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Lingering fatigue: trust Resmed sleep report?
#51
RE: Flow limits tweaks/lingering fatigue
Hi,
Grtchley
1_ yes, indeed, your graphs strongly suggest sleep disrupted by flow limitation, either flagged or not;
2_ your detailed 2minute_windows of your former thread, indicate you have kind of textbook-flat top -ratty atennuated inspiratory flow;
3_as your tidal curve is very compressed, comparatively low volumes, wondering If you could plot some enlarged scale (say maximum at 950) for TV, together with FR leak FL, as well as some 10minute and 2minute windows, so that we could eventually evaluate how often, if, your FL are arising you.
4_at first glance you would be having a low Sleep Efficiency (% sleep/bed time);
5_Pressures: most important to tame FL is pressure suport (PS). First of all, It would be worth trying EPR: 3 with your machine. However, after scrutinizing this blog last 3 months, i don't remember have seem cases in which FL was resolved just by raising pressures, yet this appears to be necessary. What i have seem are true overnight miracles when you move to PS of 4.0 and higher (need bilvel machine).
All the best.
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#52
RE: Flow limits tweaks/lingering fatigue
(08-16-2019, 05:40 PM)mper6794 Wrote: Hi,
Grtchley
1_ yes, indeed, your graphs strongly suggest sleep disrupted by flow limitation, either flagged or not;
2_ your detailed 2minute_windows of your former thread, indicate you have kind of textbook-flat top -ratty atennuated inspiratory flow;
3_as your tidal curve is very compressed, comparatively low volumes, wondering If you could plot some enlarged scale (say maximum at 950) for TV, together with FR leak FL, as well as some 10minute and 2minute windows, so that we could eventually evaluate how often, if, your FL are arising you.
4_at first glance you would be having a low Sleep Efficiency (% sleep/bed time);
5_Pressures: most important to tame FL is pressure suport (PS). First of all, It would be worth trying EPR: 3 with your machine. However, after scrutinizing this blog last 3 months, i don't remember have seem cases in which FL was resolved just by raising pressures, yet this appears to be necessary. What i have seem are true overnight miracles when you move to PS of 4.0 and higher (need bilvel machine).
All the best.

Thanks you mper6749!! 

I thought I'd look forward, and try your EPR:3 tweak suggestion first (before looking deeper at the details of past charts) and tweak things a little and see if it helps with flow limitations. Sure enough, it does look like it worked and is the right step. I brought the pressures up to the same amount (essentially CPAP I guess), and decided to try 7.8 on both inhale and exhale, and see how I feel and what the data says. As you can see, my AHI is still low, and I think some of the other new flags (a zero second duration RERA, and a few short CA's) will probably go away. I attached screenshots from the last three nights, and yi think the Flow Limitations do look better last night - or at least less frequent. 

Perhaps I should now continue to raise the pressures, (both) to maybe 8.6 or something, or even 9, and see if that helps the FLs, and see if my cheeks start puffing out and waking me up for a different reason, which would also disrupt sleep

Do you see see the positive difference in last night's charts? they seem less frequent. What would you suggest for tonight - adjust both pressures up further?

Thanks again for your help with this!


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#53
RE: Lingering fatigue: trust Resmed sleep report?
I merged the two threads discussing flow limitations and lingering fatigue. It is useful to keep related therapy threads together to observe how problems react to therapy changes. In this case, the use of EPR has reduced flow limitation, hypopnea and RERA at the small expense of a few CA. Tidal volume is up. This looks to be a positive direction.
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#54
RE: Lingering fatigue: trust Resmed sleep report?
(Yesterday, 10:53 AM)Sleeprider Wrote: I merged the two threads discussing flow limitations and lingering fatigue. It is useful to keep related therapy threads together to observe how problems react to therapy changes.  In this case, the use of EPR has reduced flow limitation, hypopnea and RERA at the small expense of a few CA.  Tidal volume is up.  This looks to be a positive direction.

Thanks for doing so. Sometimes it's tempting to start a new thread if one feels like it's lost course, and responses have stopped - and that's my own lack of patience and wanting to feel better soon.

Looking for exact advice on what to do next? raise pressures and keep EPR at 3? Go to CPAP mode? (which it essentially is with both pressures set to the same number.)
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#55
RE: Lingering fatigue: trust Resmed sleep report?
(08-14-2019, 09:55 PM)alexp Wrote: The mean value is the one you should look at from what I understand not the max one.

Is "mean value" same as "med value?" So my Med value should be 500? I'm 5'10
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#56
RE: Lingering fatigue: trust Resmed sleep report?
Median value, yes. There is a lot of individual variation, though. Your TV is a little low and your RR a little high and your resulting MV quite normal.

The big news is that you have the FLs licked, without ballooning your cheeks or your AHI. I’d suggest you leave your settings alone for now. Give it a week and see if you start feeling better. If you don’t, try inching the pressure up a bit, but leave EPR at 3.
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#57
RE: Lingering fatigue: trust Resmed sleep report?
(8 hours ago)Dormeo Wrote: Median value, yes. There is a lot of individual variation, though. Your TV is a little low and your RR a little high and your resulting MV quite normal.

The big news is that you have the FLs licked, without ballooning your cheeks or your AHI. I’d suggest you leave your settings alone for now. Give it a week and see if you start feeling better. If you don’t, try inching the pressure up a bit, but leave EPR at 3.

Thank you!! Do I have them "licked?" I still see them, but I'm inspired by what you're saying - what constitutes success in the case of FL events?
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#58
RE: Lingering fatigue: trust Resmed sleep report?
Hi, gcrichtley
Glad to see this your minor improvement on taming your FL's; first good signal.....however, your battle has to keep going.
Just to let you know some more things, based on my own experience:
1_there are two types of flow limitations for sensitized people like me (maybe you too): flagged and non-flagged by the machine, both can disrupt our sleep a lot, including arousals (following nightmares, mini-suffocations, etc, in my case);
2_Flagged FL are computed as numbers you can see on "details"; this should be always P95=0.0 (zero), and Max as lower as possible (say < 10). See my two atachments herein: april 16th, with AUTOSET, EPR:3.0, and August, 14th, with VAUTO PS:4.2
3_to evaluate the non-flagged FL's significance, I always have to see what they are doing to me, particularly whether or not they are waking me up. After carefuly observations and calibration of my curves (audio-recording my breaths and leg movements, touch machine button off, etc), I think I am able to pinpoint my arousals, taking into account the curves: FR, FL, TV, Leak; That's the reason I asked you to plot such curves, in ten-minutes windows to start with, above: to evaluate what your FL's, either flagged or not, are doing to you.
4_Your full night windows above, in spite of the compressed scale, appear to me still rather noisy; I would like to go througn them observing 10min and 1min windows.
GL


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#59
RE: Lingering fatigue: trust Resmed sleep report?
....say, 4_Your full night windows above, in spite of the compressed scale, appear to me still rather noisy; I would like to go througn them observing 10min and 2min windows.
GL
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#60
RE: Lingering fatigue: trust Resmed sleep report?
I was looking at the graph for 8/17/19, which looks good to me. But I agree with the idea that it can be helpful to use other ways to assess what is going on. First and foremost, does you feel more rested? Also, how do the inspiratory flow lines look -- mostly nice and round on top, or not? For that, you need to zoom all the way in and scroll. I think it is quite usual to have *some* misshapen lines; the question is what does a normal one look like?

I do also think that if 8/17/19 is the new normal, it is worth just letting things settle in for a week. That allows time for you to see whether you're feeling more rested or not. It is also generally good to give new settings some time, because some nights are inevitably better or worse than others.
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