Flow Limitations, For Her, UARS, etc.

[mper6794]

....But the sleep tech that did my titration study (and of course, we're all different) found that only at PS 6 were my RERAs eliminated. So it seems likely that in my case, at least, I'm highly sensitive to FL.

Hi, Slowriter
Apologies, I am here too, sorry....you know, UARS (and PLM's; my case in addition) is my quest! As per your thread information, I would say you are very close to ultimate get your fine-tuned PS, which I strongly suspect is going to be, indeed, close to 6.0.
I am also in this process of getting an ultimate PS, which appears is going to be 5.6, based on my best results on optimizing "Air Flow Reduction", AFR, (a lab term I saw somewhere, and I like it), in association with respiratory rate, and (EPAPmin+PS).
AFR means any kind of flow restriction, which leads to arousal/awakening/wake-ups, no matter how sublte it may be, either flagged or not.

Good Luck

[jomama]

I've been following this thread because I have lots of flow limitations and low AHI, and am experimenting with how to eliminate them by raising pressure, but that brings more CAs. I'll start my own thread asking for help/suggestions when I have more data, but regarding the issue of PS discussed in this thread, and elsewhere, my question related to that, and am curious about the OPs experience, is: when I use EPR 2, it feels okay, but when I use EPR of 3, my (Simplus) mask, often feels like it's inflating and deflating from the difference in pressures, and I find this disturbing. I'm also not sure I'm comfortable with an EPR of 3 even without that inflating deflating sensation. I can't imagine using a bipap and raising even higher. Can you speak to your experience on this matter (and anyone else, too, who has dealt with this issue)?

(Disclaimer: I have no insurance, and am doing this all on my own. I've already spent well over $1,000 (which, for me, is a heck of a lot of money) on seeing sleep doc (basically no help other than getting the CPAP prescription from him), on home sleep test, and hundreds more on CPAP machine. I don't know if I can afford to spend another $800 on a used VAUTO machine when you can't really sell these things to make your money back, and it might not even help. Also, I had a falling out with my sleep doc and can't use him anymore for another prescription for another machine, so I'd have to pay even more money to get permission from another doc (it's so patronizing...) to get another machine, which even more money. It's very frustrating, so many unknowns. Anyway, this is why I ask, as I feel like I may be headed down that road, and I'm clawing on the ground not wanting to go, because I'm so sick of wasting so much money on things that ultimately don't help me get more restful sleep (which is my goal, as AHI is low, no concern with O2). Anyway, like I said, I'll start my own thread at some point to discuss my own case, but in the meantime, I'm curious if you could speak to the issue of EPR and PS. Is EPR/PS higher than 3 absolutely necessary to reduce flow limitations, I guess is the main question...?)

[slowriter]

... I'll start my own thread at some point to discuss my own case, but in the meantime, I'm curious if you could speak to the issue of EPR and PS. Is EPR/PS higher than 3 necessary to reduce flow limitations, I guess is the main question...?

Yes, start your own thread, because a lot of this is so idiosyncratic, and it helps to see your data.

On the second question, for many people (me, OP, others on this thread and on the board), yes.

PS - I totally sympathize with you about all the uncertainty. This is difficult enough to deal with even with insurance support.

[mper6794]

_" but that brings more CAs"...not sure about this, I have not experienced CA's (the ones I recount, not Resmed's ones; very often awakness artefacts) increasing with pressure, but rather aerophagia, yes. Recounted  CA's  may do rise with PS....

_I'll start my own thread...this is good....

_curious about the OPs experience.....kindly suggest  you to scrutinize this blog, and you will see by yourself, what is the average outcomes while moving from EPR 3 to PS: 4.0 and higher....

_like it's inflating and deflating ....yes, I experienced this, however no issue with time, in my case....

