Problem with mask and EPR

[Sleeprider]

That chart looks great. I sure would not be chasing flow limitations with those results, they are outstanding,a and comfort should be the priority.

If you have some room at bedside you might want to consider a drawer-nightstand. I keep my machine in the drawer with a 2-inch hole out the back for the tube and power connections. Absolutely dead silent. I have pics if you need. Secondly, a tube cover like the snugglehose or snuggleskins CPAP fleece tube cover is a great buy. Inexpensive and reduces noise from the tube. It makes contact with the tube much softer and more comfortable. They are generally not recommended on heated tubes, but I have always used them with no problem.

[jomama]

It sounds like neither of you think my FL are necessarily a problem, which would be music to my ears if not for the flattened inhales I see. In the third image, there's what seems to be a spontaneous arousal, though I'm not sure. What are thoughts about these images?

[sheepless]

I'll bet most of us have some flow limitations evident in the flow rate. my flow rate looks depressingly ugly most nights but I don't know what it looks like for someone wo apnea. with fl, it comes down to how many, how severe & how you're feeling. judging by the numbers you're doing great.

[jomama]

I'm no expert but fwiw:

1. I wish my leaks were as low as yours. your 2-4 is pretty much what one hopes for; peaked at less than 14, nowhere near the red line of 24. I thought I saw ffm in your profile and that made sense because your flow rate, at least at the scale shown, isn't suggestive of mouth leaking. might be worth zooming in on some leaks to see if flow is abbreviated below the zero line.

2. you may be very sensitive to flow limitations but they barely make the 95% column. as such my inclination is that while it's possible they're causing you problems, without more information I'd be inclined to look elsewhere.

the most noticeable thing I see in that screenshot is 2 mask offs. is that the problem or is it more about how you feel? awakenings suck but for context, I've been working my # of mask offs down over 3 years from a rough average of about 8 per night. still getting 3 or 4 but I now know my remaining sleep issue is something other than therapy related.

1. Glad to see the leaks not necessarily a problem. Thanks! Don't think it's mouth leaking, as I was using tape and it seemed snug all night. How do I see below the zero line? Not sure what you're looking for there...?

2. I was thinking of starting a separate therapy thread once I have more charts at different pressures, but out of curiosity, what more information would be helpful? Honestly, I don't even know if PAP therapy is doing anything for me, since my original AHI/RDI was so low to begin with. But PAP is my last chance at this point (other than looking into ENT/surgery, which I don't want to mess with, mainly because even though I have occasional mild stuffiness, which I think might be normal here in the PNW, and I have a slightly deviated septum, I have no trouble nose breathing all day and when falling asleep, so I figure it can't be that bad in there), having tried and looked into pretty much everything (sleep hygiene, blood tests, thyroid, Vitamin D, etc.).

The mask offs were 1. First large wake up of the night. Decided to pee then. 2. While trying to fall back asleep, noticed condensation in mask, and took off to try to figure out if it was rainout or what.

[jomama]

I'll bet most of us have some flow limitations evident in the flow rate. my flow rate looks depressingly ugly most nights but I don't know what it looks like for someone wo apnea. with fl, it comes down to how many, how severe & how you're feeling. judging by the numbers you're doing great.

Did you see the images in post #62? Those don't look like potentially problematic flow limitation breathing?

[Sleeprider]

When I looked at your full-night chart, I could see some minor flow limitations building until just after 2:00 with a big spike in flow rate, then the flow limits ended.  I assumed an arousal, and that is what the third screenshot shows.  Completely normal stuff, and not worth worrying about or changing settings to chase.  At this stage of your therapy, comfort is the priority, and you might even find less need to look at data. I think the fixed pressure works well for you and results in little sleep disturbance. Keep an eye on therapy breaks and why those occur, otherwise, there is nothing in this chart, except a monthly calendar, that needs fixed.
 

[sheepless]

sure but how many & how severe? there is a problem inasmuch as the resmed id's flow limitation as some x amount of reduction in flow from some y number of preceding breaths or minutes. this means if you are chronically flow limited, the machine won't recognize it. your numbers are great but if you scroll through your flow rate & see lots & lots of it, particularly followed by arousals, then there might be some basis for suspecting & targeting flow limitations.

