Flow limitation question

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
tan
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Flow limitation question

Post by tan » Thu Oct 23, 2014 8:54 am

I tried to search for an answer on the subject, but I did not find anything concrete. I would appreciate if anyone could please point out to the right source. The reason I am asking is because I feel like I am not fully utilizing my APAP. Though considerably better than I was, I am still not getting completely refreshed after my night sleep. My AHI is below 1 most of the time.

In reviewing my APAP data in SleepyHead, I notice that I have some flow limitation through the night all the time but I am not sure what to make of it. Here is a few pic:
Image

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Jay Aitchsee
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Re: Flow limitation question

Post by Jay Aitchsee » Thu Oct 23, 2014 9:12 am

Hi Tan,
I don't think you will find anything "concrete" about flow limitations. They're talked about a lot, but no one that I know of has said anything like, if your flow limitations are above a certain level, it's bad. Yours look relatively mild to me, however. We do know that the S9 series acts on flow limitations as precursors of apnea and will increase the pressure in their presence. Some people find pressure changes disturbing, other do not. To reduce flow limitation, some people try increasing the minimum pressure.

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tan
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Re: Flow limitation question

Post by tan » Thu Oct 23, 2014 9:18 am

Jay, thank you, I have tried to increase my lower pressure minimum from 5 to 7-9, didn't find that comfortable and my sleep became disturbed with frequent leaks. Though, my max pressures may occasionally peak around 12-14 on different nights, it comes down to around 6-7.

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Denial Dave
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Re: Flow limitation question

Post by Denial Dave » Thu Oct 23, 2014 9:36 am

Palerider posted a great link to a RESMED video that explains them. I can't seem to find his posting right now

My understanding is that Flow Limitations & Snores are indicators of "near events". Sometimes we have a partial blockage of airways that don't get to the point of being a hypopnea, etc.... These show up as flow limitations or snores.

IMHO-- you need to look at several charts, leaks, flow limitations, snores.....the combination of them will give you a better idea of what's going on

The resident experts here will be around shortly to further explain.


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johantv
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Flow limitation question

Post by johantv » Thu Oct 23, 2014 9:54 am

Hi Tan,
I have exactly the same issue/question. AHI is on average 0.7 and in 7 months the highest AHI was 2.3. Doesn't matter which pressure I'm using, AHI stays low. The Flow limitations are still there. My investigations indicate that FL's are blockages in the Upper Airways Area. These blockages are not counted for AHI but ResMed S9 is responding to the FL's and also snores. Currently my APAP is set to 6-12 so the S9 can attack these FL's. Even when 12 cm is not reached most nights) FL's are present. When CPAP was set to 5 FL's where hitting the ceiling and I felt very tired.
Maybe we have UARS and need BIPAP, I don't know but like to find out.
Grtsz Johan
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

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palerider
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Re: Flow limitation question

Post by palerider » Thu Oct 23, 2014 10:00 am

Denial Dave wrote:Palerider posted a great link to a RESMED video that explains them. I can't seem to find his posting right now
here ya go: https://www.youtube.com/watch?v=-gie2dhqP2c

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tan
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Re: Flow limitation question

Post by tan » Thu Oct 23, 2014 11:12 am

palerider wrote:
Denial Dave wrote:Palerider posted a great link to a RESMED video that explains them. I can't seem to find his posting right now
here ya go: https://www.youtube.com/watch?v=-gie2dhqP2c
hm, the question is: what to do to overcome this, if it is UARS?

tan
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Re: Flow limitation question

Post by tan » Thu Oct 23, 2014 11:30 am

johantv wrote:Hi Tan,
I have exactly the same issue/question. AHI is on average 0.7 and in 7 months the highest AHI was 2.3. Doesn't matter which pressure I'm using, AHI stays low. The Flow limitations are still there. My investigations indicate that FL's are blockages in the Upper Airways Area. These blockages are not counted for AHI but ResMed S9 is responding to the FL's and also snores. Currently my APAP is set to 6-12 so the S9 can attack these FL's. Even when 12 cm is not reached most nights) FL's are present. When CPAP was set to 5 FL's where hitting the ceiling and I felt very tired.
Maybe we have UARS and need BIPAP, I don't know but like to find out.
Grtsz Johan
I guess that makes two of us... I read about BIPAP, not sure how it helps and neither is Dr. Krakow ("Why bilevel works so well is still a puzzle.") .

Has anybody experienced improvements when switching from APAP to BiPAP?

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johantv
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Re: Flow limitation question

Post by johantv » Thu Oct 23, 2014 12:26 pm

We seem to read the same articles. I'm diagnosed with OSAS which is under control with APAP but don't know if specialists looked at other stuff. My feeling says UARS, BIPAP but can't prove it. Don't think my specialist/insurance is willing to try BIPAP when AHI<1. Also curious for switch from À to BI but also why they switched...
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

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Wulfman...
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Re: Flow limitation question

Post by Wulfman... » Thu Oct 23, 2014 1:51 pm

(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
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johantv
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Flow limitation question

Post by johantv » Thu Oct 23, 2014 2:24 pm

Don't know what to think of these articles. Should I try the ResMeds EPR setting for pressure relief?

@tan, did you try the EPR settings? (My specialist advised me not to use it!). What I read it's just a pressure relief of 1,2 of 3 cmh20 at exhaling but not benificial to treatment. Tried it one of two night but didn't notice much difference.
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
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palerider
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Re: Flow limitation question

Post by palerider » Thu Oct 23, 2014 2:44 pm

johantv wrote:Don't know what to think of these articles. Should I try the ResMeds EPR setting for pressure relief?

@tan, did you try the EPR settings? (My specialist advised me not to use it!). What I read it's just a pressure relief of 1,2 of 3 cmh20 at exhaling but not benificial to treatment. Tried it one of two night but didn't notice much difference.
it drops your base pressure, in cm, by whatever number it's set to.

if you're on the borderline with just barely enough pressure to prevent events, then turning on epr will drop you below that level and you'll have more events.

so, if for example, your pressure is 10, and you turn on 3 epr, then your pressure will actually be 7, except when you're inhaling... and that can cause people trouble.

in that case, they might be better to set pressure to 13, with 3 epr. and see how it feels for them.

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johantv
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Re: Flow limitation question

Post by johantv » Thu Oct 23, 2014 3:10 pm

OK, but do you think EPR is beneficial for reducing FL's?
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
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Wulfman...
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Re: Flow limitation question

Post by Wulfman... » Thu Oct 23, 2014 3:56 pm

johantv wrote:OK, but do you think EPR is beneficial for reducing FL's?
Probably one of those "Your Mileage May Vary" situations. Not everyone has lots of FLs and depending on their physical characteristics, it isn't known until it's tried.


Den

.
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palerider
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Re: Flow limitation question

Post by palerider » Thu Oct 23, 2014 4:05 pm

johantv wrote:OK, but do you think EPR is beneficial for reducing FL's?
maybe, if you crank up the base pressure.

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