Flow limit

[cyclist56]

A question I have is regarding flow limit data. Mine is below .20 95% of the time. It might spike to .30-.55 once or twice per night. Is there anythng to be concerned about with those numbers? My AHI is now in the 1-3 range consistently.

[Pugsy]

Are you sleeping well and feeling decent?
Do you have any nasal congestion issues that might account for the flow limitations?

[curems]

I'm still trying to figure out what all of these numbers mean. My FL has been .75 at it's lowest up to 3.54. I'm still in my first month of therapy. I'm not aware of any major congestion but I do have asthma (and I believe some irregular breathing patterns) and a deviated septum (although I don't believe this is major). My first follow up is a week from Tuesday. Is this something I should be questioning with my sleep doc (or with my ENT)?

[Pugsy]

My FL has been .75 at it's lowest up to 3.54. I'm still in my first month of therapy. I'm not aware of any major congestion

Your Respironics machine flags FLs differently than the ResMed machines flag FLs so don't try to compare your FL numbers to a ResMed FL number.

Sometimes nasal congestion can cause flow limitations and that's why I asked about the nose. If there is nasal congestion and a high FL count then maybe try dealing with the nasal congestion first.
If no nasal congestion then a high FL count could mean that the airway is trying to collapse and when this happens it usually means that a little more minimum pressure (when using apap mode) is needed to better hold the airway open in the first place.

To evaluate your FLs I prefer to look at the events graph to see if there is a pattern or clustering going on.
If you are seeing snores along with the FLs and any tendency to cluster then probably a little more baseline pressure is needed because those FLs and snores mean the airway is trying to collapse.
Now if more pressure creates a problem like aerophagia...and a person is sleeping well and feeling decent during the day then sometimes it is a better compromise just to let the FLs and snores happen.

[cyclist56]

Are you sleeping well and feeling decent?
Do you have any nasal congestion issues that might account for the flow limitations?

Not much nasal congestion, not feeling much better, either, despite the low AHI and getting 7 hours or so of sleep.

[Pugsy]

not feeling much better, either, despite the low AHI and getting 7 hours or so of sleep.

If you were feeling good then we might not worry about the FLs but since you aren't feeling the good numbers you might want to consider trying to reduce the FLs just to see if it makes a difference or not.
It might and it might not but worth trying.

Do you have a detailed report image handy (I don't remember seeing a report from you)? One that shows the FL graph along with the other usual graphs?

[Pugsy]

To give you an idea what a FL graph from a ResMed machine looks like when it is pretty much showing no FLs here is one of mine.
Now don't misunderstand me...this isn't necessarily the goal to strive for because sometimes FL graphs that show a lot more don't necessarily mean that we need to do something.

[curems]

My FL has been .75 at it's lowest up to 3.54. I'm still in my first month of therapy. I'm not aware of any major congestion

Your Respironics machine flags FLs differently than the ResMed machines flag FLs so don't try to compare your FL numbers to a ResMed FL number.

Sometimes nasal congestion can cause flow limitations and that's why I asked about the nose. If there is nasal congestion and a high FL count then maybe try dealing with the nasal congestion first.
If no nasal congestion then a high FL count could mean that the airway is trying to collapse and when this happens it usually means that a little more minimum pressure (when using apap mode) is needed to better hold the airway open in the first place.

To evaluate your FLs I prefer to look at the events graph to see if there is a pattern or clustering going on.
If you are seeing snores along with the FLs and any tendency to cluster then probably a little more baseline pressure is needed because those FLs and snores mean the airway is trying to collapse.
Now if more pressure creates a problem like aerophagia...and a person is sleeping well and feeling decent during the day then sometimes it is a better compromise just to let the FLs and snores happen.

Thanks again Pugsy! Your responses, both to me and to others, are helping me to understand so much more about what I'm seeing in SleepyHead. I'm not seeing any clustering or snores along with the FL but perhaps I'm reading it wrong. I've posted an image (still having erratic results after a pressure increase from 4/8 to 6/12 with the Fitlife whole face mask and this is one with the higher FL):


I will see what my doc says when I see her but I keep trying to understand better - Knowledge is Power!

[cyclist56]

not feeling much better, either, despite the low AHI and getting 7 hours or so of sleep.

If you were feeling good then we might not worry about the FLs but since you aren't feeling the good numbers you might want to consider trying to reduce the FLs just to see if it makes a difference or not.
It might and it might not but worth trying.

Do you have a detailed report image handy (I don't remember seeing a report from you)? One that shows the FL graph along with the other usual graphs?

This is from last night.

[Pugsy]

I'm not seeing any clustering or snores along with the FL but perhaps I'm reading it wrong.

