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I tried to address the problems in the order that they appeared to need to be addressed, ie: worst problem addressed first.
I wasn't going to post (in this thread) about the flow limit and the very predominant lack of flow if I zoom in on the flow rate plot. When viewing the flow rate chart zoomed in, it's clear that something is VERY wrong-my perception of the problem was that the mask leak was a more significant problem! So, I thank you for the enlightenment and the perspective!!
I did compare the data before I changed to EPR, and my flow limiting and flow rate variations looks very much better with the EPR set to 1. I've been seeing the flow rate anomalies for awhile now, especially because I figured out how to zoom in and to use the pin function-still learning OSCAR!
My guess is that I could use a bit more pressure as well, though I hesitate to increase the pressure until I get my mask leak under control. A higher pressure just makes the leak more severe.
Honestly, I feel like crap, (or worse)....even though my AHI is reasonable (1.7)! But, looking at the zoomed in flow rate, it's clear that I have MANY near misses. I have many indications of breathing stopped (or nearly so), but not quite lasting 10 seconds.....so there is no apnea indicated on the event plot! But, I can see very small respiration peaks as the flow trace eventually goes to flatline. If two or 3 seconds was added to each of these marginal flow rate plots, I'd probably have hundreds of them per night!
A question......based on the observations above, are these flow rate restrictions causing arousal(s)?? If so, I clearly need to do the increased pressure and EPR sooner rather than later.
I will immediately increase my EPR to 3 and my pressure max up to 14 (presently it's at 13). Please advise.
That will work better. Your flow limitation is driving pressure, and even if you reduce EPAP with EPR, you should see much more stable pressure at EPR 3. Certainly, it is going to increase comfort...you have seen the light, follow it.
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The EPR may or may not reduce the amount of time between breaths, but I think it will be helpful to you whether it does or doesn't. And don't hesitate to raise your maximum; the pressure will go no higher than it "needs" to. I'll be really curious to see what your chart looks like with EPR of 3.
I don't expect the change to make me breathe more often-but, when I zoom in on the flow, I can see a pattern of extremely frequent minimal flow rate breaths leading up to a 5-7 second flatline-which is just long enough so the apnea isn't flagged. This goes on for a significant portion of the sleep session! I will post some zoomed in views, a picture is worth 1000 words! Then. the breaths resume, but they start out small and build over time to a 'normal' level. Then the cycle starts all over again!
I'm anxious to see if the data from tonight shows this pattern is continuing.
As I spot check the zoomed in data, I can also see other anomalies that (my) words can't describe, through they don't appear to be apnea(s). They generally don't repeat, but they are there. These miscellaneous anomalies look like some of the same anomalies I see when I look at my flow during times when I am laying in bed, but haven't gone to sleep or gotten up yet. I am curious whether these might be signs of an arousal that I don't realize are occurring?
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UPDATE:
I was dead tired yesterday and felt like crap. I tried to stay awake until a more 'normal' bedtime, but I dropped sometime around 9PM. I did change the CPAP settings before trying to sleep. And, I installed a larger cushion, I can normally use the 2 largest cushions as they appear ro fit me well. But, I put in the largest size cushion Resmed sells before bed (the XL-WD, extra large - wide). I changed the cushion size to see if it eliminated the mask leaks.
I have not seen the data from the sleep session yet.
However, my first impression upon waking up was that I felt much better rested than I had in a long time. My headache was gone and the constant tension I feed in the shoulders and the back of the neck was gone.
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I am not totally confident that Somnifix will help, in part, based on my snore plot-I do not snore at all!!! If my tissues in the mouth/upper throat were relaxing causing flow restriction, wouldn't I tend to snore?
I did order the Somnifix anyway.
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In my pricing search for Somnifix, I came across a large number of of silicone devices that are worn in the mouth during sleep, most were not expensive. They promise snore relief. I'm curious though, would these devices be effective in helping me to sleep better or are they to good to be true? A mechanical device that prevents the tissue in the upper throat from collapsing and blocking respiration seems like a worthy pursuit though a CPAP will likely still be needed. Thoughts?
I'm very glad to hear you had a restful night! I'll be interested to see your daily chart from last night when you have a chance to post it.
Devices to reduce snoring focus on getting the mouth to stay closed or moving the jaw forward. Flow limitations can, and often do, occur in the absence of snoring.
I understand better what you're saying about the breathing pattern. Please do post a chart with a zoomed-in view that includes three or four repetitions of the pattern.
Leak rate still to high, but much improved, there were no instances of the leak rate exceeding the capacity of the CPAP to compensate.!
Ditto the flow restrictions, much improved also!
And I slept for 8 hours, I haven't slept that long in months, maybe longer!
FYI, there was no snoring (again).
Attached data for the day before and for last night, for comparison. WHAT a difference. I woke up feeling much better, it was so significant that I noticed it when I woke up, before I even opened my eyes! And today at midday, I'm not running out of gas and wishing I could nap!
I was just looking for the irregular breathing patterns that I previously noted. They are still there, but it takes me a lot longer to find them now, as I scan across the zoomed in flow rate data. It's difficult for me to know if these are normal/typical or whether they are precursors to other problems which might show up later.
I think I need MORE EPR, which I think means a different CPAP, something capable of APAP operation. I'm curious whether the Autoset can be made APAP capable with a firmware change, or do I need to buy a new CPAP to get the full APAP capabilities?
Is there a (known but simple) hardware hack that can give me more APR without buying another CPAP?
I found it very interesting to note that not only was the flow limiting reduced, but that my Pressure was actually down from 13 to 11.8! Interesting! With less flow limiting I'd expect the Pressure to rise to higher numbers! I'm not complaining, the lower pressure numbers are probably better (health wise) and might further indicate I am on the right track.
Sorry for the questions, it's in my nature to understand rather than take the easy road and follow blindly::>
