[Treatment] Why am i getting a very high flow rate with long inhale, hold, and short exhale?

[sw33ttsunade]

[attachment=3731]
I am wanting to find out if anyone knows what this set of events shown below from sleepyhead would indicate? I have been using APAP for almost 5 months, and I am still not very refreshed (although I am somewhat better- I have enough energy to work a full day most of the time, but still have periods of dizziness, and I force myself to workout, although I do feel better afterward). I started looking at all the data and have found that my worst nights include several episodes like this, although most don't see the tidal volume above 8000, but he graphs follow the same pattern. I am hoping for any clues you can give me because my next appt is 2 months away and the doc seems a bit dismissive of me at times- he is a sleep specialist, but I don't know if this is the way it usually goes lol.

[Sleeprider]

This looks like an anomaly. It would help if your graph was revised as follows:
Click the triangle next to the date and minimize the calendar
Turn off the pie chart in File/Preferences/Appearance and unclick the pie chart on the right side
Use function key F12 to take a screenshot. That will automatically save the screenshot in My Documents/Sleepyhead/Screenshots
Read the directions in the first 2 links in my signature about posting images in Imgur and linking them here. Until you have 4 posts just post the link with a space like h ttp://imjurxxxx

Much of the valuable summary data is missing in your screenshot, and the image is small. The most useful graphs are events, flow rate, pressure, leaks and snores. In your present graph, that big inhale is either a huge sigh or a series of flow limited breaths with a leak. I would not be so concerned about that anomaly as much as look at the remainder of the night and see why you are still feeling fatigued. I'd rather see the improved graph, but I'm thinking you might do better with a higher minimum pressure.

[Gideon]

So that we can see things in context can you show us the entire night,  Pay attention to the organization for which graphs to show.

See my signature for links.

[sw33ttsunade]

Thank you for the directions and quick replies

I posted the entire night and the data...

h ttp://imgur.com/sWRwzSJ


h ttp://imgur.com/EldQtw1


I did raise my minimum pressure before, but it was leaking out the nasal pillows as I started using a chinstrap because my mouth was opening while I slept. I have noticed I do better with the chinstrap and the lower minimum pressure. I usually have the most events at the end of the night, I am guessing during REM sleep (when I had my first sleep study, they really screwed it up, including starting 2 hours after I was ready to fall asleep and waking me up before I had much REM sleep... I went home and slept another 4 hours and had several dreams and arousals from events... had a home sleep study and confirmed the events were taking place more oftern in REM and sleep doc set me up with the APAP )

[sw33ttsunade]

Here I posted the last time I was at min pressure of 7, and then last night I dropped it back to 5.... I sometimes take off the mask while sleeping, and wake up and the machine has turned off, so that's what is missing...

h ttp://imgur.com/a/AZ9ZR

[ajack]

I think as you say, you are mouth leaking. It seems the only thing you haven't tried is mouth taping. If it were me I'd sort your treatment pressures and AHI out, using a face mask the also covers the mouth. So you know what is working for you, you need a full face mask when you have a cold anyway, so it won't be a waste. Then try the nasal mask again later.

[trish6hundred]

Hi sw33ttsunade,
WELCOME! to the forum.!
Good luck with CPAP therapy and getting it fine-tuned to better meet your needs, hang in there for more responses to your post.

[Sleeprider]

You no longer need to add a space to a URL and can post images directly.  Either enclose the image URL in IMG tags [ img] URL [/ img] or use the "insert an image" icon in the middle of the editing bar.  Since some critical information is missing in the graphs, use the pressure instead of snores or resize to fit events, flow rate, pressure, and leaks.

Your event rate is low and most of it is hypopnea.  Your Dreamstation Auto does not appear to increase pressure very much and even where your pressure settings are 5-13, your 95% pressure is 6.5.  I can't see if you changed Flex settings between the two nights, but there is not much differential in IPAP/EPAP on either night.  I might suggest setting AFlex at 2 and using a slightly higher 6-13 pressure range.  I like your tidal volume and event rate better at the lower pressure, but if we add in more AFlex, you will need a slightly higher starting point.