[Pressure] Need opinions on my flow rate please

[Osiris357]

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Hi everyone, I just started on my APAP on Sept. 27th 2019 and its going so so to be honest. I'm still taking stimulants to not fall asleep while I'm at work welding. Could those of you with knowledge please take a look at my attached screenshots of OSCAR? I'm being told 2 different things. My doc says I don't need a bi-pap but my respiratory therapist says I do. When I look at my flow rate in those screenshots and the rest of the charts for that matter, it seems to me that I need to lower my pressure at the very least. I tried turning on EPR with my docs permission but that shot my AHI up to 10.3, 8.7 and 6.1 on the 3 nights I tried it while on EPR 3, EPR2 and EPR 1. My average AHI is 1-3 most nights and that's the reason my doc wouldn't entertain putting me on a bi-pap. Any help or advise would be most appreciated because that flow rate, to me at least looks a little scary. Thank You

[Dormeo]

Welcome, Osiris357! Before an expert comes along to advise you, could you reformat your chart a little? First, include the vertical panel on the left, but also turn off its calendar and pie chart. Then take a screenshot of the whole night (i.e., without zooming in). But include exactly the same graphs—great job there.

It’d also be helpful if you could say which aspects of your flow rate concern you.

[Gideon]

It would be easier if you also presented a full night to provide context. Your flow limits are significant and as such a bilevel such as the ResMed VAuto would help. You NEED EPR or PS (BiLevel). I see significant differences in the size of your breaths and this is significant and the low volume ones are significantly flow limited.

You said your AHI went up when your EPR went up. What part of your AHI went up? There are many components to AHI and the specific makeup of your AHI is very important. I suspect your AHI rose because of a significant increase in your Central Apnea. It is critical to know these details when designing an optimum therapy.

[Osiris357]

Thank you very much guys I’ll try and format it different and interesting I did shut off the left side panel before I took the screenshots. I see what happened. And you are 100% correct Bonjour. I’ll send and new screenshot of the entire night when I get back to my computer in about 20 mins or so

[Gideon]

do include the left sidebar, minus the calendar and piechart so we can also see that data.  ANd also include charts from your EPR =3 night.

[Osiris357]

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Ok here are the new screenshots that I took from inside Oscar and not on the Mac itself so I believe they should be ok now. I couldn't get rid of the piechart though. The 1.4 is EPR off and the 6.9 is EPR on.

[Osiris357]

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This is from the other night with EPR on 2 when I tried pillows for the first time. Failed miserably but may try the pillows again with tape

[SarcasticDave94]

It's looking to me like EPR pressure swings are inducing CA. It did look better with no EPR.

[Osiris357]

That's what I thought also so I turned it off. But at higher pressures my breathing appears to be very drawn-out and looks very bad to me

[Gideon]

The more EPR the more CA, with essentially no CA with EPR = 0

Your original question, which machine?
As I suspected, the BiLevel (VAuto).  I suspect you will have trouble justifying this because your AHI is near 5.  You need the additional PS that you can get with the VAuto.  You have significant Flow Limitations with a PS (EPR) of 3.
This brings up the issue of the CA.   I believe this problem will go away with EERS therapy.  Note: this requires the Mask and hose and the technique is not in wide use.  I'm sure your doctors are not aware of this so it is a do at your own risk.

As we add PS we are making your machine more efficient.  This, in turn, more efficiently washes the CO2 from your blood, sounds good doesn't it?   Unfortunately, this reduces your drive to breathe as CO2 in the blood is a major driver for central Apnea.  The EERS simply causes you to rebreathe a little of your exhaled air which increases the CO2 in your blood providing the proper drive to breathe.  This is a major mechanism that causes treatment-emergent central apnea.

Another way that works for many, not all, is to wait 2-3 months to see if the central apnea goes away.  This is the normal way of managing treatment-emergent central apnea, basically, do nothing.  Do note that EPR=0 does also minimize the central apnea.

So the question to you is Which way do you want to go?

PS you can eliminate the pie chart in the preferences.