You aren't reading it wrong but there's a lot of stuff being flagged there all night long and there's some clustering of OAs and the AHI is higher than we would like to see.
In general...talk to your doc about increasing that minimum pressure and the maximum as well.
The combination of everything points to sub optimal pressure...at least with this particular mask. Those pressures might work well for a different mask.

[Pugsy]

This is from last night.

That FL graph isn't very active at all. I don't think it warrants trying to reduce the activity and I seriously doubt that FLs are the culprit for your not feeling so great.
The cluster of events in the middle of the night go along with the break in therapy where the machine was turned off and then back on and I think those flagged events are very likely SWJ (Sleep/Wake/Junk).

In general the report looks quite decent.
How many wake ups do you normally have during the night? Any reason why that you know of for those wake ups?
It may be that you just need more time to see or feel the good numbers but while giving it time you might as well investigate the other usual causes of not feeling the good numbers.
The usual...
hours of sleep
fragmented sleep (many wake ups?)
Medication side effects...dig deep
other health issues
sleep hygiene ...good or bad

Oh...what was your diagnostic AHI?

[cyclist56]

This is from last night.

That FL graph isn't very active at all. I don't think it warrants trying to reduce the activity and I seriously doubt that FLs are the culprit for your not feeling so great.
The cluster of events in the middle of the night go along with the break in therapy where the machine was turned off and then back on and I think those flagged events are very likely SWJ (Sleep/Wake/Junk).

In general the report looks quite decent.
How many wake ups do you normally have during the night? Any reason why that you know of for those wake ups?
It may be that you just need more time to see or feel the good numbers but while giving it time you might as well investigate the other usual causes of not feeling the good numbers.
The usual...
hours of sleep
fragmented sleep (many wake ups?)
Medication side effects...dig deep
other health issues
sleep hygiene ...good or bad

Oh...what was your diagnostic AHI?

Thanks for the response. I started on .25mg. of klonopin in the evening a couple of weeks ago(ben on CPAP for two and a half months), and now I only wake once at night (bathroom) or sleep through the night. I do have PLMD and take paxil for depression, plus blood pressure, cholesterol meds, plus provigil in the a.m. Maybe I need more time, too, to feel the benefits of therapy. I had been diagnosed with mild apnea (AHI 7.1) so maybe I'm never going to feel a lot of benefit from therapy.

[Pugsy]

Dig deep into the side effects for your meds especially the Paxil and BP meds and Klonopin.

If you are taking Provigil (remember it isn't totally out of your system by bedtime) then I assume you are having excessive daytime sleepiness and/or maybe fatigue.
Paxil is known to cause excessive fatigue and excessive daytime sleepiness along with messing with sleep architecture in general (pretty much all those SSRI type of meds will mess with sleep architecture and/or cause insomnia). Messing with sleep architecture means that the normal stages of sleep in normal cycles and in normal % don't get met and to have the best chance at our sleep being restorative we need those normal cycles. Read up on SSRI meds and sleep in general.

BP meds also...my sister was having excessive fatigue and found out that was a side effect to her BP meds so she had her doctor change BP meds and her fatigue symptoms improved drastically.

Meds are a common culprit for not feeling so great despite the good numbers.
So are the conditions that the meds are being taken for...like depression.

Unfortunately stopping some meds isn't an option for various reasons but sometimes it helps just knowing that the meds are likely playing a part in not feeling the good numbers.

Remember...the cpap machine fixes sleep apnea issues but it can't fix problems unrelated to sleep apnea no matter how much we want it to.

So dig deep and research all the side effects of your meds...here's some info on Paxil
https://en.wikipedia.org/wiki/Paroxetine

Are you meds the sole cause...probably not but they likely play an important factor in your unwanted daytime symptoms.

somnolence 23%, insomnia 13%

Somnolence is excessive sleepiness

[curems]

I'm not seeing any clustering or snores along with the FL but perhaps I'm reading it wrong.

You aren't reading it wrong but there's a lot of stuff being flagged there all night long and there's some clustering of OAs and the AHI is higher than we would like to see.
In general...talk to your doc about increasing that minimum pressure and the maximum as well.
The combination of everything points to sub optimal pressure...at least with this particular mask. Those pressures might work well for a different mask.

It's all been pretty erratic with this mask (I don't know how to pull an image with AHI over time from SleepyHead so I'm posting that from SleepMapper). I'm much better with the Wisp but can't find anything to resolve the pressure sores I get. The guy at the mask fitting clinic tried everything he had - adjustable forehead supports to reduce the pressure, different sizes and even SleepWeaver but the only one he had that might work is the Amara View so I'm waiting for that one.



My home sleep study AHI was only 10.

[palerider]

(I don't know how to pull an image with AHI over time from SleepyHead

three pages, please read all three: https://sleep.tnet.com/resources/sleepyhead/shorganize