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New user, have reduced AHI but flow limit is high
#1
New user, have reduced AHI but flow limit is high
Hi, this is the first time I've asked anything so hope I'm doing it right.  I started APAP 2 months ago including a month trial on APAP, the last month I've been managing my settings myself...to try and reduce the CA's which were up to 41 per night I turned off the ramp and EPR which did reduce my overall AHI and now it rarely goes over 5.

But my flow limitation is too high and the Resmed algorithm from what I've read, adjusts the pressure according to the FL to a great decree. I've got my setting on min 7.8 and max 14.4 but because the FL is so high most of the time I'm almost maxing out at the max pressure.

Any idea how to reduce the FL to be able to reduce the max pressure?
thank you in advance.
 

   
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#2
RE: New user, have reduced AHI but flow limit is high
Welcome to the forum.
You have a good idea of what is going on.

A question for you. Why do you want to decrease your flow limits? Stating that they are high I'll say is insufficient reason. What are your current symptoms? Are the sufficiently bad to require fixing them?

I haven't seen data on how bad your central apnea gets with EPRs of 1, 2, and 3.

I'm sure we can get your flow limits down via the use of EPR. Your dialog implies this. It also implies that your CAI goes unacceptably high. With a machine such as the AutoSet we look for a balance between obstructive events and central events.

To achieve this balance we utilize EPR and pressure.

A BiLevel (VAuto) brings an additional tool to the table in the form of the Trigger setting. By triggering the shift from exhale to inhale easier with more sensitivity we can somewhat reduce central apneas.

Then there is the ASV which will treat both OSA and CSA but most likely will cause flow limitations which is exactly where you are at now.
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#3
RE: New user, have reduced AHI but flow limit is high
Hi Gideon, thank you for replying to my post. My aim is to try and decrease the max pressure to try and titrate it down gradually to a reasonable max... 12-13? Of course the AHI is the priority, and how I am feeling.

To do that I have thought that because Resmed algorithms react to the degree of flow limit ( and it does seem like that is the case if you follow the FL and pressure increase throughout the night) that to try and decrease the FL will stop the triggering of high pressure.
It seemed to me with trying to learn as much as possible in such a short time that EPR was actually causing an increase in CA's and when I turned it off, I got an immediate reduction to around x2 a night from in the high 30's. Something to do with too much CO2 being blown off causing the chemo sensors to fail to trigger the brain to tell me to breath.

My symptoms before treatment were absolute total exhaustion and fatigue every day to the point of not being able to do much at all. That has improved somewhat but I am aware that years of sleep apnea doesn't necessarily go away speedily for everyone.
thanks
Layne
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#4
RE: New user, have reduced AHI but flow limit is high
Gideon I just looked back when I was on EPR 3, I had CSR for 29 minutes and 42 Central apneas, along with H and OA as well during one night.
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#5
RE: New user, have reduced AHI but flow limit is high
yeah, see if you can post chart for one of those nights. thanks.
also, you may have a PAP machine that can run in a mode called "for her". The algorithm acts more slowly, so the pressure bump ups are more gradual.

QAL
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#6
RE: New user, have reduced AHI but flow limit is high
yeah, see if you can post chart for one of those nights. thanks.
also, you may have a PAP machine that can run in a mode called "for her".  The algorithm acts more slowly, so the pressure bump ups are more gradual.

QAL

The machine I used for the trial was on "for her" but the one I purchased doesn't have that mode.

I've added the screen shot of the day with the EPR of 3 and the CSR.


   
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#7
RE: New user, have reduced AHI but flow limit is high
Thanks for the Nov chart.
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#8
RE: New user, have reduced AHI but flow limit is high
I have a dream station so I don't get that info, but it looks like most of the night on your last pic was .18 or less. It also looks like the most of the apneas were when you weren't having any restrictions. I wonder if these episodes of apnea are related to rem sleep. I thought they were supposed to be less during that period.... NEWay, am thinking maybe the max pressure is too high causing the central issues. Is this a common appearance of your flow? Maybe trying to lower you max pressure and raising your epap.
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#9
RE: New user, have reduced AHI but flow limit is high
Your pressure chart says your min pressure could be 9.
Also your ramp pressure is therapeutically way too low. The jump to therapeutic pressure could be acting as a trigger. Please turn Ramp off.

Let's see what that does. Depending on what shows we may decrease EPR.

While AHI is important, your comfort is moreso. The end goal is a good and restful night's sleep not having begging rights over your low AHI, ok.

A key is pretty much one step at a time, that way you know what works.
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#10
RE: New user, have reduced AHI but flow limit is high
(12-17-2022, 04:07 PM)Gideon Wrote: Your pressure chart says your min pressure could be 9.  
Also your ramp pressure is therapeutically way too low.  The jump to therapeutic pressure could be acting as a trigger.  Please turn Ramp off.

Let's see what that does.  Depending on what shows we may decrease EPR.

While AHI is important, your comfort is moreso.  The end goal is a good and restful night's sleep not having begging rights over your low AHI, ok.

A key is pretty much one step at a time, that way you know what works.

Thanks to all who replied,

The last screenshot was taken in Nov and the last night I had EPR on, the ramp was also turned off at the same time. 
I've been titrating both the max and min down slowly over the past few nights. 

So the suggestion of 9 for min is sort of where I'm heading , just didn't want to do anything in big steps as it is hard enough to try and figure out what is happening being totally new to all things sleep related. 

I've got the min to 8 at the moment and will increase in increments to get to 9 as suggested.

One question about max pressure....what do I take as the guide to that?  median, average or 95% ??
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