Need some help reading and fine tuning therapy

[quiescence at last]

i would not make a change here. I did notice the FL values at 95% changed back to 0.11 which to me is good. The FL does not suggest that you are bothered by them, an RE would likely result. In your charts you can see the RE came in the beginning of higher FLs or leaks, and not like a gradual awakening because of FL. More probable is that if leaks continue long enough, you notice and adjust. Nothing to fear from your current settings.

QAL

[SeePak]

expat,

i am wondering how to distinguish between pressure rise due to mask leak or

pressure rise due to flow limit increase?

The reason i ask, is that there are flow limit increases before the pressure goes up on blubarbs charts.

or i guess maybe due to mask leak, flow limiting is triggered and pressure increases?

[Expat31]

@Seepak

Hi, a pretty fair question! (ref graphs for 9th September) 

At around 6.30 am, you will see a simultaneous peaking in

1. Pressure maxing out at 14 cms. 
   
2. Leaking maxing out at approximately 34.4 l/min. 
   
3. Flow limitations maxing out at approximately 0.36
   

I think you considered that the flow limitations occurred before the pressure went up on the Blubard charts. 

If you look carefully at the three slope increases, from the very low level around 6.10am, to the peaks at around 6.30am, they look to me, as far as I can tell, were moving in unison. 

If this is the case, what caused the pressure, increase? Leaks or flow limitations? 

Here we get to a matter of opinion. From my experience, when you have both leaking and flow limitations, the primary driver for pressure is the leaking, especially significant mouth leaking, with pressure increasing trying to compensate for this loss. 

To explain the simultaneous increase in flow limitations, I can only hazard a guess, in that there was a reaction of this sleep stress environment of arousals resulting in impedance (narrowing) of the airways. 

I personally was blighted with both flow limitations and leaking. Only when leaking was finally controlled, did my  flow limitations decrease somewhat. 

Complete mastering of flow limitations was only achieved by increasing minimum pressure. 

A long answer, but your question was good and needed a full explanation. 

A caveat, I am not a doctor, just my own layman's opinion. 

[SeePak]

expat ( and blubarb )
what i see in the latest oscar is flow rate narrowing, suggesting either breathing change or obstructive/hypopnea oncoming event.

And pressure increase seems to happen more in time with the resulting flow limiting chart.

My thinking is that the pressure increase is causing some air leaks due to the high pressure swing.

Also, i am wondering if the EPR setting, with the low min pressure can cause some of the flow restrictions we see in Blubarbs flow rate.

And eventually OA events due to low pressure.

Prescription is for 12 cm, so i am thinking to stay closer to that number.

And as you have suggested expat, which is raising min pressure which will level out the pressure swings.

So my strategy here would be....

min. pressure 11 max pressure 13 EPR 2

or

min. pressure 12 max pressure 13 EPR 2 depending on OA events and comfort of exhale EPR3