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My wife has always had good AHI numbers and most of the time they are below 1.0. Most of the time most of here events are always central apneas. Her main problem seems to be her leaks. She has been using the Resmed N30i and she complains that when she rolls over in bed the mask keeps moving off her nose. But she also seems to have a lot of flow limitations. I hope someone can take a look at her charts and see if we need to make some changes on her therapy or just need to find a better mask for her.
Flow limits are mostly negligible in these charts with 95% flow limit at zero, however there are strong spikes on individual breaths, and we might want to zoom in to see why that is happening. AHI is excellent, and we don't see events or inspiratory/expiratory flow times that suggest flow limits. I think if you zoom in on the flow limit spikes, you might see a few low-volume breaths that approach hypopnea. In terms of changes, the minimum pressure for EPR 3 should be 7.0 cm to provide consistent EPR. That should not be a difficult change as her median pressure is a bit above that. I don't think the mask is a big problem as the leak rate seems low. If she is using a small nasal pillow, have her try a medium for better flow.
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I have posted a few charts. 2 are from back in September that better reflects a normal night for her in which I had her EPR set to 1. Then I turned EPR up to 3 hoping that would help her with the flow limitations. I also told her to tighten her mask a little tighter to see if that would help with leaks which has dropped her leak rate a little. The third chart is a zoomed in shot of her flow rate during some flow limitation spikes. If I raise her Minimum to 7 wouldn't that put her into a fixed rate pressure with EPR at 3? Her biggest complaint is feeling very tired during the day. She saw a new sleep doctor recently who wants her to have another sleep study done. Her first one was a home sleep test in which he says he doesn't trust them.
