EPR Settings and Flow limits

[DJCpap]

The detail is well before the events, which is why I am concerned. They happen at other times through the night. I don't know how to read the flow rate, I just know it looks wonky.

[Sleeprider]

This zoom of the flow rate graph is very early in the night, and may be early sleep transition. Respiration is variable in rate and volume with five notable spikes of inspiration that are high volume, low duration.  These appear to be reflexive jerks or gasps.  Other graphs that have been posted do not show these spikes normally occur very far past onset of sleep, and I don't think this is a common artifact of your sleep.  There are two small anomalies in the expiration curve at 00:09:30 and 00:10:00 that look like swallows to me with exhale briefly being interrupted.  There is nothing in settings we could adjust to remedy any of these artifacts and we can't definitively suggest a cause.   One characteristic of your charts that has been consistent is a relatively low tidal volume. This would suggest you may be a person of small stature?

[DJCpap]

Thanks for looking, Sleeprider. I see this at other times of the night. See attached.
I am 5'4" and overweight with a BMI of around 26. I do think spikes in tidal volume wake me up.
I understand that maybe there is nothing that can be done with settings to help this, but just want to make sure the present setting aren't hurting anything. 
ai do have diastolic dysfunction and I have trouble lying flat because it affects my breathing. I have to sleep on my back with the head of the bed raised.

[DJCpap]

I appreciate your help. I want to know what to ask my doctor about.

[DJCpap]

Hello, it's me again. I just found out that my upcoming appointment with my sleep doctor was canceled because the doctor left the practice. The other two sleep doctors are booked until July (not that they seem very good according to some reviews). Anyway, I am still struggling with getting things right. I woke up about an hour ago and I feel so tired and out of it. Once again my AHI is under 5, and I know we shouldn't be chasing numbers, but I tend to feel better when it is under 1. Also, noticing more hypopneas lately and erratic flow curves. Maybe some that are cardiogenic?
I do feel there are times in the night when I slump down, so maybe that is having some effect. Also, my apnea is much worse in REM and I know I have been dreaming a lot lately. Very vivid dreams.

[Sleeprider]

Your tidal volume is appropriate for an individual 5'-4". Spikes in flow are normally the result of arousal, not the other way around. You have apparently spontaneous arousals, and your most recent chart shows one at 05:48:15. I don't see much in the way of cardiogenic artifacts here. "Spontaneous" means these do not seem to arise out of respiratory events or stress and is external to CPAP treatment. If these arousals are disrupting your sleep to a significant extent, they may be worth discussing with the doctor. Some arousals are normal, and it's important to realize that it is unlikely we can eliminate them through any changes in the CPAP therapy, however there may be other alternatives you can try such as medications, improved sleeping conditions or mattress, sleep hygiene etc. It's kind of hard to narrow down, and will take some time and effort to learn what works best. When therapy is good, focus on what is working vs what is not working when events or sleep disruptions increase.

[DJCpap]

Thanks, Sleeprider.
I would like to get my apneas down. I had two other screen shots of weird flow rates but I have gone over my posting amount. 
I am wondering if it is just my position? I have to sleep on my back with the head of my bed raised. When I sleep flat on my side (left), I have trouble breathing due to a heart issue. Sometimes in the position I am in now, I slump down.

[Sleeprider]

The obstructive apnea and flow limits can come from poor airway alignment. We often refer to it as "chin-tucking". There are a couple wikis worth your time:
Positional Apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

You don't have the worst positional problem we have ever seen, but many members have used a soft cervical collar or modified their sleep position to improve results. You might find it resolves all of your remaining issues. If you're already using a soft collar, you may need to tweak the fit or size.

[DJCpap]

Thank you. I ordered a collar in the past and had to return because it was too high, but never tried another.
I do have a small airway and my jaw is quite recessed. A long history of difficulty breathing through my nose.
I guess I will try another collar.
I wish I didn't have to sleep on my back. Side sleeping would help a lot if I didn't have so much lung congestion from the blood rushing up to my heart. Maybe someday.
I will try the collar and maybe play around with the height of the top of my bed.

[DJCpap]

Also, just listened to this podcast on AHI:
https://aasm.org/professional-developmen...p-podcast/
Very good! They discuss the shortcomings of using AHI solely in sleep apnea diagnosis and management. Worth a listen.