Would these flow limitations benefit from a VAuto machine?

[Zackio]

I'm trying to resolve my FL as it's affecting my quality of sleep. My restriction in breathing is so bad that I just by relaxing in the daytime I can completely shut off my breathing. So despite my stats "looking good". But when you look closely at the breathing there is much doggy looking breathes where it looks like I have a micro arousal or wake up.


My FL is better with ESR 3 but there is still an awful lot of restricted breathing patterns that I think is UARS.

I have signs of hypoxia in my blood works  which the doctor things in my sleep.

Thanks all

   
   
   

[Sleeprider]

It would help if you posted the full night chart with the left sidebar. This way we can see your respiratory statistics, settings and other information important to giving you an informed answer.

[Zackio]

Yes of cause, thanks. But In the overview, the statistics look good. But looking at the breathing to me it doesn't. 

What is really confusing me is that it doesn't seem to be scoring the flow limitations as high as it did on my previous machine. Breathing that to me looks exactly the same. I can see a similar reduction in tidal volume. There really shouldn't be any change in my flow limitations just changing machines, I know it can be a co-incidence but my breathing patterns look similar to me, as is the reduction in flow limitation.

I am getting more hyponeas on the new machine, more of my user defined flags too. I swear I feel worse too.

   

[Zackio]

I have just gone through my old machine and new machine and calculated the drops in volume.  My old machine is always spot on with it's FL calculation, whereas my new machine which was issued by my clinic is wildly out. I'm calculating is wildly out.

It hadn't occured to me that my problem may have been my machine. Not that it takes away the original problem of fixing my flow limitation but it's not going to help matters if it's not able caclulate and thus respond as it is supposed to.

[2SleepBetta]

Your charts, overall and zoomed (including movement), both look a lot like mine did with the AutoSet, which cut down my OSA, but left me with lots of FL with its max EPR of 3. My bilevel AirCurve VAuto does a much better reduction of FL with Pressure Support of just 4.0. 

While awaiting SleepRider and others' follow up, here are things you might consider. 

I don't know what machine you had. If a ResMed, then, as I understand, the Flow Limit chart reflects a report on airflow volume delivery changes as measured for a certain number of preceding inspiration waves (in a sliding window of them and lying above the 0-axis of the chart). It is my understanding that if the delivered volume is significantly but constantly limited over a stretch of time, no or few FL will be indicated. When we were kids, in the days of playing with garden hoses, we'd kink them to stop or slow water flow for play or a drink. Think of kinking the hose enough to cut flow in half continuously for a period of time; flow will be limited but invariable. But if you'd partly kink the hose enough and release the kink somewhat cyclically over time the flow rate would change continually. What I think I see in your charts is somewhat similar: a constant flow restriction along with the flaggable restrictions that result from uneven volume flow pattern that is superimposed upon your underlying constant restriction.

Accordingly, I think your FR curve shows persistent flow limiting deformation of the inspiratory half waves of the FR curve but, relative to constant restriction, few flagged flow limits.


This UARS related topic is a present focus and interest of mine. You may be interested in reading at some links on the topic as can be found in my post here: http://www.apneaboard.com/forums/Thread-...r-FR-peaks. (Keep in mind, in reading my comment here, that a guy with "a hammer in his hand" can be mistaken in seeing every problem as a "nail".) I've been slow to post more in that thread as I had promised because of unfinished and related ongoing work I had hoped--still do hope--my disappointing Dreem 2 device purchase would contribute there regarding scoring of arousals. But I plan to continue.

Good luck with finding effective treatment and better sleep.

[Zackio]

Thank you 2SleepBetta. Your interpretation matches what I feel is going on, but have been stuck in knowing what to do about it. I think my restriction is extreme in how easily it closes with just a very small relaxing of my jaw. I instantly can't breathe. So it makes sense to me that there would be a constant restriction. I have been stuck on what to do about it. As far as my clinic is concerned I am cured, but to me, far from it. 

There is very little, if any good looking breathing curves. Even on the bits where it does look better, the inspiry time is a lot longer than expiry as you've indicated, I can see that from the inspiry chart.

My previous machine is also a resmed airsense 10 but a for her modal ( I am a man but wanted to try algorithm ). On the APAP mode the algorithm should be the same from what I understand. But there are places where I can see a huge reduction in tidal volume from baseline that should be marked as 50% or 60% that it marks as sub 15%. It could well be that it's confused by the constant reduction in airflow but it seems strange that my old machine recognised it correctly. I am going to try sleeping with the other machine tonight to compare, just in case it's a coincidence.

The machine is so expensive, but it's well worth it if it would work. But as a gamble it's a little daunting. 

I'm exploring all avenues - I'm going to be speaking to some consultants.

Good information in that thread, going to do some reading. Thanks!

[Sleeprider]

The reason for asking for the full night results was to get some perspective of what we were looking at in the closeups, and even knowing what settings were in play. As you discussed above, the flow limitation metric is not the same for every individual, and is calculated against a baseline, rather than being a fixed metric. We can see very low flow limitation indicated in the statistics and still see distinctive inspiratory flattening or flow variation in the inspiratory flow. In your case, we see cardioballistic artifacts http://www.apneaboard.com/wiki/index.php...cillations along with some false-starts or hesitation in inspiration and some evidence of obstructive flow limitation. Pressure support and inspiration controls can resolve the incomplete breaths and flow limitation, resulting is a more steady pace and volume. Many of us have found the Vauto offers a much greater degree of comfort, even when AHI is low with CPAP. I'll join 2SleepBeta as another that benefits from the Vauto, but may not have a clinically significant condition that mandates the use of bilevel.

I really think bilevel should be the base therapy level. The fact of the matter is, your Airsense 10 has all the hardware and firmware of the Vauto, but the capability is disabled in firmware. So even the costs should not be more. We have to deal with the cards we're dealt and if you're in a position to obtain a Vauto, I fully endorse that as likely to give you the same benefits many of us enjoy.

[Zackio]

Thank you sleep rider. I did wonder if those bumps were cardioballistic artifacts.

That's interesting what you said about the false starts and hesitations, I hadn't realised that was happening.

There are no garentees, but it gives me confidence to try it hearing that it's helped for you both.

My FL is less with ESR 3 so it does make me feel if I could have more of a gap it could help even more.

Just the firmware is different? Damn!

[Zackio]

I managed to mess the font of my last post, I'll try again.

Thank you sleep rider. I did wonder if those bumps were cardioballistic artifacts.

That's interesting what you said about the false starts and hesitations, I hadn't realised that was happening.

There are no garentees, but it gives me confidence to try it hearing that it's helped for you both.

My FL is less with ESR 3 so it does make me feel if I could have more of a gap it could help even more.

Just the firmware is different? Damn!

[Zackio]

I slept with my old machine, scoring of the flow rates isn't much different so actually a coincidence after all.