New and seeking advise

[FlaThunder]

Hi all, I started CPAP on January 6th but have been lurking and reading everything I could for the last 3 months. I have to say thank you to Pugsy and all the other forum members for all the helpful information you guys provide. I would not have an APAP machine without you guys as my Dr. is against them (he has no idea I convinced the DME to give me APAP). I began my treatment @ 10 (cmH2O) per his script and my highest AHI was 3.68 but I wanted better. I have since increase to 11 (cmH2O) 6 nights ago and my highest AHI has been 1.35. As you will see below I have been able to get my Obstructive, Hypopnea, and RERA all under control. Now I have directed my focus towards the Flow Limit & Flow Restrictions. Last night my 50% Flow Restriction set @ 6 seconds showed 16 events and my 20% Flow Restriction showed 5 events (1 while I was awake). The reason I have not tried APAP is I have an appointment with my Dr. in a few weeks and would prefer for now to use CPAP just because as mentioned he is against APAP, after my appointment APAP may be an option only if needed. Ok now on to the question...How concerned should I be on trying to improve the Flow Restriction stats ? What can I do to improve my Flow Limit? I still wake up tired and still get tired during the day and did not know if they may be the cause. Yes I also know that I should not expect to feel like a new man with being on CPAP just 2 weeks. Really appreciate you guys for what I have already learned and what I will continue to learn, next item on the list will be the CMS50F to watch the PulseOx. Forgot to mention I was diagnosed as severe with an AHI of 52.

[Pugsy]

Do you wake up often during the night for various reasons known or unknown?
Or do you sleep soundly with minimal awakenings that you remember?
Do you normally get 7 plus hours of sleep?
What meds do you take ..if any?
Do you have issues with nasal congestion during the night?

I don't know that the flow limitations are a problem but they are a bit ugly at times so in theory it's possible.
I suspect if you were in apap mode the machine would try to do a better job preventing them with an increase in pressure. Something worth investigating later once you won't be under your doctors watchful eye if you choose to investigate it.

[FlaThunder]

Wow...Im speaking to Pugsy lol. Thanks for getting involved!
I may wake 1-2 times a night for a snack and bathroom break, other then that pretty sound sleep.
I always get a min. of 7 hrs of sleep nightly
Flonase to help clear the sinus congestion and Allegra also to see if it will help congestion.
I will definitely try APAP in the future, may try to do a minor increase of .2-.4 just to see if the Flow Restrictions improve, do you think APAP will also improve Flow Limit?
Also included snore so you can see that as well

[Pugsy]

do you think APAP will also improve Flow Limit?

Depending on the cause of the FL....it will at least try to reduce the FLs.
If the FLs is more in the nasal area though...it may not try or if it does try it may not help.
I have seen some really ugly (worse than yours) reports where no amount of increased pressure seemed to help reduce the FLs...and that includes not just apap mode but even more minimum pressure to start with.

FLs aren't always a problem but since they can sometimes be a problem it's worth trying to reduce them to see if it helps or not.
If your FLs are primarily in the nasal area I am not so sure that more pressure will make that much of a difference but again...it might. I find that humidified air throughout the night really helps any minor nasal congestion that I might have when I went to bed. Last night was a prime example...the dry air in the house (winter, cold, furnace) caused me to have some nasal congestion issues last night which I normally don't have.
This morning they are gone but they will return a little bit by this evening as that's what has been happening the last few days since we are in the deep freeze right now. I use Simply Saline often during the day to help out the dryness.

I having looked at my FL chart to see if it changed much though. This new machine I have totally over reports FLs so I don't bother looking at them anyway.

What I do is try to treat the symptoms if they are unwanted and not so much try to treat the numbers or the graph results. Perfect numbers or perfect graphs don't mean squat....don't guarantee much except a nice math score.

If you were sleeping soundly and well rested then I wouldn't worry about the ugly FL graph...but since you aren't ....trying to reduce the FLs is worth trying. It may or may not help and it may or may not be related to your unwanted daytime symptoms.

Do you take any other meds besides the Flonase and Allegra?

[FlaThunder]

I take no other meds.
Right now I have the ResMed Auto set to Auto for humidity. Do you suggest I change from Auto and start @ 4 or 5 and set a temp? My wife and the sleep tech told me I occasionally am breathing thru my mouth, would you suggest going nasal and chin strap in place of FFM to attempt to improve FL?

[Pugsy]

First of all I don't know that your flow limitations are caused by nasal congestion. I just mention it because it is possible.
As for changing the humidity level or air temp in your hose by going off of auto...question for you.
When you wake up is your nasal congestion worse than when you went to bed?
Unless it is worse I would leave those settings alone.

How often do you take the Allegra? Are you aware that it does have some potentially unwanted side effects and drowsiness and tired feeling are listed as known (but not hugely common) side effects.
It wouldn't be impossible for your meds to be a contributing factor if you take them routinely.
In rare situations it can also cause sleep problems (waking often).

Flonase doesn't seem to show tired feeling or sleep disruptions as potential side effects from what I can find.

While I doubt your meds are a huge contributing factor in your unwanted daytime sleepiness it wouldn't be impossible for it to be a factor...but then not taking the Allegra might create a worse problem. I know I don't sleep well and feel like crap if my nose is congested.

And again...I don't know that the flow limitations you are seeing are nasal related anyway.

If it were me I would try more pressure..either in changing to apap mode and see if the machine wants to kill them or more fixed pressure...but do it when you are comfortable making the changes like after you see your doctor. See if
1...the machine wants to give you more pressure in the first place (that's apap mode)
2...if the FLs even reduce with more pressure and if they do does it help with the unwanted daytime symptoms.
3...if no change in FLs or how I feel...then maybe look at the humidity settings.

Now if you are waking up with more congestion than when you went to bed...then I might look at humidity settings first but you don't seem to be complaining about nasal congestion...just the tired sleepy thing which may or may not be related to the flow limitations shown on the graphs.
The usual course of treatment for FLs in the airway (not the nose part) is more pressure but FLs themselves aren't always the biggest part of the problem ....but since they potentially could be...we try to reduce them in an effort to maybe get lucky and sleep quality improves and when sleep quality improves we usually feel better during the day.