Raise or Lower Pressure for Flow Limitations?

[Gideon]

A definite maybe. If they grouped and higher it can be an issue. If they are not spiking. These are involved in RERAs and UARS, you have a history of RERAs. As far how well your machine is performing for you the Flow Limit Chart is one of the most important. It is the most common cause of increasing pressure.

But most doc and med teams ignore them.

[CPAPUserDave]

   

   

Flow Limit Charts:

this what you need to look at Bonjour?

tried to zoom in closer on second image...

[Gideon]

Thanks,

You said in your original post

still not fully rested during day (I say operating at about 80%) and thinking my flow limitations may be the issue. getting some deep sleep but just not enough during the night.

Can you elaborate on how you feel?  Just looking for hints.

What I see,
Your Flow Limits are definitely driving your pressure as there is a VERY good correlation to this.  You are an example of why I don't respond to what a "gold standard" is for flow limitations.  


Some individuals are much more sensitive to flow limits than most users.  I think you may be one of those.  This condition is called different things by different people,  I tend to look at it as being sensitive to Flow Limits, Others call it UARS (Upper Airway Resistance Syndrom).  If you look hard enough you can see "issues" in almost anyone.  Frequently these people have not very good charts, but excellent charts (sound familiar).  The hard part is to determine who needs to treated further.  IMHO it is determined via Symptoms, how the user feels.  The goal is to get to an acceptable nights sleep, not to totally 100% eliminate all POTENTIAL issues.

Thus my question, and the request for a deep dive into how you "feel".  

Pressure support is a much better approach to take than increasing EPAP/min pressure.  Any chance you can get access to a ResMed VAuto for about a week?  I'd like you to increase your pressure support to see if that helps you, 1 cmw at a time.  Your AutoSet is just not compatible with that.   Also a good chance we would also lower your base/min/EPAP pressure. Most UARS user require a BiLevel machine such as the ResMed VAuto.

Until we can try that Let's increase your min pressure from 9 to 10.

Along the way be very critical of how you feel and please let us know.

You can look thru the night looking for irregularities in the charts (2-3 minute views), especially the Flow Rate, Tidal Volume, Minute Vent, and Respiration Rate.  A count would be great.

[CPAPUserDave]

i had a feeling we might be heading down this road (VAuto machine) so...

let me think/gather info tonight/tomorrow and will post later in day

already increased pressure to 10.0 a few days ago (to see what difference that would make)

not sure what I am counting by looking at flow rate/tidal volume/minute vent/respiration rate but since i never looked at them before, i will explore and figure out (i hope)


thanks Bonjour!

[Gideon]

Look at this chart.  http://www.apneaboard.com/forums/attachm...?aid=17625
see any potential disruptions?  Thought so.  You can see this on the detailed view of the flow rate too.

[JoeyWallaby]

If you still feel bad with these settings, you probably have a high sensitivity to flow limitations, which as Bonjour said, requires a Bilevel machine to completely treat.

[CPAPUserDave]

Last nights Oscar data:

Note minimum pressure raised to 10.0 (was 9.0 for last six months or so)

more attachments to follow...


       

[CPAPUserDave]

More OSCAR data from last night:

Beginning of Sleep Session / Middle / End

any areas need to zoom in closer?


           


How I feel to follow....

[Sleeprider]

Bonjour is on this one pretty good, but I thought I'd comment on this chart.  The big fluctuations in respiratory rate together with flow limitations is what RERA looks like (respiratory event related arousals).  The reason you don't feel rested in spite of very good AHI.

[CPAPUserDave]

How I Feel:

As I have been describing to my primary physician, sinus pressure. no pain but feels like sinuses below eyes are swollen. 
ever since started CPAP 2 1/2 years ago.  some days better than others, but pretty consistent throughout day. every day.

tried antibiotics, antiflamitory medication, flonase for allergies, blood tests, ENT doctor, CT scan, etc...
no significant findings but vitamin D deficiency last year, 
none of the medications seem to do anything
just started using flonase just before I go to bed. letting CPAP pressure blow that medication back into my sinuses. Maybe?

CT scan done last month shows mild paranasal sinusitis
also slightly deviated nasal septum with nasal spur on the left

lately having mild headaches when waking (say 2 on scale of 10)

some days IBS symptoms (unformed poop, gaseous)
same issues when sleep apnea was untreated ( i call it stress poop!)

feeling better since allergy season has pretty much ended but...

the more i think about it, i can see how my sinus 'pressure' could be lack of good sleep. 
i typically fall asleep and do not wake for six hours, get up for bathroom break, back to bed for another two hours.
i do not wake during those first six hours consciously, but after bathroom break, wake up more frequently from dreams.
I wonder if i am getting enough good sleep the first part of the night? seems like OSCAR data shows more limitations during the earlier part of the night?

my body feels pretty refreshed (good for a carpenter!) and i am not nodding off during the day like when my sleep apnea was untreated.

no excessive yawning either. must be getting some good deep sleep.

but by time work ends, i am ready for home and my chair. too tired/no ambition to do anything else. i can stay awake until bedtime, but really don't do much but watch TV

its like i wake up with cobwebs in my head like most people do, but they stay with me all day. and by the time the day is nearing the end, its wears on you. day after day.

its not like some days good, some bad. some days are better, but feeling running at 80% efficiency (and some bad days at 65%) every single day for last two years. its wearing on me. Never had kids, but i imagine somewhat like parents of newborn, except I do not get any days were I can 'catch up' on my sleep deficite. 

something can (and will) have to be done. Have not given up, but is getting frustrating. That is why I have explored various options with my PCP (who I see this week for my yearly physical) and why I am asking for help from my fellow apnea peeps.

Thank You,

Dave