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[CPAP] Strange (to me anyway) flow rate data
#1
Question 
I am a long-time (since 2007) but intermittent CPAP user. I have just acquired a data-capable APAP machine (Remstar System One A-Flex 550p). After some experimentation, it appears that I do best on CPAP at 10L/min, although I may need to tweak the setting (advice welcome). However, on Sleepyhead I get several instances of the attached screenshot. Can anyone explain what's going on with the flow rate here?

   
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#2
Well with an AHI approaching 10, you have a lot of room for improvement. That is some pretty ragged breathing there, but nothing that can really be diagnosed or pointed to as a problem. You have an arousal (rounded respiration) followed by a series of large breaths (hyperpnea), that may have reduced CO2 enough to lead to a CA event, which is flagged as OA. This is followed by more deep respiration and a hypopnea, that borders on a CA.

So, have you ever tried the auto settings? It would be interesting to see you at 9.0 minimum and open maximum pressure. I suspect there are some appreciable flow limitations that would be visible in APAP mode, and I would guess your pressure would probably move to somewhere between 12-14 as a 95% pressure. FWIW, 10 is not doing particularly well.
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#3
(05-19-2015, 05:49 PM)gbesq1 Wrote: I am a long-time (since 2007) but intermittent CPAP user. I have just acquired a data-capable APAP machine (Remstar System One A-Flex 550p). After some experimentation, it appears that I do best on CPAP at 10L/min, although I may need to tweak the setting (advice welcome). However, on Sleepyhead I get several instances of the attached screenshot. Can anyone explain what's going on with the flow rate here?

gbesq1,
Congrats on acquiring a data capable APAP machine, but why aren't you using the Auto feature? Your AHI is too high, and the only way to advise you on tweaking settings is if you set a pressure range and watch your data for at least a week to see what is going on.

You've been an intermittent CPAP user for 8 years. What settings have you used in the past? The only way for CPAP to work is if you use it consistently. It's good that you have a new machine, and we can help you get better numbers. I also see a high leak rate. It could be your mask doesn't fit properly, or you are breathing through your mouth.

You can request the clinical manual for your machine (top of page).

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#4
Hi gbesq1,
WELCOME! to the forum.!
It's good to hear that you got a data-capable machine, CONGRATULATIONS.!
In order for CPAP therapy to work, you need to use it every time you sleep instead of intermitten usage.
Much success to you in fine tuning your CPAP therapy.
trish6hundred
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#5
(05-19-2015, 06:55 PM)Sleeprider Wrote: ......You have an arousal (rounded respiration) followed by a series of large breaths (hyperpnea), that may have reduced CO2 enough to lead to a CA event, which is flagged as OA. This is followed by more deep respiration and a hypopnea, that borders on a CA. .........

Out of my curiosity, what is it about the rounded respiration that indicates an arousal?

Best Regards,

PaytonA
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#6
Thanks so much for the replies. It really is terrific to find folks who are willing to help.

Here is my situation.

I was intermittent but no longer. I know I need CPAP and have been using it every night for several months and will continue. My 2007 Remstar recently conked out and I replaced it a week ago with the 550.

I tried APAP (8-20L/min) and got AHIs from 16 to 29 (the high ones using a nasal mask, the lower using a nasal pillow). Obviously no good. Since I was originally prescribed 8L/min CPAP with a recommendation of 10L/min if I could tolerate it (which I can), I switched to 10L/min on my new machine and got a much better (but not great) AHI. However, when I was using APAP, my median pressure was around 13.

I had a major leak excursion for an hour (total leak spiked from about 22 to 90 and then dropped back to 22) which must have resulted from me displacing my nasal pillow mask. Otherwise my leak rate appears to be OK (please tell me if I am wrong about that). I have a beard and mustache and am a side sleeper (and I change sides during the night) so a nasal pillow seems like the way to go, although I do not have and have not tried a full face mask.

Sleepyhead recorded 8 hypopnea events the hour-long leak excursion. I do not think these are reliable so my true AHI may be lower.

I have only 5 days of data which is not enough to draw conclusions. Since a constant pressure with nasal pillow (with included chin strap) has given me the best AHI, I intend to continue with that for a week or so to see how it goes. Is this the right way to go? Maybe I should do a week of, say, 11L/min constant pressure and then try a week of APAP with a 10-20 range. Any advice?

Thanks again




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#7
I think your idea of working with a fixed pressure of 10 is fine, however if you switch to APAP mode with a minimum and maximum pressure set at 10, the pressure will be the same, but the machine will record flow limitations. That may or may not be useful, but can't hurt. Many do better on fixed pressure. What Flex setting are you using?
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#8
First, congratulations for graduating to full time CPAP. And, nicely done in getting data capable and deciding to actually look at your readings. This is a great step toward taking charge of your health care. Now, you'll have the feedback needed.

I am guessing from the short fragment [not much to go on] that you are moving around a lot more than you think. suggestive of movement are: (1) awake-ness shown by breathing in and out without a pause, tied with (2) high volume breaths, (3) a space of halted breathing that is accompanied with the halt starting after inhale rather than exhale. [when you are about to make an effort to flip or change positions, you fill your lungs and then hold it while exerting.]

So, I think you are seeing the episodes of purposeful body movement, shifting.

note: Normal NREM sleep usually is signaled by inhale, exhale, pause, repeat. Check as you start going to sleep, you will see a shift from inhale, exhale, repeat to incorporating a pause. One indicator of REM sleep is the breathing is back to no pause but with shallower breathing.

Happy PAPing

QAL

p.s. In referring to your settings, you'll notice that they are listed as cm of H2O, and do not have anything to do with litres or minutes.
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#9
(05-19-2015, 05:49 PM)gbesq1 Wrote: I am a long-time (since 2007) but intermittent CPAP user. I have just acquired a data-capable APAP machine (Remstar System One A-Flex 550p). After some experimentation, it appears that I do best on CPAP at 10L/min, although I may need to tweak the setting (advice welcome). However, on Sleepyhead I get several instances of the attached screenshot. Can anyone explain what's going on with the flow rate here?

For what it's worth, the settings are in "Cm of H20" which is pressure, not L/Min which is a flow rate.

The machine generates pressure to keep your airway from collapsing, not airflow.

Terry




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#10
(05-21-2015, 07:47 AM)quiescence at last Wrote: note: Normal NREM sleep usually is signaled by inhale, exhale, pause, repeat. Check as you start going to sleep, you will see a shift from inhale, exhale, repeat to incorporating a pause. One indicator of REM sleep is the breathing is back to no pause but with shallower breathing.

That's fascinating!

Any chance you could post the flow rate chart from sleepyhead and mark off a section with REM and NREM sleep so we can see what it looks like?

Terry
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