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How to squash flow limitations?
#1
How to squash flow limitations?
Below are a couple of my latest graphs. 

-- Can anything be done to eliminate the flow limitations? 

-- Will this eventually help me sleep through the night without awakening so much?

Many thanks!

   

   
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#2
RE: How to squash flow limitations?
Maybe. Increase pressure support. That requires a BiLevel machine. In lieu of that increase pressure may work.

Will that improve things, maybe, or maybe you just need time
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#3
RE: How to squash flow limitations?
Insopita, I suffer from fragmented sleep so I can relate. sorry if you've addressed this elsewhere: do you have any sense of what's waking you up? have you inspected the last 2 minutes of a bunch of your sleep sessions to see if anything jumps out? do you feel you wake from a deep sleep, maybe a little confused, disoriented? do you wake gradually or abruptly? dreaming or not? are you panting, gasping, sweating, dizzy, etc.? urgent nature's call? hungry, thirsty? mask leak? pain? illnesses? medication side effects? anxiety, agitation, racing thoughts? temperature, lights, noise, pets? what do you think keeps you from rolling over and going back right back to sleep without shutting the machine down? why do you shut the machine down? what do you do between sleep sessions? etc., etc.

honestly I can only guess at some of these for myself, but there are so many possible reasons for waking up it's worth devoting some energy to narrowing the list. even keep a journal or voice recorder on your nightstand to note your observations after being roused.
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#4
RE: How to squash flow limitations?
It appears from your data that you aren't using EPR. Setting EPR to full time at 3cm will provide a little pressure support and may help.
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#5
RE: How to squash flow limitations?
(06-18-2019, 04:04 PM)Melman Wrote: It appears from your data that you aren't using EPR. Setting EPR to full time at 3cm will provide a little pressure support and may help.

Pressure is set at 7.0 fixed, with EPR at 3. It's hard to see the EPAP line at 4.0, but its there.  I agree with Fred that an increase in pressure may be the best first step.  Just increase the fixed pressure a little bit at a time, and that should show if you can eliminate FL with your current machine.
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#6
RE: How to squash flow limitations?
I heartily thank you all for the responses.  So, I will creep up from pressure of 7.  And verify that EPR is set to 3.

I will also try to identify why/what awakens me in the night.  Goodness, I've never considered that.  It always just happens.

Will return with an update somewhere down the road.  Thank You!  Rolleyes
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#7
RE: How to squash flow limitations?
Screen time is a serious impediment to good sleep, particularly if you tend to browse late into the night...…………....as I do.  Too-funny 

That was a good comprehensive list up above by sheepless.  I added screentime, but a full bladder, bowel gas and its expulsion, sore spots or 'sleeping limbs' due to constricted blood vessels, money problems or other real-world stressors, relationship problems...they can make turning over into a full awakening.
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#8
RE: How to squash flow limitations?
(06-18-2019, 05:09 PM)Insopita Wrote: I heartily thank you all for the responses.  So, I will creep up from pressure of 7.  And verify that EPR is set to 3.

I will also try to identify why/what awakens me in the night.  Goodness, I've never considered that.  It always just happens.

Will return with an update somewhere down the road.  Thank You!  Rolleyes

For me, the awakenings are due to my dog snoring. He drinks too.

[Image: attachment.php?aid=4562]
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: How to squash flow limitations?
(06-18-2019, 02:16 PM)Insopita Wrote: Below are a couple of my latest graphs. 

-- Can anything be done to eliminate the flow limitations? 

-- Will this eventually help me sleep through the night without awakening so much?

Many thanks!

As has been said, you raise the min pressure to resolve FL. There is no need for a BPAP, except in rare circumstances where it induces true CSA .
This video will help explain further
https://www.youtube.com/watch?v=-gie2dhqP2c

As will the titration guide, explain that you raise pressure.
https://www.resmed.com/us/dam/documents/...er_eng.pdf

As to waking up. We all wake up during the night. Most just go back to sleep and don't even remember it. Some fully awake. The main thing is not to fret about it. Don't toss and turn. If needed, get up and read till you become sleepy again. I would suggest you google sleep hygiene.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#10
RE: How to squash flow limitations?
"As to waking up. We all wake up during the night. Most just go back to sleep and don't even remember it. Some fully awake. The main thing is not to fret about it. Don't toss and turn. If needed, get up and read till you become sleepy again. I would suggest you google sleep hygiene."

I agree that the first thing to do is not fret and the second is to attend to our sleep hygiene. many times that'll help, particularly, I believe, with respect to apnea-conditioned awakenings. yes, we all wake up briefly but some more than others. for some of those, it may not be as simple as rolling over and going back to sleep. pain, gerd, flow limitations and other precursor events and plm are just a few examples of things that make it difficult to sleep but may require more than improved sleep hygiene.

I wake, roll over and go back to sleep dozens of times a night. IDK, but I believe this is more than 'normal' and I'd like to reduce the frequency of these arousals as I'm sure they add up. more troublesome are the 5-9 times a night I wake so abruptly and so fully that I turn the machine off to do something else for a few minutes before feeling able to go back to sleep. those definitely take their toll. in my case I attribute these arousals to periodic limb movement, which, to my knowledge, is not a sleep hygiene issue. I am not saying that's the OP's issue; just that fragmentation may be easy to discount after all the hard work of optimizing machine settings and that resolution sometimes goes beyond sleep hygiene.

so, yes, don't fret, but don't ignore either. fix sleep hygiene issues so they can be ruled out. meanwhile pay attention, look deeper, to try to determine or rule out if anything else is going on.
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