_Is EPR/PS higher than 3 absolutely necessary to reduce flow limitations, I guess is the main question...?)....well, as I mentioned, unless I have missed something, I am afraid I would still have to see cases in which subject completely overcome air flow reductions (either flagged or not; the very subtle ridiculous ones), those serious ones that lead to arousal/awakenings/wake-ups. Yet, literature says there are less common cases, wherein Flow Limitations would have been worked out with EPR up to 3.0

But, you might know, " I am new duck here, trying not diving deep", and counting on more experienced folks willing to appraise this. 

Good luck

[Gideon]

I have requested a moderator to split this thread.

[jomama]

No need to split into my own thread. I'll start my own at some point. I was mainly curious as to whether the OP's new machine and protocol were helping him get more restful sleep, and it sounds like it has, which is great.

[Gideon]

I've been following this thread because I have lots of flow limitations and low AHI, and am experimenting with how to eliminate them by raising pressure, but that brings more CAs. I'll start my own thread asking for help/suggestions when I have more data, but regarding the issue of PS discussed in this thread, and elsewhere, my question related to that, and am curious about the OPs experience, is: when I use EPR 2, it feels okay, but when I use EPR of 3, my (Simplus) mask, often feels like it's inflating and deflating from the difference in pressures, and I find this disturbing. I'm also not sure I'm comfortable with an EPR of 3 even without that inflating deflating sensation. I can't imagine using a bipap and raising even higher. Can you speak to your experience on this matter (and anyone else, too, who has dealt with this issue)?

(Disclaimer: I have no insurance, and am doing this all on my own. I've already spent well over $1,000 (which, for me, is a heck of a lot of money) on seeing sleep doc (basically no help other than getting the CPAP prescription from him), on home sleep test, and hundreds more on CPAP machine. I don't know if I can afford to spend another $800 on a used VAUTO machine when you can't really sell these things to make your money back, and it might not even help. Also, I had a falling out with my sleep doc and can't use him anymore for another prescription for another machine, so I'd have to pay even more money to get permission from another doc (it's so patronizing...) to get another machine, which even more money. It's very frustrating, so many unknowns. Anyway, this is why I ask, as I feel like I may be headed down that road, and I'm clawing on the ground not wanting to go, because I'm so sick of wasting so much money on things that ultimately don't help me get more restful sleep (which is my goal, as AHI is low, no concern with O2). Anyway, like I said, I'll start my own thread at some point to discuss my own case, but in the meantime, I'm curious if you could speak to the issue of EPR and PS. Is EPR/PS higher than 3 absolutely necessary to reduce flow limitations, I guess is the main question...?)

Please post your daily charts, that will give us more info to help you with.
Increases in Pressure and pressure variance, in those that are susceptible tend to increase central apnea.  When managing central/clear/mixed apneas with anything other than a ASV (very expensive advanced CPAP/BiLevel machine) is doe by avoiding the centrals.

This means (usually) first decreasing the pressure variance from PS or EPR, not increasing it.  After this if centrals are still an issue we reduce pressure.  It is a balancing act, looking for a good compromise between obstructive and central events.  

BiLevel titration protocol calls for increasing pressure support for hypopnea, flow limitations, RERAs.  But we can work within the limits of your machine.

[jomama]

Thanks, Fred. Yes, I plan to start my own thread at some point, once I have more data. Yeah, I think it's going to be a balancing act for me in terms of pressure and EPR. Need to do some more experimenting, which will take some time, and then I'll start a thread asking for interpretations and advice. I certainly don't want to hijack this one!

I'll be keeping an eye on this thread, as I'm very curious if WakeTired is able to solve his problem with fragmented sleep (and if so, what was the thing that did it...if it was eliminating the flow limitations, or perhaps something else....). Sounds like things are a bit better since starting BPAP....

[Gideon]

Everyone is different. Some people think they are doing absolutely fine and they are not. We do help those that new as well as those that are established pros. Post your daily charts and the blurb you posted above. We can help you see what we see and if we see the same things that is awesome too.

[Bumblebee]

Hi All, new to this forum. Can someone please explain to me how you're interpreting flow limitations on the graph? Is it the tops of the inhale curve? They should be consistent and rounded?