAMP pressure to 8.0 {and min pressure at 8.6}.
If I liked EPR=2, then I would try setting RAMP pressure to 7.0 {and min pressure at 7.6}.

I noticed in the chart that I would bump up against the 10.6 maximum routinely, so I also would raise that upper limit to 11.60.

I hope you feel empowered to make changes to your treatment to establish a best breathing and best restfulness.

QAL

[Sleeprider]

My recommendation is to start pestering your doctor to swap you to bilevel for more comfort. Your sleep disordered breathing is best described as upper airway resistance (UARS). Even though your AHI is low, you have persistent flow limitation and a high level or RERA through the night. Your machine is under-counting RERA. If you can afford it, pick up a used Resmed Airsense 10 Autoset, or wait for a sale at Supplier #1. The answer to your severe flow limits is more pressure support. The machine replaces physical effort with pressure support to normalize inspiration rate and flow. I bought my first bilevel out of pocket and it made such a positive difference I was able to work with my doctor for a prescription change. It's pretty clear that with your settings at 8.0 to 10.6 EPR 3 your pressure pegs at the max. I think you may want to consider increasing the maximum pressure to 12.0 or whatever you can comfortably tolerate.

[melody]

By ramp pressure, do you mean the start pressure? The current ramp time is 10 minutes, should I change that?

[melody]

  If you can afford it, pick up a used Resmed Airsense 10 Autoset

Thanks for the response. I have an Airsense 10 autoset now. Did you mean something else? I haven't been able to see the doctor yet and the appointment is 3 months out. I'll try and increase the pressure.

[melody]

If this were my chart, I would want my RAMP pressure set to something just below the lowest pressure needed in sleep.  

By ramp pressure, do you mean the start pressure? The current ramp time is 10 minutes, should I change that?

[SarcasticDave94]

I think what Sleeprider is pointing out is that since the AutoSet you have now only allows the PS, or in the case of this AutoSet EPR, can only be up to 3, and it's not enough of a differential for UARS.

If that's the case, the VAuto which is bilevel, will have a lot more PS differential, and will be a better therapy fit with better results.

[Sleeprider]

Thanks for the response. I have an Airsense 10 autoset now. Did you mean something else? I haven't been able to see the doctor yet and the appointment is 3 months out. I'll try and increase the pressure.

I really misspoke. I meant a bilevel Aircurve 10 Vauto.