flow limtations

[zarnola3105]

hey 
as you can see i have some flow limitations
i would like to know how can i reduce it
epr is already set on 3
im know that bipap is the best solution, but unfortunately i cant afford it

thanks

   

[zarnola3105]

    i also uploading my flow pattern
is it looks normal? 
can you interept it?

[Sleeprider]

The relatively long inspiratory time and flattened inspiratory peaks are typical of moderate flow limitation. As you already pointed out, bilevel treatment or pressure support is the best way to treat flow limits because the positive air pressure adds to your inspiratory effort and can create a normal breath. I think it's important that your results show periods of high flow limitation and long periods with very little, so that holds out hope that you can use your existing therapy and achieve good results. Your periods of low flow limitation correspond to periods of low pressure. I think you need to look at whether your sleeping position or chin tucking corresponds to periods of higher or lower FL. It may help to use a night camera to record your sleep and see what positions or postures cause higher FL or lower FL There definitely seems to be a likely positional aspect to your results.

[zarnola3105]

thank you very much

as you can see in this photo my flow limitations always start after im falling asleep and the pressure is rising. maybe a fixed value of 11cm water can help me with that?

   

[Sleeprider]

I think it's one of those "what came first" questions. Generally pressure rises in response to flow limitations, rather than flow limitations rising in response to pressure. Increasing minimum pressure to 11.0 may prevent the flow limitation, or may have very little effect which is why we prefer to treat with pressure support. Sometimes the airway opens up with more pressure, so it's worth a try, but don't be surprised if it doesn't change much.

[zarnola3105]

OK
tonight i will try 11.0....

the question is if the limitation occours in exhale or in inhale ?
if in inhale high pressure will help
if in exhale high pressure can do worse
am i right?

[Sleeprider]

Zarnola, easy to see for yourself. Just zoom in on the Flow Rate wave-form. You will probably see a flattened peak flow.

[zarnola3105]

   
again the flow limitations occurs after im falling asleep
this time overall better stats
but the pressure wasnt comfort and i think i was swallowing air and it cause me bloating

[zarnola3105]

I'm also think that if the flow limitations occurs always in the same time, it's maybe related to the sleeping position that I'm using when I'm falling asleep
maybe a soft cervical collar can help?

[Sleeprider]

With the higher pressure, flow limits have dropped from a 95th percentile of 0.08 to 0.02 which is a good improvement and completely acceptable.