UARS linked to flow rate or fluctuating breathing?

[Willgetthere]

           
Do these Oscar pics suggest I have UARS. Partly I wonder this as the peaks of my breaths are never nice and round,
look like plateaus with spikes in. Am at the end of my tether trying to work out what is gong on and
would really appreciate thoughts on whether biLevel would be more appropriate for my therapy.

Over 7 months into CPAP (ResMed Airsense 10) some good results:
AHIs mostly under 3 (from 43 so happy with that)
O2 Ring shows stable Sats - mostly 9.8 / 9.9 (sometimes 9.7 with a lot of drops)
for the last 30 nights zero or very low leaks (due to finally finding a mask that works for me)

Daytime tiredness is my motivation to find out what is wrong. I've read many posts here plus Googled to try to see if I might have UARS. Also trying to work out what role my highish Flow limits play or if I have CO2 problems.

But for sure something is off because my Flow Rate all night, every night, has a clear pattern of very extreme fluctuations.  I can’t workout why even with stable O2 and no mask leaks my breathing is a raggedy mess - it doesn’t look suggestive of peaceful sleep.

Regardless of pressures I have tried (with EPR 3) its the same night after night.
Yet here is the weirdest thing…...
there was one night in July my leaks were off the charts. I slept ok - but that night my Flow rate was less fluctuations and more steady. Why would be that be? It makes no sense which is why I a wondering about the role of CO2.

Reading some of your contributors’ comments about Flow Limit I noted this:-
Flow limits -  ideally be under 0.03  / or at least under 0.10 above 0.2 as needing more pressure or pressure support; below 0.15 as marginal;  0.1 as good -  levels below 0.05 as excellent
Have to have EPR on or flow on 3 (have tried Flow Limit off, can breath fine with it off -  but my Flow limit goes sky high) 
Also, I gave the V com a try - for me a complete disaster

[Sleeprider]

It really helps is you follow the format for charts suggested in the Organizing your charts wiki. The Daily Sidebar (F8) is especially useful to view respiratory statistics relevant to flow limitation and UARS and the pressure associated with the flow rate results. Oscar charts are not really used to diagnose UARS, however the 1-1/2 minute zoom you provided, and the full-night flow rate does suggest there is flow limitation that results in arousal, and your leak rate is not so great either. Flow limitation increases respiratory effort, and that increased respiratory effort can interfere with sound sleep. Your charts don't provide much insight to offer more suggestions.

[Willgetthere]

It really helps is you follow the format for charts suggested in the Organizing your charts wiki. The Daily Sidebar (F8) is especially useful to view respiratory statistics relevant to flow limitation and UARS and the pressure associated with the flow rate results.  Oscar charts are not really used to diagnose UARS, however the 1-1/2 minute zoom you provided, and the full-night flow rate does suggest there is flow limitation that results in arousal, and your leak rate is not so great either. Flow limitation increases respiratory effort, and that increased respiratory effort can interfere with sound sleep.  Your charts don't provide much insight to offer more suggestions.

Thank you famed Sleeprider : -)  have read many of your replies to others and value those comments. In fact my leaks have been at zero for almost all of the past month. I was showing a very bad night of leaks from back in July because that night my breathing was calmer and imagined there was a reason for the way leaks affected flow rate.  Thought I could only post pics, could I post more t show a typical night ?

[gainerfull]

Agree w/ Sleeprider, it would be helpful to see the full daily view w/ calendar minimized. The 3rd screenshot looks like REM breathing and is normal.

What's your nasal hygiene regimen like? Are you doing a nasal rinse? Taking care of your allergies?

[Willgetthere]

gainerfull pid='495484' dateline='1702507014']                 Agree w/ Sleeprider, it would be helpful to see the full daily view w/ calendar minimized. The 3rd screenshot looks like REM breathing and is normal.

What's your nasal hygiene regimen like? Are you doing a nasal rinse? Taking care of your allergies?

Thank you for your interest. Yes nasal spray every night, plus soft cervical collar.  I have no problems or stress breathing, 
even with EPR off, but as mentioned above, EPR 3 helps Flow Limits to stay lower (0.10 or a bit lower) 
Are these screen shots what is wanted?

[BoxcarPete]

OP, third chart looks like mouth breathing to me. I had a mouthbreathing problem even when using tape which pushed me towards using a FFM. It helped, sort of. Fixed the leaks and some of the other issues, but caused some new trouble of its own.

[Sleeprider]

The daily sidebar reveals the inspiration time exceeds expiration time which is classic for flow limitation and UARS. All other respiratory stats are normal, good therapy time and acceptable AHI. I think your original suspicion of upper airway resistance or at least chronic flow limitation is correct. Your complaint about daytime tiredness or fatigue is common with flow limitation that increases respiratory effort and arousal at night. I assume your comfort and flow limits are a lot worse without the EPR, correct? The best path to resolving it is going to be bilevel (Aircurve 10 Vauto), so you might want to follow the path of others and work with your doctor to upgrade therapy, or consider buying a bilevel to expedite the process. Depends on your insurance and providers. A little more pressure support and some more sensitive trigger and you could be near zero AHI and fully resolve the flow limits... As far as the "famed Sleeprider", wow! My little corner of the internet is not known for fame, but I enjoy the successes of the people I help.

[Willgetthere]

OP, third chart looks like mouth breathing to me. I had a mouthbreathing problem even when using tape which pushed me towards using a FFM. It helped, sort of. Fixed the leaks and some of the other issues, but caused some new trouble of its own.

There is a perfect saying for this: 'one step forward, three steps back'
Yes I used to only want to use Nasal masks and taped my mouth-  but leaks were horrendous.
finally went over to ffm and much much better, zero leaks for nights on end, 
but strangely, my AHIs were lower with Nasals even with very bad leaks

[BoxcarPete]

Yes, I had the same experience switching to FFM. Leaks even with mouth tape, then after switching to FFM, AHI (and especially RDI) went significantly up when back sleeping. No problems back sleeping with nasal pillows. Side sleeping with FFM gives me pretty good stats but it's not comfortable for me and I am always worrying about the pillow pushing the mask around and causing leaks.

[ancheero]

I'm dealing with the same thing with the switch from a nasal mask to a FFM. I am working on tongue exercises to strengthen my tongue with some faint hope that I can make the nasal mask work, but it seems like I can't sleep more than an hour or so with it without my mouth blowing open and waking me up. I can't maintain a seal with my tongue for the nasal mask to work - it's so bad that it blows tape off my mouth. I'm sleeping with a cervical collar too.

I switched to an f20 FFM, and it completely solved that chipmunk cheek mouth leak issue, but I immediately had an increase in apneas. I'm going to keep on experimenting but hoping the myotherapy exercises help.