flat topped flow rate

[car54]

I saw some unusual flat topped flow graphs that I do not recall seeing before. 

close up
   

this is what my breathing normally looks like
   

   

Any ideas on what is going on.

Thanks, car54

[car54]

Here is a picture of the whole night
   

[Sleeprider]

The flat-topped inspiratory waves are flow limitation, and you can see they are clearly higher when these events occur at 22:00 and notice your pressure is at the maximum setting. This event and one at 00:15 end in a cluster of RERA. Flow limitation can arise from upper airway restriction that may be related to nasal congestion and airway inflammation from colds or allergies. If this condition is not common for you, then a course of Flonase (Flucisone Propionate) may help. If this is a common problem, then bilevel therapy to provide more pressure support can help replace respiratory effort to overcome the flow limitation. This is of course very disruptive to sleep, and causes a significant reduction in the amount of air you can take in.

Let's start with a discussion of how frequently this occurs. Have you tried increasing the maximum pressure setting of your machine? Focus on your flow limit chart and see how often you see this much flow limit. Your median FL is 0.1, 95% at 0.40. I try to help members keep the median at 0.00 and the 95% below 0.10, and expect there will be problems and discomfort when those goals are not met.

[car54]

Sleeprider,
 Now that I know what I am looking for I do see more occasions of it.

Right now my life is in limbo. I just had a shoulder replacement and I sleep most of the time on my back. Normally I sleep on my side. I am not on any narcotics that would affect it. I am very surprised that I don't see more clusters of apneas and hypopneas.

I have lowered my pressure from 15 because  the pressure would increase in response to the flow limitations causing leakage which affects my sleep.

I would say that flow limitations are a problem for me and I have bought and tried and a vpap (aircurve) on my own but since going on medicare they will only allow a airsense . My doctor is not bothered by any of my charts(which he doesn't look at) because my numbers are good.  I am on a 13 month rent to own on the airsense with 5 months left. After that I will probably switch to the aircurve.

car54

[Sleeprider]

Well, here is hoping the shoulder heals quickly. Flow limitation can only be treated effectively with pressure support, and higher pressure is of minimal value. You are already using the full 3-cm of EPR that you have available with the Autoset. Your doctor is lazy or doesn't care, and just doesn't want to do the necessary documentation to justify bilevel. On the other hand your awareness of the problem and ability to document it in your results could make a big difference. If you still have the machine in your profile, then I would suggest you return to that and we can optimize again. Nothing says "I don't tolerate CPAP" better than returning the CPAP machine and using your own. I recommend you seriously consider the costs to you of a 13 month rental and consider simply buying out of pocket a used machine from Supplier #2 ($799) or other source for even less. I get full coverage on machines and would still decline a downgrade after using the Vauto.

[OpalRose]

car54,
Glad you clarified that... I was just about to question why your profile showed a VAuto, but your using an AutoSet.

I used to put the blame on Medicare, but I really believe that it's the Doctor's responsibility to send the proper documentation to Medicare.  Some don't want to be bothered because they feel it will be denied.  

I switched to a used VAuto in January on my own. (Borrowed from a friend).
I documented my progress and a comparison to my previous machine which was a 60 serious Apap.  
I copied charts, told my doctor that I was sleeping better, waking up less and generally had better readings.  My doc couldn't argue with the results when I saw him recently.  I told him I wasn't going back to the Auto machine, and I was counting on him to get it approved by Medicare for a new VAuto, otherwise, I'll just bypass insurance and buy a used one on my own.  
Medicare denied it 6 months ago, and just this week after doctor resubmitted another request, I received approval for a new VAuto.

I don't want to hyjack your thread, my point here is to keep hounding your doc, document your progress and print out graphs.  Don't give up on what you know will work best.

And praying for a speeding recovery with your shoulder surgery.

[SarcasticDave94]

Dr. Do Very Little strikes again. Me would replace him with a doc that cares for the patient and not the dollar.

[Sleeprider]

There is a used Vauto with 1510 hours in the Iowacity Craigslist in Washington IA, post id: 7150497110 $350.00

[staceyburke]

I just purchased from Supplier #2, I am on my 3rd night with the VAUTO. MY results are startling BETTER. GREAT experience with supplier. My machine had 285 hours (one month) usage. Paid 799 no shipping or tax charged. Highly recommended!

[Hodgebot]

Did the used Bilevel machine work out for your therapy? Curious if this was fully resolved since I have similar data/issues. I'm actually about to engage with a new sleep doctor in about 2 hours because my existing one was only concerned with the AHI number and ignored everything else I said about being really tired every day.

Cheers