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Update: flow limitations, I:E ratio, and switch to VAuto - Printable Version

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Update: flow limitations, I:E ratio, and switch to VAuto - Dormeo - 06-29-2020

I’m writing to provide an update to this thread from January of 2019:
 
http://www.apneaboard.com/forums/Thread-I-E-ratio-and-FL-questions
 
Per recommendations from Bonjour and Sleeprider, I addressed flow limitations by switching from a ResMed Airsense 10 Autoset to a ResMed Aircurce VAuto  (self-funded) in July of 2019.  I gradually raised the pressure support, encountering aerophagia and an increase in centrals along the way.  Once PS reached 4.8, the 95% values for FLs were consistently 0.  Above 4.8, the aerophagia and centrals were a little too much for me to deal with, so I backed down to 4.8, and after about 2-3 months, the centrals settled down.
 
Given that my AHI has always been good, I suppose the big question is: how do I feel?  The answer is: definitely better.  I have a chronic pain problem that makes the second half of most nights pretty choppy, so I can’t say I feel tremendously rested during the day.  But my mood is better, my sense of energy is better, I rarely want a nap, and my cognition is better.
 
A few other observations:
 
*  I no longer think the FL problem was the dust-mite allergy.  That is still with me, but the FLs aren't. 
 
*  I’m also completely reassured about my I:E ratio.  The VAuto measures these values differently from the Airsense, and it gets them right, i.e., it is not fooled by cardiogenic oscillations (aka cardioballistic effect).  My I:E ratio is around 48-49.

*  My TV has gone up from a median of 440 to a median of 460, and MV has increased from a median of 6 to a median of 6.25.  Respiration rate is about the same.
 
*  The ResMed algorithms pick up a lot of flow limitation, but not all.
 
I’m attaching before and after pictures (note a custom Y-axis).
 
I’m so grateful to Bonjour and Sleeprider for steering me aright, and I hope this update will be helpful to other forum members who struggle with flow limitations.


RE: Update: flow limitations, I:E ratio, and switch to VAuto - Sleeprider - 06-29-2020

Looks a lot like my own experience, and I think it's fair to say, we're as good as we can be, if not picture perfect. This is the result of a careful trial and error process that brought you the best possible results. If this is what makes for better sleep then everything was done right. I say this as I personally had a really bad sleep last night, disrupted from the need to get up early for an eye procedure (laser capsulotomy to clear up a post-cataract surgery issue). Good therapy does not solve all the problems, but is makes things better, and hopefully that's good enough. Congrats!!