+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: managing flow limit issues for a newish user? (/Thread-managing-flow-limit-issues-for-a-newish-user)
managing flow limit issues for a newish user? - ja989 - 09-16-2023
Hello all, first post here
Some background for context...
I'm relatively new to CPAP. I was diagnosed with severe obstructive sleep apnoea (AHI 120.3) 10 months ago. I started CPAP therapy immediately and noticed my AHI went straight down to less than 3 from the very first night on the trial machine (Resmed Autoset 10), on the very first night using my personal machine (F&P Sleepstyle Auto) I scored 11, initially I attributed that to the sensawake feature being too aggressive, so that I turned off after that night and haven't had such a high score since then.
Throughout the day I noticed a big improvement almost straight away in staying alert, and not being chronically fatigued and lethargic like I was before my diagnosis. However the first thing in the morning I often feel like crap, like my quality of sleep hasn't improved as much as I would have liked. and I often find it difficult getting out of bed. However once I'm up I feel much better.
I had a bad experience with the clinic that I was referred to and did my sleep study. Initially things were going well. I noticed that the machine they sold were priced a considerably higher than what I could get elsewhere for the same machine (like over A$1000 more). I called the clinic and was advised over the phone I could buy a machine from a third party and advise them the serial number, however on my next appointment after I had already bought my machine I was told this was not the case and I could only buy or rent a machine through them. They cut me off after that with an email saying I had requested to terminate care, and they were handing me back to my GP. I called both my GP and the clinic and tell them I hadn't voluntarily terminate care to cover myself as it looked like I was abandoning CPAP therapy, which wasn't the case at all. The clinic said they should be able to monitor my third party machine and wasn't sure why I was told overwise on my appointment I gave them the serial number and they said they will reinstate care, but haven't heard back since so I have to assume no one apart from myself is monitoring my CPAP therapy. Initially my pressure settings were 4-20 cmH2O, but after month I increased the minimum to 8 cmH2O which yielded better results.
Now my question...
Initially I was focused on my AHI, and assumed my low numbers meant I was getting a good night sleep, however the initial morning poor sleep feeling has persisted. After lurking here a few days I've learnt that flow limits impact sleep quality, after taking another look at my stats I noticed every night I had quite a few FL events spread out throughout the night, averaging just under 5 p/h. In the previous few days I have changed the pressure settings to 8-14 cmH2O and increased EPR from 2 to 3 cmH2O. but last night I still had FL events throughout the night, lower than average, but a higher AHI than average also. Any tips on how to manage my FL events.
Attachment 1: Overall stats last night
Attachment 2: Zoom in of apnoea and flow limit events
Attachment 3: Overall summary of statistics
RE: managing flow limit issues for a newish user? - staceyburke - 09-16-2023
You are having some positional apnea. You can see positional apnea where either H or Oa events are clustered together. There are not a huge amount but getting rid of as many as you can will lower your AHI.
Positional apnea can NOT be controlled by pressure changes. You have to find out what position you are getting into and cutting off your own airway. Have you changed your sleep position? Sleeping on your back? Using more (or new) pillows? These things can cause positional apnea by chin dropping to your sternum and cutting your airway. Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar. I have a link to collars in my signature at the bottom of the page. It shows people who are not wearing a collar and the SAME person wearing a collar. There is a huge difference between the two.
RE: managing flow limit issues for a newish user? - ja989 - 09-17-2023
Thank you for your reply,
I normally sleep with about two pillows, a habit from pre diagnosis when I used to suffer from acid reflux. I suspect this angles my neck in such a way that interrupts air flow into my oesophagus. I tried with one pillow last night to reduce the elevation of my head, I had similar results to the previous night as far as AHI and Flow Limit events go. I have tried side sleeping but I invariably always end up on my back at some stage. I also suspect i move around quite a bit in my sleep also. I have bought a soft collar earlier today from Amazon so I'll give that a try when it arrives.