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flow limits, periodic breathing and unflagged events
#21
RE: flow limits, periodic breathing and unflagged events
The Resmed S10 Elite can use either of 2 tubes from Resmed. They are both inexpensive and available from any supplier or Amazon which will be faster to deliver. Resmed Slimline Tube is universal fit with 22 mm connections on both ends. You can even use a generic CPAP tube which has standard 22 mm connections. These non-heate tubes are available from $10 to $15 on Amazon. You can also upgrade to the Resmed Climate Line tube for Airsense 10 for $25.13. This upgrades your machine to heated tubing and is automatically detected.
Sleeprider
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#22
RE: flow limits, periodic breathing and unflagged events
Because I live in Colombia (I'm a US expat for 15 years), am unemployed and usually short on cash anyway, ordering a new tube from Amazon or from sources here would be impractical. In any case, I, or rather my wife, figured out a repair, simply removing the flexible tube from the cylindrical connector, cutting off an inch and reinserting. the coils on the tube allowed it to compress to enter and expand to tighten. This repair would only work if the damage was close to the end, otherwise you'd be left with a very short tube.

I do have another question based on sleeprider's post that he or someone else could answer. He mentioned a heated tube was available but doesn't my machine already have the option to provide heated air? its an option on the regular menu, not the secret clinician's menu and I try to use it because I assume it would enhance comfort but I don't notice any difference. Is this because the climate here is always the same, humid and about 70 degrees F at night? Also is there a way to turn it on permanently? Every time I turn it on, it turns off by the next night and I have to reset it.
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#23
RE: flow limits, periodic breathing and unflagged events
For hose repair, you can use electrical tape to tape over a leak.  Just make sure you keep the tape taut when applying it.

A heated hose reduces or eliminates "rain out" caused when the ambient room temperature is so much cooler than the CPAP's temp setting.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#24
RE: flow limits, periodic breathing and unflagged events
Thank you for your response. That answers most of my question. Just now I read the manual which only talks about hose heating and that, combined with your and sleeprider's post, make me think there is no heat in the machine and temperature control can only occur if there is a heated hose attached. Is this correct? Does this explain why the heat control in the menu doesn't stay on and why I don't notice any difference when I turn it on? Just for clarification, I do not have a heated hose. Or are there two potential sources of heat - in the machine and in a heated hose?
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#25
RE: flow limits, periodic breathing and unflagged events
Instead of calling it a 'heated' hose, call it an anti-condensation hose or an anti-rainout hose..
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#26
RE: flow limits, periodic breathing and unflagged events
No problem. That's what I'll call it. A very small price for all the help I'm getting here.
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#27
RE: flow limits, periodic breathing and unflagged events
I've attached the last three nights. Any suggestions welcome.

I'll give a summary so its not neccessary to go back through the thread. I was told here to use epr 3 which I didn't realized I had and to increase pressure to 10 and then to 9.4 with epr 2 from the original 9 with no epr. A leak was occurring during the first adjustment which was resolved for the second adjustment. The numbers have improved with an average ahi of 1 before adjustments and 0.5 after as well as flow limits dropping from 0.15 to 0.08. These are just back of the envelope averages based on a few nights.

I'm thinking of raising the pressure up more dramatically, to 12, and resetting epr at 3 with the idea that there's a flow limitation problem that could still improve. I'll report back.

   
   
   
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#28
RE: flow limits, periodic breathing and unflagged events
I agree with your direction of using 12/9 pressure to knock out flow limits. Your AHI results at 9.4 with EPR 2 looks very good and 95% flow limits are decent and improving. You seem to have connected the dots that flow limits affect sleep quality, and you're managing your self-titration very well. With the exception of the 8/28 session, your sleep time looks much better, and your bedtime has become more consistent.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#29
RE: flow limits, periodic breathing and unflagged events
Here's an update of the past week or so. Any suggestions or comments welcome.

I upped the pressure to 12 then 15 then 18 on the first 3 three nights and then brought it down to 10 all at epr 3. The increased pressure brought the flow limits down a little but also raised the leakage and otherwise didn't change things much so perhaps that means I don't need those higher pressures.

I've posted below my three best nights in the past month and a half of trying different pressures. My criteria was to choose the nights which had the longest period of time, more than an hour, of constantly low tidal volume. I don't know for sure what it measures or its significance but I found that it corresponds to the period of time when the flow rate is constant, that is, periods of time with no disturbances. It appears like the flow rate chart but with less noise, allowing one to look at it and in one quick look see these periods without disturbances for the whole night. I have to zoom in and scroll through the whole night using flow rate. I think that it acts as a surrogate for sleep architecture so I moved it up replacing the snoring chart which, for me, only has activity at lower pressures. The nights I chose have either a 9.4 epr 2 or 10 epr 3. At this point I'm not sure which direction to go, up or down or both.

   

   

   
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#30
RE: flow limits, periodic breathing and unflagged events
For what it's worth, the timing of the flares in TV suggests these are REM cycles.
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