Are my flow limitations cause for concern? (PLEASE reply!)

I'm still having symptoms of sleep apnea/sleep fragmentation despite a low nightly AHI. I wonder if UARS could be at play, but so far haven't seen anything in the data suggesting it. Should I be worried about flow limitations? The chart is pretty busy every night, but I don't know whether or not it looks "normal". Are my flow limitations suggestive of UARS?

Since it would appear that you have Central (or possibly mixed) sleep apnea, you should probably be on BiPAP. Also, since you're almost at machine capacity, I suggest that you need a BiPAP in case you have to go higher.

However, before you try that, make sure that you really need such high pressures. Try lowering your pressure and see what happens. Sometimes (not always), Central Events are cause by very high pressure. You need to rule that out given that your pressure is so high.

D.H. wrote: ↑

Wed Apr 25, 2018 3:38 pm

Since it would appear that you have Central (or possibly mixed) sleep apnea, you should probably be on BiPAP. Also, since you're almost at machine capacity, I suggest that you need a BiPAP in case you have to go higher.

However, before you try that, make sure that you really need such high pressures. Try lowering your pressure and see what happens. Sometimes (not always), Central Events are cause by very high pressure. You need to rule that out given that your pressure is so high.

The problem with this is that every one of my centrals is SWJ. They are all post-spontaneous arousal, and aren't disturbing my sleep. The fact that I'm waking up so often leads me to suspect UARS, but there's no way of knowing for sure. Various lower pressures never worked out for me so I set it to 20 cmH2O and pray that it's handling all my breathing problems and that I feel bad because of depression or something.

I suggest you wait for (or PM) Pugsy's opinion rather than DH's...

DankShroud wrote: ↑

Wed Apr 25, 2018 4:39 pm

. . .
The problem with this is that every one of my centrals is SWJ. They are all post-spontaneous arousal, and aren't disturbing my sleep. The fact that I'm waking up so often leads me to suspect UARS, but there's no way of knowing for sure. Various lower pressures never worked out for me so I set it to 20 cmH2O and pray that it's handling all my breathing problems and that I feel bad because of depression or something.

I think that you'll need a Bi-PAP machine so you can go above twenty, even if you use a constant pressure.

I have already exhausted my replies to this person. I ran out of ideas and the ones I had he didn't care for.

As for these latest reports...I have no idea if they (the FLs) are responsible for OP's problems or not.
And he has already been told that for a UARS definitive diagnosis that a sleep study with Pes device is needed.
We cannot tell or spot UARS on these reports.

If you are correct in that those CA's are false due to SWJ, then it clearly means you are having MANY arousals.
The cause of arousals (if true) could be due to UARS, due to the pressure being too high, or many other things.
Unfortunately, your many threads have not enabled you to solve your problem. As I have said before, I suggest you upload your SD card to a shared site so others can download and review your data in its entirety. MAYBE something good will come from it.
Good luck.

Follow Pugsy's advice. I would trust her with my life . . .

Pugsy wrote: ↑

Wed Apr 25, 2018 7:06 pm

I have already exhausted my replies to this person. I ran out of ideas and the ones I had he didn't care for.

As for these latest reports...I have no idea if they (the FLs) are responsible for OP's problems or not.
And he has already been told that for a UARS definitive diagnosis that a sleep study with Pes device is needed.
We cannot tell or spot UARS on these reports.

Understood. I knew using sleepyhead as a diagnostic tool was a long shot. But does the activity of my flow limitation chart appear basically normal? Also, is it possible that my pressure of 20 is too weak to treat some breathing events? In your experience, do some patients require pressures exceeding 20 to prevent airway obstruction? I don't think "more pressure" is the solution, but could there be a remote possibility that it actually is?

Here's an example of my flow limitation graph. See image below
Now your FL graph is a bit more active but in the grand scheme of things it really isn't all that bad.



For an example of an ugly FL graph see here in this thread...and believe it or not I have seen much worse than this one.

viewtopic.php?f=1&t=171056&p=1244103&hi ... h#p1244103

As I have told you before...you have crappy sleepy for some reason. I have zero way to know if your crappy sleep is related to your breathing because there's a mile long list of potential culprits for crappy sleep besides some sort of sleep disordered breathing.
Just the extra stuff you have done in an effort to stay off your back and pull your tongue forward and whatever else...those things alone can cause crappy sleep. Your self treating pressure at 20 cm...that can cause crappy sleep.
I don't know that you need 20 cm pressure...I don't think that more pressure is the answer though.

I think you are wanting the cpap machine to fix a problem that isn't related to sleep disordered breathing and it's not going to happen no matter how much you keep asking the same questions over and over again. The answers aren't going to change.

You need to see a sleep doctor and probably one that can think outside the box. Unfortunately those are few and far between.

Like I told you before....it's the arousals causing the crappy sleep and there are breathing related arousals and there are spontaneous arousals (which means no known cause but not breathing related) and figuring out what is causing the spontaneous arousals (which I think is your primary issue) is extremely difficult.
At this point I am not even sure that the obstructive stuff seen on your reports are real or SWJ. From what I have seen of your reports the bulk of any obstructive stuff are false positive flags from SWJ...centrals and obstructives.

You are asking questions that are impossible to answer but in general I think you are over treating whatever sleep apnea you had and doing some weird stuff (like the tongue pulling thing) and are you still using the tennis balls to keep you off your back...those things aren't comfortable and are bound to cause some arousals.

I will say it one more time...you need to back way up and use no extraordinary measures and use the apap with a modest setting and range...and quit trying to blow the airway open more with more pressure. Then see what might be going on.
I have yet to see any report done with none of the weird crap you are doing and at any pressure less than max.

You can't fix crappy sleep with a cpap/apap/bipap machine unless the crappy sleep is related to sleep apnea alone.
No matter how much you might want to blame sleep disordered breathing...that doesn't make it happen.
The list of potential culprits for crappy sleep...a mile long and sleep apnea is just one of that list.