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Need help with flow limits/understanding waveforms
#1
Need help with flow limits/understanding waveforms
Hello,

I've been using APAP at 10cm with an EPR of 3 for two months now and the clear airways I've been having don't seem to be subsiding. Also I can't increase the minimum pressure anymore because I already suffer from aerophagia likely due to a weak esophageal sphincter (LPR symptoms as well). Would you recommend I try a BIPAP machine so I can crank up the pressure without having aerophagia? Also, most of my waveforms look like the ones in attachment (from a good night) 1. Are these normal? Also sometimes there are obstructive events that are surrounded by similar events of a shorter duration like in attachment 2. Also, the clear airways occur right now occur without flow limitation being present in the nearby time period and are always preceded by a small leak of 1-3 (I don't know the units) like in attachment 3. Other larger leaks of around 10 units? don't seem to cause clear airways but cause a sharp breath to occur. I use a full face mask with a soft cervical collar. Could someone please help me understand what is going on and how I could possibly fix it, because I'm very uninformed and haven't gotten any benefits from APAP despite being on it for ~2 months. I don't know what aspect of this is causing my tiredness. Thanks for your time and help and sorry for the trouble.


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#2
RE: Need help with flow limits/understanding waveforms
Please post screenshots of the full night, not zoomed in, so we can see an overview of your sleep and interpret the zoomed screenshots in the context of the overall night.
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#3
RE: Need help with flow limits/understanding waveforms
Hello, thanks for the reply. Last nights data can't be viewed for some reason but here is the night before. I can sleep with min pressure 10 epr 3 sometimes without getting painful bloating which wakes me up. The data I previously posted was from late August but I was concerned about the breathing pattern when no events are occurring. Normal breathing is supposed to be sinusoidal right?


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#4
RE: Need help with flow limits/understanding waveforms
I was reading through this thread on UARS (I got it here, but don't remember who to thank!)
https://fastasleep.substack.com/p/premie...t/comments

He actually discusses mask leaks as being a cause of aerophagia...
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#5
RE: Need help with flow limits/understanding waveforms
First, kudos to cathyf for the link to Dr. Krakow's discussion of (1) unclear causes, beyond high EPAP pressures, that contribute to aerophagia and (2)  how reading and seeking  roundedness of the inspiratory wave tip is an important guideline toward--but not the be-all and end-all--for achieving sustained rest from our  best-sleep potential.

   

Looking at bb's latest "30,000 ft." view (as a novice interpreter of any zoom-level's OSCAR presentation) these observations and questions come to mind and its not clear how to consider, proceed or prioritize them:


-----The first three CA are at significantly higher pressures than the last two CA events. The last two occurred at the long time lower pressure level of the early session, but there were no CA at that pressure. Idiopathic or sleep stage variability at a critical pressure? What could it mean, miniscule sample that it is, if frequently prevalent in other sessions? Further, the center 4 to 6 min. OSCAR view shows CA- or OA-like signs below the flagging the threshold.


-----Within context of the aerophagia matter and my item above, the 3:2 CA occurrences  seem to rule out raising IPAP pressure to fight FL  given the present EPR limit of 3 cm. It looks like another need for more PS and faster (?) IPAP response to FL of the VAuto. At the  zoomed-in image scales I think I see frequent if not chronic inspiratory tip deformation. 

------The FL cluster looks like positional effects from either supine posture or chin tucking or both.

blancobonzo, I regret not being more helpful rather than needing help myself to suggest the direction you should go. Let's look forward to an expert weighing in again.
I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  

Of my 3 once-needed, helpful, and adjunctive devices I have listed, only the accelerometer remains operative (but now idle). My second CMS50I died, too, of old age and the so-so Dreem 2 needs head-positioning band repair--if, indeed, Dreem even supports use of it now.



 
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