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koy23 - Flow Rate Analysis
#21
RE: Do I increase pressure till flow limit disappear?
the uf2's, occasionally low volume flow, events and near events aren't determinative to my eye but they are pretty obvious respiratory indications of what may be rousing you. the trick is to determine what's causing those anomalies. some of your awakenings are preceded by oa or near oa (shorter than 10 seconds). epap is what staves off oa. 4cmw is the lowest possible setting, not enough for most adults. in addition to trying higher min ps you should probably try higher epap (one change at a time though and I think I'd start with higher min epap). idk if vauto acts like the apap where flow limitations can trigger runaway pressure but again yours aren't high by any stretch of the imagination and besides, the way to deal with runaway pressure is to cap your max to a tolerable level. you can do that with both epap and ps.

the uf2's may be instructive because many of them are fairly evenly spaced. video would tell us if they're related to movement.

these visually minor anomalies notwithstanding, your charts are better than most so if bumps to min epap and min ps don't reduce your awakenings, you should start thinking about things other than apnea and pap that might be waking you.
  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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#22
RE: Do I increase pressure till flow limit disappear?
yeah i don't see a respiratory disturbance that is causing the hypnic jerk, and there doesn't seem to be a consistent cause to waking. I assume you feel most of the jerks, though. hey, just check on the following by asking dr. google and nih: (1) amount of caffeine, (2) deficiency of magnesium. on the caffeine, some people are wired to get a depressant effect from caffeine, so reducing or eliminating may not be effective. ADHD specifically get this response to caffeine. good luck.

QAL
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#23
RE: Do I increase pressure till flow limit disappear?
qal, that's very interesting. are you saying caffeine, like ritalin or other stimulants, produces a more calming than stimulating effect in those with adhd? insofar as both are stimulants, it makes perfect sense. I'll have to pay more attention but don't think that's been my experience though. or perception, at any rate.
  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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#24
RE: Do I increase pressure till flow limit disappear?
To answer the original question 0 flow limitation is never the target, 0 is unrealistic.

The ideal PAP titration is a balancing point. If your pressure is too low your airway will be prone to collapsing. If your pressure is too high you will be more prone to aerophagia, extra noise, venting and just overall discomfort. The key is to find the pressure or range that maximizes how open your airway is and minimizes the negative effects of high pressure. The best way to find ideal pressure range in a low pressure case like this is to use fixed pressure (make max IPAP = min EPAP + PS) and slowly raise pressure every few nights to see if your data improves. Once data stops improving or other negative effects are noted then you will have a good idea as to what the effective pressure/range should be.

Once you get a pressure dialed in then you can change focuses to PS to see if it causes any improvement. Similar to pressure too low or too high PS will cause issues and you are looking for the balancing point. Start low and titrate up slowly seeing where data and how you are feeling improves, stagnates or gets worse.

Then with pressure and PS dialed in you are pretty much finished titration but if you want you can try playing around a little bit with timing controls to see if that makes any difference.

Regarding the data you posted those spikes can be caused by numerous things. Swallows, sighs, deep breaths, twitches, arousal are just a few of the main things I have caught on camera associated with my similar spikes (I get them every 5-10 minutes). The big thing to note is that they aren't a breathing issue and the only way they are related to breathing is if there is bad breathing preceding them but RERA's are usually more noticeable with more recovery breathing rather than just the single blip breath.

Edit: When titrating pressure/PS you are looking for noticeable differences not minute ones. Once your changes are barely noticeable it is unlikely the benefits outweigh the negatives of higher pressure/PS.
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#25
flow rate under magnifying glass! not seeing the difference
Another trial at finding the elusive arousal cause:
1- it's not PLMD or limb movement, it is affected with the different PAP settings.
2- i'm disconnecting the machine each time i'm waking up.
3- I always feel i was just dreaming before waking up.

This is comparaison between changing only one paramater min IPAP 6.6 VS 7.6 
and trying to see what is happening in the airflow right before waking up.

