(01-22-2024, 10:58 AM)BoxcarPete Wrote: Have you considered jumping over stateside to consult a doctor privately? I have heard plenty of stories from our neighbors to the north getting the run-around from the Canadian health system for diagnostic or elective procedures who jumped over to get some work done and most all were highly satisfied with the results and even how much it cost. Don't be intimidated by the sticker price of procedures over here, they are all inflated so that insurance can pretend to do something by slashing it back down to something halfway reasonable and then they can pat themselves on the back for all their hard work. Montreal is a big enough city close to the border so I'm sure there are some docs in upstate NY or VT who have a reasonable cash price for their Canadian friends, it's a pretty established thing in Buffalo for all the folk from Toronto. Note that this advice applies equally to ENT evaluation and/or getting a second opinion on your sleep results for a bi-level prescription, whichever method you prefer to pursue.

(01-22-2024, 05:23 PM)PeaceLoveAndPizza Wrote: Overall things look good. If anything a pressure range of 10-14 EPR 3 full-time should help with the pressure swings. If you are okay with things as they are then I would leave it alone for a bit and see how it goes.

I still think a bilevel would work better for you, but for now your current machine is providing the therapy you need, just not the comfort.

(01-22-2024, 05:23 PM)PeaceLoveAndPizza Wrote: Overall things look good. If anything a pressure range of 10-14 EPR 3 full-time should help with the pressure swings. If you are okay with things as they are then I would leave it alone for a bit and see how it goes.

I still think a bilevel would work better for you, but for now your current machine is providing the therapy you need, just not the comfort.

(01-22-2024, 08:00 PM)PeaceLoveAndPizza Wrote: I need to see a 2-3 minute zoom. Try around 04:40 and 06:20.

You will typically see a series of spikes in the flow rate and respiration rate graphs during sleep. Arousals will look like a number of equal breaths, then a decrease, followed by a recovery breath. They can be micro and macro arousals, as the small ones are barely noticeable and the big ones may bring us out of a deeper state of sleep. 

See the link in my signature “Optimising Therapy” for more information.

(01-23-2024, 05:12 PM)PeaceLoveAndPizza Wrote: The flow rate shows flow limitations at the peak. It is not enough to trigger much of an increase in the counting of FLs, but they are there. See the attached chart for how the waveforms look for different FLs. The bulk of what I see are what I call micro-arousals in that they are not enough to wake you up completely, but are enough to keep you from reaching deeper sleep stages.

Everyone differs in how things look during REM. For example, I do get some irregularities in the waveforms, but do not get more FLs. It would be worthwhile bumping up your pressure by 0.2 per night for a few days to see if it changes, or you could just set your min pressure to 9 and adjust from there up/down as needed.

The goal is not to eliminate events as it is near impossible, but to find the happy place where you get a good nights rest with the minimum pressure needed to handle most events. We want to smooth out the flow rate/respiration rate graphs as best we can. I think we are the point where making micro-adjustments will help zero in on what will work for you.