[jomama]

When I looked at your full-night chart, I could see some minor flow limitations building until just after 2:00 with a big spike in flow rate, then the flow limits ended.  I assumed an arousal, and that is what the third screenshot shows.  Completely normal stuff, and not worth worrying about or changing settings to chase.  At this stage of your therapy, comfort is the priority, and you might even find less need to look at data. I think the fixed pressure works well for you and results in little sleep disturbance. Keep an eye on therapy breaks and why those occur, otherwise, there is nothing in this chart, except a monthly calendar, that needs fixed.
 

Hm. I'm kind of surprised to read you saying this. I've been reading so much on these boards about what looks like my issues, and you guys often recommend people move to bilevel, which is my fear (since I am really wary of spending upwards of $800 to simply try bilevel). I am kind of surprised that you don't feel those first two images above are concerning. 

Just to be clear, I am doing all of this to see if PAP therapy will help me sleep better. That's my only reason for doing it, since O2 and apneas don't seem to be a big problem with me. So, as to when you mention comfort, the truth is that what would be most comfortable would be not to use a PAP machine at all (if it's not helping me sleep better)! I really, really want to get to the point of saying with reasonable confidence, backed up by semi-scientific evidence (like I get from these charts), and the opinions of experienced users like yourself, that PAP is not going to make a difference (like it hasn't so far), and I can put it away and go back to the drawing board as to what might be causing my fitful sleep, and stop worrying that if I only gave PAP therapy enough time, and got to almost zero FL, it might help (this is what's been in my mind for a while, nagging at me, which is why I'm pushing myself to do another trial period).

But it's really hard to figure out if my FL are actually causing most of my arousals (I suspect not, from my charts). But I'm still learning, and it's hard to tell sometimes. It's also hard to tell if I'm asleep at any given time. Often, I will see an arousal and then another disturbance soon after, and the same again, and this goes along with my memory, of waking up during a dream, relaxing, nodding off, waking up from a dream again, and so on. That's almost always the second part of my sleep time. But my sleep is fitful pretty much all night long. When you say "works well for you and results in little sleep disturbance" it confuses me, because my sleep is being disturbed all night long. The question is: from what?? 

Here are a few more close-ups of a couple of arousals, and then the 3rd is what looks like it might be some sleep breathing, which looks kind of ragged, but I'm not sure it's worth worrying about treating with bilevel to normalize. In the second image, it looks like round breathing that then flattens a bit to an arousal, which leads me to think that that was an arousal caused by FL/SDB. But then I look at the first image, and those breaths don't look that bad, and then an arousal (why? that's the mystery/question!). I have lots of arousals like that, it seems. 

By the way, I am sorry if I'm being picky here and asking similar questions, but I have been spending countless hours studying the forum, and learning, and trying to solve my problems, because the chronic exhaustion I have from bad sleep has pretty much made having a productive life impossible at this point, which is very disheartening, so your patience with me, and your assessments of these images, are a huge help, and it's very appreciated.

[sheepless]

wait to see if Sleeprider disagrees but I don't see any arousals in the last 3 screenshots. can't tell what scale these graphs are; there might be some lower volume breathing but I don't think they're particularly flow limited.

[jomama]

sure but how many & how severe? there is a problem inasmuch as the resmed id's flow limitation as some x amount of reduction in flow from some y number of preceding breaths or minutes. this means if you are chronically flow limited, the machine won't recognize it. your numbers are great but if you scroll through your flow rate & see lots & lots of it, particularly followed by arousals, then there might be some basis for suspecting & targeting flow limitations.

Yeah, I see what you're saying. That's exactly what I'm trying to figure out: if I need to target FL. Because sometimes it looks like an arousal comes after some FL breathing, but many arousals seem to come out of the blue, when FL don't seem to be happening, so it's rather confounding. 

If you will, take a look at the three images above in my reply to sleeprider, and see what you think. At some point I feel like I want to post a bunch of close-ups like these, and get experienced opinions as to what might be going on in them. But one step at a time. Thank you so much for your help, by the way. I greatly appreciate it.

As a point of comparison, here is an image from a couple nights ago, this time with my FFM, and a close-up of what looks like an arousal preceded by breathing that is a bit flow limited, but maybe not that bad? I can't really tell. What can we say from these images and from those above?