I can't see what is happening, hope you can help me read the graphs.

6.6 IPAP:

[Image: MXdQejQ.png]

[Image: 0wIsJMM.png]

[Image: u6cdvWt.png]

[Image: V2xgGhD.png]

[Image: zmQMcgn.png]

7.6 IPAP
[Image: P7EMOs9.png]

[Image: A3nA8mc.png]

[Image: FSZMN8V.png]

[Image: qeZ5wQD.png]

[Image: BI8qlg5.png]

[Image: 5jbNvGQ.png]
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#26
RE: flow rate under magnifying glass! not seeing the difference
I haven't looked but think you have other threads. if so, better to continue your queries there so no one has to search to see your history.

I see a tendency toward central apnea in all of the screenshots, worsened by the higher min epap (looks like lower flow rate amplitude plus more waxing and waning at 7.6).

venturing a guess, I'd say you were roused mostly by leaks at lower min epap and mostly by diminishing ventilation at the higher min epap.

since you don't seem to have many obstructive events, I'd use the mode with a set epap and reduce it until you see too many obstructive events. limiting the range is often better for ca. then raise min ps in small increments. ps 1 is pretty low.

have you tried high and very high trigger setting for the ca?
  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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#27
RE: koy23 - Flow Rate Analysis
koy23 - You have another thread that also deals with your flow rate.  I will be combining both threads and will rename it, koy23 - Flow Rate Analysis.
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#28
RE: koy23 - Flow Rate Analysis
I see a few things.

Leaks although often in lower amplitude appear to be an issue and potentially causing arousal. I believe they are mouth leaks as they often stop right at arousal (you shutting mouth).

I see your machine is set to full face mask but profile says nasal mask and mouth leaks would support that. I don't know how much of a change it makes but you should adjust machine setting to match mask being used.

More than anything your breath shapes look odd and it appears some of this is because the machine is slightly out of sync with your spontaneous breathing. It looks like you are using a very high trigger sensitivity and that it is causing you issues. If that is correct lower it to high, if high lower to normal. Curious to know what you are using for cycle sensitivity as well?

On your flow rate chart change the range to manual and either -80 to 80 or -100 to 100 (whichever fits majority of breaths best). This will make it easier to interpret and compare day to day. For example your range changed from 120 to 180 in the two examples shown and it makes it tough to compare.

Lets start with that before looking further into pressures or PS.
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#29
RE: koy23 - Flow Rate Analysis
(01-07-2022, 01:25 AM)Geer1 Wrote: I see a few things.

Leaks although often in lower amplitude appear to be an issue and potentially causing arousal. I believe they are mouth leaks as they often stop right at arousal (you shutting mouth).

I see your machine is set to full face mask but profile says nasal mask and mouth leaks would support that. I don't know how much of a change it makes but you should adjust machine setting to match mask being used.

More than anything your breath shapes look odd and it appears some of this is because the machine is slightly out of sync with your spontaneous breathing. It looks like you are using a very high trigger sensitivity and that it is causing you issues. If that is correct lower it to high, if high lower to normal. Curious to know what you are using for cycle sensitivity as well?

On your flow rate chart change the range to manual and either -80 to 80 or -100 to 100 (whichever fits majority of breaths best). This will make it easier to interpret and compare day to day. For example your range changed from 120 to 180 in the two examples shown and it makes it tough to compare.

Lets start with that before looking further into pressures or PS.

Thanks, I have trigger to very high in all these screenshots and cycle to medium.
I actually feel that when it's on the 7.6 it's better, I get some kind of laryngospasms when I'm dreaming that I think wake me up, also recovering from covid I still feel my lungs tighter then normal.
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#30
RE: koy23 - Flow Rate Analysis
Have you tried lowering trigger? I can tell it is an issue from the examples posted because you can see how the mask pressure is being triggered prematurely in some cases. Some times it is even causing a double pressure peak per breath. Being out of sync like that isn't ideal and I think dropping to high will probably fix it (if still seeing I would try normal).
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