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Fixing Flow Limits - esleepie - 02-23-2024
I've been on CPAP for almost a year now. Settings had been working well and my AHI has remained pretty steady at between 0 and 1.7 at CPAP 9.4, no EPR. Lately though, I've been waking up groggy and feeling sluggish throughout the day.
Looking at my OSCAR data, the only thing I see is that maybe flow limits could be causing this sluggishness. I'm wondering what suggestions you all might have and how might I best go about making adjustments.
TIA!
RE: Fixing Flow Limits - SarcasticDave94 - 02-23-2024
I would try the AutoSet mode, Min pressure 7 to 8, Max between 12-15, and EPR 3 full time. With the AutoSet, EPR is the key to maximize therapy regarding flow limits.
RE: Fixing Flow Limits - esleepie - 02-23-2024
Thanks Dave.
Forgive me for not providing background - I started CPAP therapy on APAP, 8-14, EPR 3. I found that higher pressures caused CAs but lower pressures allowed too many OAs. The amount of apneas I would have caused the machine to always run up to whatever max was set and strings of CAs ensued. The machine would interpret these strings as OAs and keep the pressure high. With help from Opal Rose, I titrated to CPAP, 9.4, no EPR. This has worked for me for a good while, but now the flow limits are causing problems (possibly). So I am hesitant to return back to my original settings.
It sounds like I need to re-incorporate EPR and I am wondering if maybe there is a slight tweak to my settings that could be tried to keep EPAP at, near or average of 9.4?
RE: Fixing Flow Limits - Gideon - 02-23-2024
set EPR=2, Fulltime
based on results we may want to adjust pressure.
no other changes
RE: Fixing Flow Limits - OpalRose - 02-23-2024
Can you tolerate moving to a pressure of 10.4 with EPR 1? This will give you the Epap needed to keep Obstructives down. We'll have to see how FL respond.
RE: Fixing Flow Limits - esleepie - 02-23-2024
Thanks Gideon and Opal.
I wasn't sure if something along these lines would work, so I appreciate the input. I think I will combine both of your input and start with making changes in small increments - going to try 10, EPR 1 and see what happens.
RE: Fixing Flow Limits - Sleeprider - 02-23-2024
We generally treat flow limits with EPR unless it causes more CA events. It's the best tool we have, however sometimes we need to increase minimum pressure to compensate for the pressure EPR subtracts from CPAP pressure. All three of your charts show clusters of high flow limitation with relatively clear periods between them. That is positional or sleep stage related. Almost all of your events are correlated to those periods of higher flow limitation. With fixed CPAP pressure at 9.4, I think you should add EPR, but also move to Autoset mode with a minimum pressure of 9.0 and maximum pressure of 10 for EPR 1, 11 for EPR 2 and 12 for EPR 3. In other words, offset your use of EPR with higher auto-pressure to compensate.
RE: Fixing Flow Limits - esleepie - 02-23-2024
Understood. Thank you, Sleeprider!
And yes, these periods and most of my apneas are during REM sleep. They tend to wake me slightly and ruin what would otherwise be a good nights rest.
RE: Fixing Flow Limits - SarcasticDave94 - 02-23-2024
FWIW the Centrals were very likely during your introduction to CPAP, APAP, etc. Those Centrals you were avoiding were treatment emergent Central Apnea, and for most users would have diminished in about 3 months time.
RE: Fixing Flow Limits - esleepie - 02-23-2024
That's quite probable but without all the adjusting, I don't know if I would've stuck with therapy. Tinkering and fine-tuning gave me hope that I would get it "just-right". Now, after 225 days on fixed rate of 9.4 and an overall average AHI of 1.03, I find myself still sleepy and wanting to tinker again.