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Flow Limitation
#1
Flow Limitation
I have been without restorative sleep for 5 years. I started using a Resmed 10 for her in Sept 2020. I had my first experience of Cheyne Stokes respiration a week after I started using the machine. I still have episodes of CSR anywhere from 14 to 18 days a month. But what I want is an explanation of Flow Liimitation.Going through all the data I noticed that in early Nov 2021 the Flow Limitation reading changed and had many more in the 25 to 50 range and quite a number between 50 and 1. This is still continuing.
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#2
RE: Flow Limitation
Welcome to the board.  When you post a night it is much better if we get the left side with the information instead of the sessions listing.  Would you please post another one with the information on the left.

Just for information - ALL apnea is a closing of the airway.  It can be totally cut off, 80% (any percent) cut off.  The classifications are made to tell how closed off the airway is and the duration.  Flow Limits are smaller obstructions and are not as long.  But flow limits do disrupt sleep and stop us from getting into deep sleep or can cause us to wake up.

Another problem with flow limits is that the cpap machine raises the pressure to stop the flow limits from becoming larger events like a total obstruction.  

I see that you have yours set so it will not increase the pressure and the pressure is constant all night.  With it set like that you will not get the high pressure that can cause large leaks but it does not effect the flow limits.

Flow limits are treated using EPR (exhale pressure relief).  If you want to try and lessen the flow limits you need to turn on the EPR to FULL TIME. and chose 1, 2 or 3 for the EPR setting.  Also it may be better to set a min and max number and use it as a full range machine.  Something like min 7 max 10....
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Flow Limitation
Not much you can tell from the full-night view, but we could definitely see the respiratory wave and pattern with a zoom at 3-5 minutes. Not likely CSR, but there seems to be plenty of variable or periodic breathing.
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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#4
RE: Flow Limitation
Thanks for your reply. I have the machine set with EPR on fulltime but as you observed it appears to be off according to the printout. is there anyway I can test whether it is on or not? Do I have to set ramptime yes in order for the EPR to work?
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#5
RE: Flow Limitation
Take a look at the chart with the mask pressure chart showing. It shows the breath by breath changes in pressure, and it resembles the flow rate chart.  If you don't see a distinct pressure wave between EPAP and IPAP then EPR is not set correctly.  Should look like this.  This is a Resmed Autoset with EPR 2. This kind of view of your charts would really help us to understand what is going on.

[Image: attachment.php?aid=27301]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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Organize your OSCAR Charts
Attaching Files
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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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#6
RE: Flow Limitation
[attachment=50409][attachment=50409]Thanks for your reply. The screen shot I sent was from Nov 2021. I did switch to EPR on a long time ago. As I said in the reply to the other post it is set as on level 3, fulltime on my machine but is showing as off in the printout. I am attaching another record from April1 2023 that will show a night when I did have CSR.  And you can see my settings.I will change the pressure settings following your advice and see if that helps. The good news is that after waiting for years because Covid made it impossible to see a respirologist I finally got to talk to one over the phone a couple of days ago. He asked me all the questions I wanted to answer, was very receptive to my Oscar use, and has ordered an overnight oximetry monitor for Monday, a lung test and I will be booked for a polysomnagraph. Finally things may be on the move. I saw another post on the Forum about Flow Limitation and when i had a good look at mine I started to wonder what they indicated and whether they were a factor in my inability to obtain restorative sleep.
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#7
RE: Flow Limitation
[attachment=50411]

Here is the format you requested
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#8
RE: Flow Limitation
There are two pressure charts, both are shown in my image above. Look for mask pressure. Your statistics data suggest it is not on and the device settings are not visible. EPR must be set to on Full-Time and a setting of 3 selected.
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: Flow Limitation
I found out when I stopped having EPR activated. It was on on July7 2022. The next day I had a phone call to say that my duaghter had a brain tumour and was being operated on  the next day. I flew out to London UK to be with her and did not use my cpap again until July 24th when my son arrived from Canad ith a converter plug so I could run the machine. .I chwcked the 7th and the EPR was on and the wavy line was there when i checked the mask pressure. The machine continues to  that the EPR was on and until yesterday I never noticed that it was showing as off on Oscar. I did a TOTO in the hope that it would reset and I will check in the morning to see if tht worked. If it doesn't I will bring it in to the Resmed dealer and see if they can fix it. But it's absence made no difference as my sleep problems remained the same before and after the EPR stopped working. On Monday  I am picking up an overnight oximeter kit and i am hoping that the result will narrow down the search for the cause of my poor sleep. Overall I thank you and others who responded as it did lead me to the realisation that the EPR is not working . In the long run the EPR isn't really a factor as the sleep issues are the same with or without the EPR working.
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#10
RE: Flow Limitation
I am attaching a picture of last night( Friday's) sleep. I noticed that the EPR has lowered the intensity of the Flow Limitations. Sadly that didn't mean a better sleep. As you will see I had 2 bouts, first one for 42 minutes and the second 64 minutes of CSR with 125 CAs. I mostly sleep through them but wake up unrefreshed. In the past 4 years I can remember maybe 2 mornings when I woke up with a clear head and enough energy to do chores. I won't play around with the pressure settings as i will be having the sleepover sometime soon and will wait and see what that turns up. Thank you to all who have responded - I appreciate your help and it was because of your posts that I investigated the EPR settings. I will update you all once all the testing is over and the respirologist either has figured it out or is stumped.
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