Question about Previous Post Discussing Flow Limitations

All,

Having just got back and read a previous post on RERA's and FL's some of the attached articles, I had a question and some thoughts for discussion. Hope no one minds me bringing it back.

http://journal.publications.chestnet.or ... ID=1079416

In the CHEST study above, Type 1 normal flow shapes and the flow limited shapes are normalized. Thus, we get the normal Type 1 as the standard upside down smile. However, in Figure 4. we see an example of each study group's flow rate in a 1 minute sample. To me, Type 1 looks like the description of Type 6 in Figure 4. I assume this is the normalization. If this is the case, does anyone have an example or link to what Type 6 actually looks like before normalization or in greater scale? My untrained eye doesn't see much difference when comparing the normal group's 1 minute sample to the group sample which should be showing Type 6. In other words, what does "a peak during late phase preceded by a plateau" actually look like if not similar to Type 1? Are these described shapes best shown by looking at individual breaths on a 4 to 6 second scale on Sleepyhead?

I like anything that helps me learn about what I'm actually seeing on the flow rate and really appreciate your thoughts and expertise. I've really found the posts on what are we doing in regards to flow limitations interesting disussions.

I know I obviously have "way" less limitation than pre-therapy. Yet, how do we proceed with therapy adjustment if we aren't looking at individual breaths or we don't have the expertise to know what we are seeing in FL's each night? It does seem from this study that those without SDB do have FL breaths. At what point do we stop addressing FL's? I can't tell anything from my dial winging with fixed pressure, auto, narrow range. Maybe I'm not giving it enough time to correlate to how I feel.

It seems to me that logic would dictate if way less FL's than before and low obstructive, hypopnea, and no snoring that one would be on the right track. However, the whole effort related arousal and general disturbance aspect adds variables that I'm not experienced enough to factor. Sometimes I seem to wake up with every apnea, floor creak, mouse fart, etc. Yet, early in therapy with incorrect treatment parameters, I would ring the bell on the snore meter, blast the leak rate, and clearly be eating the bottom of my ffm and have no recollection. I'm clueless if respiratory effort is a component in my SDB with better optimized Pap.

Just thoughts.

Best,

Mike