Need help with flow limitation interpretation

[Clementine39]

    Hello,

I finally started sleeping all the way through the night on APAP.  I have mild moderate APA, but with high-ish(?) RDI and severe apnea during REM. The settings on APAP are 4-9 pressure currently. 

RDI: 19
HPI: 10
HPI during REM: 36
Nadir O2 saturation: 84%

I have suspected myself of having UARS due to being thin, cold extremities, low blood pressure and younger female.  Low and behold, these are my results with actual OSA. I am very symptomatic with a lot of fatigue, cognitive and memory problems.

I wonder with the roughly even HPI and RERA if I might have some aspects of UARS?  I read in another post that people with UARS need to get their flow limitations close to zero and I don't know from looking at the graph if I am. I would also like to know if I have hit the target with APAP goals or if something doesn't look right.  I am still working on mask leaks. I don't recall waking up with any mouth leaks.

Let me know if other information would be helpful. I have attached the oscar data. I snore typically, but had zero snore in this graph so did not include it.

[Clementine39]

Also, I had my PES tested and it was -19. Here is a flow rate closeup as well during a period of time where the APAP supplied higher pressure.

[SarcasticDave94]

It would be helpful to include in that Oscar chart the left panel minus the calendar. There will be pressure settings and some summaries there.

Regardless, it appears your leaks are quite high. Check the mask primer wiki on proper fit and adjusting.

I don't know which machine you're on, if it's an AutoSet, to work on flow limits, you'll need higher minimum pressure, more than 4. You'll be too activate EPR full time and number X then following this guideline:

EPR 1 will work fully with Min 5
EPR 2 will work fully with Min 6
EPR 3 will work fully with Min 7

EPR is Exhale Pressure Relief, measured in the same cmH2O as the pressure. When active, EPR reduces minimum pressure on exhale. However, there's a hard stop on the low and high pressure sides, 4 min 20 max. So EPR 1, 2, or 3, can't work with Min 4, because there's no way to reduce pressure below that hard stop.

[Clementine39]

Thank you for your help! I have attached the statistics.

[SarcasticDave94]

OK thanks.

The median leaks at 19.2 and ranges up to 45.6 in the 99.5% column. This would be something to work on.

As I mentioned earlier, for EPR to work fully, and to benefit you most in the combat of FL, min pressure needs to be 7, since you're running EPR 3.

Your max pressure almost 7 now, and at least in this chart didn't need Max 20. You could edit both Min and Max if you choose. Maybe 7-12 or so.

[DancesWithCats]

Unless you find that you can't tolerate/get to sleep without it, turning ramp off, or if using ramp making it as short as possible helps to avoid the 20 minutes when the machine isn't really doing its job every time you start. My impression is that most of us get to being able to do without ramp as we get used to the machine.

And if you don't find that setting response to standard wakes you up, that's faster to react than "soft" where it's currently set- everything varies for everyone, but I certainly did not get woken up by setting mine from soft to standard. If you do, set it back to soft.

[Gideon]

Use F12 (Windows) to take the screenshot next time so it's mostly together.

Set your min pressure=7 and will be pretty close, if not at, the best you can do with this machine.

Yes, leaks and such but that's not machine dependent.