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Help with understanding weird flow rate moments throughout the night
#1
Help with understanding weird flow rate moments throughout the night
I've been on bilevel for several months as my sleep study result showed an AHI of around 25 (only hypopneas) and RDI of 35. an EPAP of 4 didn't give any obstructive apneas and an IPAP of 10 seemed to mostly resolve all hypopneas and flow limitation. I settled on min EPAP of 4 and max IPAP of 12 with PS of 6 to give the machine some wiggle room to increase pressure if needed. I'm definitely feeling better, but I'm still occasionally having headaches when waking up and still have moments of sleepiness, so I think there is still room for improvement. My AHI is pretty much 0 every night and flow limitation 95% is most nights at 0. When looking in OSCAR, I'm seeing many what I would call weird moments throughout the entire night where there are weird spikes in flow rate. See attached screenshots of last night, overview of night, some of my normal breathing and some of those moments. I counted at least 30 of these kind of moments last night. Screenshot 10 is a bonus screenshot which I noticed but is something different than what I really wanted to post about, some odd waves in flow rate.

What is happening there? Is that normal? Are those arousals? Any advise?


I can't seem to figure out how to upload more than 3 attachments in a post  Thinking-about


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#2
RE: Help with understanding weird flow rate moments throughout the night
But when I add as reply it seems to add them to my first post?


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#3
RE: Help with understanding weird flow rate moments throughout the night
I see I forgot to upload a screenshot showing the entire night


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#4
RE: Help with understanding weird flow rate moments throughout the night
Any help would be greatly appreciated  Big Grin
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#5
RE: Help with understanding weird flow rate moments throughout the night
I would try reducing the Trigger setting based on the sharp waveform of your flow pattern.   The optimum form is a rounding of the peaks.

The headaches could be caused from the FFM headgear being worn too low and pressing on the nerves in the back of the neck.  Try adjusting the top strap until there is no mask tension change as you tilt your head back to forward. You might be able to reduce the tension, since it is equal at all head positions.
- Red
Crimson Nape
Apnea Board Moderator
Project Manager for OSCAR - Open Source CPAP Analysis Reporter
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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: Help with understanding weird flow rate moments throughout the night
Thanks. I actually set it to medium for a night about a week ago as I was trying out some different settings, but then I got a ton of central apneas (ahi jumped to 10 with only ca’s). Should I give high a try to see what happens?
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#7
RE: Help with understanding weird flow rate moments throughout the night
If myself, I'd increase minimum EPAP from 4 to 6 to get more base air into the mask. I'd be starved for air.

Next I would drop PS to 5 then 4 depending on results.

Finally, I think Ti Max of 4 is a bit long so I'd reduce it to between 2 and 3.

Is there a lung condition you're dealing with not mentioned? Above except EPAP Min is being set more like you want ventilator actions, and the VAuto isn't this.

Edit: your CA increase was likely the PS being higher. It was flushing CO2 from your lungs, taking away the breath signal of CO2 building up.
Mask Primer

Positional Apnea

Attach OSCAR, etc.

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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#8
RE: Help with understanding weird flow rate moments throughout the night
Drop it to High and test it. Seeing no Hypopneas and OAs, I would consider dropping your pressure until they appear, then bump it up by 1cm.

I don't know if this will help, but the method I used was to increase the EPAP pressure until the Hypopneas and OAs were eliminated or severely reduced. I then increased the PS until a rounded flow pattern was obtained. Afterward, I increased the Trigger sensitivity to eliminate/reduce any CAs.
- Red
Crimson Nape
Apnea Board Moderator
Project Manager for OSCAR - Open Source CPAP Analysis Reporter
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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: Help with understanding weird flow rate moments throughout the night
No lung condition. I just saw in titration guides to increase EPAP until OAs were gone and raise IPAP until hypopneas and flow limitation were gone, but to also not really go above a pressure support of 6. I’ll raise min EPAP to 5 tonight, drop PS to 5 and set trigger to high and see what happens.

I only changed timax from 2 to 4 as it was constantly cutting of my inhales while I was still awake. Once I fall asleep, my median ti is 1.6 and 95% ti is around 2.5. Is it a bad thing to keep it at 4?

Thanks for the help so far!
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#10
RE: Help with understanding weird flow rate moments throughout the night
Maybe not, it's your choice to try less or not there.
Mask Primer

Positional Apnea

Attach OSCAR, etc.

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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