Can someone help me with these flow rates?

[Sleeprider]

I agree with ajack that the events became clearly obstructive at lower pressure and higher minimum pressure is going to be needed.  There is some pronounced flow limitation in these charts, and that can be very disruptive.  Your pressure is at 10.8 /8.93 during this sequence. The inhales all start off good and drop quickly to near-zero. This is making your inspiratory time much longer than expiratory time, and more importantly, you are WORKING hard to inhale, which causes all kinds of stress.  

[emos12]

Thanks for the replies ajack and sleeprider really appreciate it!

So for now I will increase the pressure per 1cm at a night( I am used to pressures ranged 9-12) until the apneas are gone and I am just dealing with the flow limitation. 

One thing I really do not understand still... is the morphoogy of my flow limitation. I get that it is really disruptive and most likely the reason I am so tired but it seems that almost every night I have it and the shape's are so incoherent and chaotic that I just can't make sense of it. More importantly how do we tackle it? Just like we are eliminating the apnea/hypoapnea's, so by increasing pressure?

[Sleeprider]

I was going to leave this until later, but the best solution for flow limitation like yours is BiPAP. Your OA is reasonably controlled at 9-10 cm, but to kill hypopnea and flow limits, you leave the EPAP here and add pressure support. That propels your inspiration to the peak, then lets you exhale. With CPAP, you only get one tool, pressure. With BiPAP, or even the Resmed Airsense 10 you get two pressures. If you optimize your CPAP to deal with the hypopnea and flow limits, then find the pressure "uncomfortable or intolerable", that is the criteria for medical approval of bilevel under most insurance policies.

BTW, I don't see a line for CA in the chart above. Make sure the event flags are selected in the pull-down located at the bottom-left of the detail charts.

[emos12]

Thanks for the advice.

Does C-flex not have the same function as EPR that the Airsense has? Thats what you mean right? I can feel the epap is lower when I exhale then the inhale. However if I would go to higher pressures it can be difficult to breath out

[ajack]

you will get use to the high pressure, I bounced around 20 when I was on cpap. it won't be long before you are waking up, wondering if the machine is still on.
you also don't try to breathe out, you just let it happen, you really are getting enough air. your lungs don't completely empty with cpap, it is one of the reasons they use it in some cases.

this video will help you get your head around flow limits
https://www.youtube.com/watch?v=-gie2dhqP2c

[AshSF]

I would go with a aflex on setting 3 in your case to see if it helps matters a bit. It drops exhale pressure by upto 2cm. This will allow you as much latitude as possible with your machine. This is roughly equivalent to a bilevel with pressure support of 2.

The Airsense 10 can provide a pressure support of 3cm with epr setting of 3.

A bilevel from either of these vendors can provide much higher levels of pressure support. And as sleep rider has said, you would need PS to smoothen your waveforms. We just don’t know how much PS.

[emos12]

Ajack - Alright 20 sounds pretty high to get used too ! but I am already getting used to 14ish so guess it is possible ! 

What do you mean with :

"you also don't try to breathe out, you just let it happen, you really are getting enough air. your lungs don't completely empty with cpap, it is one of the reasons they use it in some cases."

This is actually something I am really worried about. I also have shortness of breath during the day and have breath very loudly and have a exhale almost like a sigh. Went to the pulmnologist and he said my lungs were all fine checked for astmha, allergies and hyperventilation test. I thought maybe because I am so short of breath during the day I am also breathing like that during the night and maybe it mimics apnea or something i dont know 

AshSF 

Thanks for the advice, its clear for me now that it functions as some sort of pressure support. For know I will try to adjust the pressures with the dreamstation and post my results here. Hopefully it will soothen the respiratory limitations and if not then next step would be BIPAP.

[Walla Walla]

I'm in the Bipap camp here. If you have trouble breathing the Bipap will make it easier to exhale due to the ability to increase the pressure support. I think what ajack meant was you never completely empty your lungs. Everyone always has some air that remains in your lungs even without CPAP. When you exhale with CPAP the pressure is equalized so though it might not feel like it, air is coming out of your lungs. With BiPap the larger change of pressure assists your lungs to get more air out.

[Madcat207]

you will get use to the high pressure, I bounced around 20 when I was on cpap. it won't be long before you are waking up, wondering if the machine is still on.
you also don't try to breathe out, you just let it happen, you really are getting enough air. your lungs don't completely empty with cpap, it is one of the reasons they use it in some cases.

this video will help you get your head around flow limits
https://www.youtube.com/watch?v=-gie2dhqP2c

The part in bold is very true.  When starting out on my machine, there were at least two nights i woke up, didn't realize i was adapted to the pressure, and turned OFF my machine thinking it had failed (then it felt like a vacuum ironically). Now if i wake up enough to wonder, i just remind myself of how hard it is to breath with the machine off, and that if i feel ok, it is on and its just me..

[emos12]

Thanks everyone for the replies and insights ! 

These are my results from yesterday, As you can see the AHI is controlled but I keep having these wave forms which I assume are flow limitations. Most importantly, I feel like crap still. should I bump up the pressure to 14-15?

If you need anymore info please let me know as I am very determined to make this work.