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koy23 - Flow Rate Analysis
#1
koy23 - Flow Rate Analysis
3 years I can not get a restful sleep.
Without CPAP, as soon as I drift asleep, my throat "snores" and "spasms" me awake, If I can finally sleep, I will wake up at each REM interval, usually every 90mns. That interval will increase in the last third of the night to sometimes every 20mns.
I have an Aircurve V10, and it seemed to increase the "spasms" when i fall asleep with it, till almost year 3, i set it at pressure 5 on VAUTO and slept, then got the spasm to wake me and immediately looked at the pressure and it was 5.2 : So a change of 0.2 of pressure caused me to jerk awake.
So in the past month i have set it to CPAP mode and finally i'm not jerking awake because the pressure is steady, but now with nasal mask any pressure less then 8 keeps waking me up.

Quote:P.S: Please ignore the AHI, my AHI is ALWAYS low less than 1, like i explained, i keep waking up because of changes in airflow very rapidely before a hypopnea is registered and almost never a full OSA, so i'm never able to have restricted flow for 15 seconds without jerkign awake. so forget the AHI!

To resume, when I increase pressure more than 8, I start puffing air from my taped mouth or get those chipmunk cheeks, so I switched to FFM dreamwear mask and I tried pressures 8 up to 9, but I am still waking up at REM, although with the nasal mask with sometimes pressures at 7.8 I could sleep 4 hours straight in the begining of the night, so I thought increasing the pressure will fix that.
From OSCAR, I could see mask leaks with the FFM, but also see the flow limit each 90 mns, and sometimes the flow limit is low with pressures as low as 5 and sometimes it is fluctuating higher with pressures of 8.8- 9.0 so I am confused!
Result is i randomly still wake up zombie some days and less in others.
Question:
Do i need to keep increasing the pressure till the flow limit line is flat 0 ? Does it react to my pressure increase so no matter what pressure I do it will be there? Isn't theroratically there is a pressure where there will be no more flow limit ?
Appreciate the advices.
thanks
OSCAR daily view graphs
[url=https://imgur.com/a/fdadhkk][/url]
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#2
RE: Do I increase pressure till flow limit disappear?
'jerking awake' may have nothing to do with pressure.

with vauto, min pressure support is the setting to address flow limitations. some people are more sensitive to flow limitations than others but yours are so minor I don't think it's your problem. with fixed pressure I don't see how pressure changes can be a factor. if you've experienced arousals after a bump of .2 cmw, my guess is that it's the result, not the cause of your arousal. both screenshots are really good charts but higher pressure produced more mouth leaks so why not leave it lower.

to figure out why you're awakening, make a note of when you wake. stop flow for a minute, spike a huge breath or leak, speak to a voice activated audio recorder, use a video camera... then you can scroll through your flow rate at various view scales (I suggest 10 minutes and 3 minutes) looking for clues, especially in the few minutes leading up to the awakening. you're looking for disordered breathing, events, pauses that are less than 10 seconds, big flow limitations, leaks and repetitive patterns.
  Shy   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.  
 
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#3
RE: Do I increase pressure till flow limit disappear?
I think it would be helpful to see what pattern you are concerned with. You have been a member here for quite a while, and I'm sure you know we normally use pressure support to deal with flow limitation (inspiratory flattening), rather than just pressure. Basically once obstructive apnea is resolved, EPAP should not need to be raised significantly. I think at one time you also had aerophagia and now this mouth-leak. Both of those conditions argue against pressure increases.

Sleep disruption is often unrelated to PAP therapy, and as you say, your arousals occur despite therapy. If your respiration and pressure are cruising along without a lot of disruption, and an arousal occurs, it is hard to connect that to your use of PAP. There are many causes of arousal including limb movement and even just a need to change sleep position. Happens to me all the time, and it can be hard to return to sleep. Anyway, let's get a look at what is currently going on in Oscar.
Sleeprider
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#4
RE: Do I increase pressure till flow limit disappear?
Thanks for the advice,  I will EPR on the coap mode, and maybe a marker when I wake up and repost.
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#5
RE: Do I increase pressure till flow limit disappear?
(12-12-2021, 05:08 PM)Sleeprider Wrote: I think it would be helpful to see what pattern you are concerned with. You have been a member here for quite a while, and I'm sure you know we normally use pressure support to deal with flow limitation (inspiratory flattening), rather than just pressure.  Basically once obstructive apnea is resolved, EPAP should not need to be raised significantly.  I think at one time you also had aerophagia and now this mouth-leak.  Both of those conditions argue against pressure increases.  

Sleep disruption is often unrelated to PAP therapy, and as you say, your arousals occur despite therapy.  If your respiration and pressure are cruising along without a lot of disruption, and an arousal occurs, it is hard to connect that to your use of PAP.  There are many causes of arousal including limb movement and even just a need to change sleep position. Happens to me all the time, and it can be hard to return to sleep.  Anyway, let's get a look at what is currently going on in Oscar.

Tbh I didn't know I will try EPR of 2 and see if it makes a difference with CPAP mode.
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#6
RE: Do I increase pressure till flow limit disappear?
sorry, you said v10 which I assumed was vauto. I see you have an A10 and you are right, epr is the way to manage flow limitations. I hope it helps but yours are negligible.
  Shy   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.  
 
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#7
RE: Do I increase pressure till flow limit disappear?
(12-12-2021, 08:03 PM)sheepless Wrote: sorry, you said v10 which I assumed was vauto. I see you have an A10 and you are right, epr is the way to manage flow limitations. I hope it helps but yours are negligible.

No you are right it's V10, I'm just using it on cpap mode, but I think its the same thing to put it on max epap 8 and min epap 6 with PS 2 than in cpap mode with pressure 8 and EPR 2. Right, same thing? I think in vauto mode it actually "syncs" little better to my breath cycle if that makes any sense!
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#8
RE: Do I increase pressure till flow limit disappear?
What are your pressure objectives? I'll give you settings to meet them. Fixed or variable pressure, any EPAP, any maximum. Your profile shows Airsense 10 Autoset, anot Aircurve 10 Vauto. This is part of the reason I'm asking for an Oscar chart.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#9
RE: Do I increase pressure till flow limit disappear?
I would use New Attachment below the textbox to add OSCAR. The one from Imgur is ok but attaching them places the chart right in the post. If it's the chart I looked at, there's random high leaks that's a bigger issue than flow limits.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Do I increase pressure till flow limit disappear?
"I think its the same thing to put it on max epap 8 and min epap 6 with PS 2 than in cpap mode with pressure 8 and EPR 2. Right, same thing?"

1st, I've never used my vauto in cpap mode so I didn't even know it has an epr setting (thanks, good to know!). 2nd, in vauto mode, min 8, max 8, ps 2 would be the same as cpap mode pressure 8, epr 2. 3rd, while epr seems to work like ps, I've never read any authoritative sources confirming epr is as effective as ps (not that I've looked very hard). resmed says it's a comfort feature. minor points. oh, another minor point for the sake of clarity, the apap us called airsense 10 autoset, vauto is aircurve 10 vauto. :-)

"I think in vauto mode it actually "syncs" little better to my breath cycle if that makes any sense!"

I'm confused by this. if vauto mode syncs better, why are you using cpap mode?
  Shy   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.  
 
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