[Treatment] Managing flow limitations

[Sleepster]

Did not have aerophagia which is a pleasant surprise given past attempts at higher pressure.

I'm going to try these settings again tonight.

I agree. You want to be careful that you don't induce aerophagia.

[fishfinderG]

Setting my pressure at Min=7.6, Max=9.2, and EPR=3 does seem to have helped quite a bit with the flow limitations.  I'm now mostly seeing CAs with a few OAs or Hypopneas.  

I tried increasing my Min pressure a little more to get ahead of the OAs and ran into aerophagia so I backed that off.  I guess I'll try a full week or two at these settings to see if I have enough quality sleep to start feeling better.


   

[OpalRose]

That looks really good! But remember that 1 night doesn't make a trend. Stick with these settings for awhile and see how you feel.

If CA's go up, you can always lower EPR.

[fishfinderG]

I've been waking up around 5:20AM most days so I bought blackout curtains to see if it was sunrise.  Still waking up earlier than desired and not feeling well rested.

Some nights I have no significant flow limitations.  Other nights I'm still having clustered flow limits with some RERAs.  Is there any good way to figure out what's causing this other than getting a video camera to make sure it's not positional?


   



And here's a zoom into right before I woke up in the middle of the night.  This happens around 1/2 of the time.  Not seeing anything obvious here other than a long (false?) CA where I took a real deep breath and then a few minutes later had a RERA.



   

[Crimson Nape]

It appears that your flow limitation is driving up your pressure. You might be sensitive to the pressure change. Your profile lists a 7-8 range, but the OSCAR report shows a 7-9. Have you considered setting the pressure to a static 8 cm, still keeping an EPR of 3, and seeing if you feel any better?

- Red

[fishfinderG]

Ah, I didn't update my profile pressure text after all the advice earlier in this thread.

I used to be at a static pressure but around 7-7.6 and that left me with a lot of flow limitations.  I can try moving it higher at a static value to see if that helps or if I get too much aerophagia.

[Geer1]

I would try to figure out if you find fixed pressure or a pressure range seems to give you better results then I would try slowly increasing pressure to see if it helps. If no obvious improvement come back to lower pressure.

[fishfinderG]

My AHI continues to be very low (.2-1) but I'm still having a lot of nights where I don't feel well rested.  One thing that I've noticed that I wanted feedback on is a waxing/waning pattern in some of my breathing.  Does this indicate that I should change settings, or is it not a concern?

   



And here's the whole night showing flow limitations persist, although they are better than when I was at a lower pressure last year.  If I raise the min pressure past 8 I have aerophagia even with EPR3.
   


I should also note that for the last 4 months or so I've been mouth taping. My wife's sleep was being disturbed by my lip flutters. Those have stopped with the taping.

[Gideon]

IMHO Not a concern. I think you are dancing on the edge of having CO2 induced central apnea, often called Treatment Emergent Central Apnea. This means to keep a casual eye on it at this time. It should dimish over time if this is the cause.

[fishfinderG]

I've been experimenting lately with higher pressures to see if I can improve my sleep quality without experiencing excessive aerophagia.  I've been trying pressures more in the 9-12 range and EPR=0/1/2/3 with mixed success. At lower pressures I see a lot of spikes in my flow rate and video of me sleeping shows lots of tossing and turning.  I had my iron checked and it was fine so I don't think it's PLM.

Last night I tried the n20 Airtouch to see how I liked it compared to the Dreamware Nasal Cushion.  The n20 had small regular leaks, which I don't get with the dreamware, but it also stayed in place a little better and I don't think I woke up at all from the mask shifting out of alignment like I sometimes do with the Dreamware.

I'm curious if this data gives any ideas for where to take my settings or treatment from here?  My flow limitation at these pressures and with this mask are more clustered than what I've seen historically at lower pressures.  I'm taking that as a good thing since it means that I can try to understand what is different during the time when I see the clusters. 

It seems like the flow limitation is happening mostly during REM?  I want to look at increasing EPR from 1 to 2 or 3 to see if that helps but then I would need to bump up my pressure even further and higher pressures are so noisy and sometimes give me aerophagia.  Does this data suggest that I should keep trying higher pressure so I can increase EPR without losing airway support?

Here's the whole night.

   



Zoomed into flow limitation cluster which looks like REM?