Flow rate shape question

[gadgetmaniah]

Some more pictures.

[Pugsy]

Your ResMed machine actually does have PS...that's what using EPR creates.
EPR at 3 is essentially the same thing as PS at 3.
Now of course the real bilevels offer more than 3 PS....do you need it or will it help you? No way to know for sure.

A sizable chunk of your zoomed in on flagged examples are arousal related. We don't have anyway to know what caused the arousals though.

[gadgetmaniah]

Yeah, that makes sense.

I have tried an EPR of 3 but that seems to make no difference.

Not sure what to do now. I thought that the breaths preceding the arousals look flow limited, so perhaps it is the flow limitation that is causing the arousals.

But if increasing the pressure doesn't help, does it mean that a bilevel device won't be helpful? Or maybe I need to increase both the pressure and the PS? I could try renting a bilevel machine to see if it makes any difference.

[Pugsy]

Actually I think you are trying to see things with the data available that it really wasn't ever designed to show.
Assuming facts not in evidence. Trying to see stuff that isn't easily seen and was never expected to be seen with the data the machine gathers.
Now just because we can't see things doesn't mean they aren't there but this data was never meant to be put under the microscope at the level you are attempting.

There is some thought that more PS will help with FLs...but we don't know that FLs are your problem...you certainly aren't having a truckload of them. No one ever has "perfect" breathing during sleep. No one ever has "perfect sleep" either.
Just way too many variables out there.

Would more than 3 PS help....dunno and no way to know unless you try it. I suspect it won't but there are no absolutes when it comes to this stuff.

Even a real in lab sleep study doesn't always give us all the answers we want. Example....while it might show arousals related to the airway...and spontaneous arousals as well...it can't tell us what caused the spontaneous arousals. All it tells us is they happened. Or maybe the in lab study shows alpha wave intrusions...but it doesn't tell us what caused them.
In lab studies aren't necessarily the end all perfect answering all questions that people expect. They come with limitations too...

More pressure doesn't fix everything...wish it were that simple.
If your arousals are spontaneous...no tweaking of the machine or changing machines is going to fix the problem.
More pressure won't/can't fix spontaneous arousals.

Your flow rate breaths do sometimes look like they are flow limited but not horribly...but you do have evidence of a lot of arousal breathing flow rate breaths.
The UF2 flag...the breaths immediately preceding the flag look arousal to me...and of course the flow rate after it looks arousal. Did the UF2 flagged event cause the arousal breathing after...I can't say it did because I saw arousal breathing before the flagged reduction. Those 2 gulps of air prior to the UF2 flag....we don't do those gulps when asleep.
You weren't asleep just prior to the UF2 flag.

My personal opinion...you are wanting the machine to fix a problem that it can't fix...crappy sleep from something other than airway issues at this stage of things. Any OSA itself is well treated but there is always the possibility that you have 2 separate problems....OSA and crappy sleep from something else.
Maybe there is a UARS component involved here...I don't know...wouldn't be impossible but we can't tell for sure with the data available. Just can't know for sure no matter how much we might want to and stretch every little not quite so normal breath.

And of course it might just be that you need to give things a LOT more time to see if anything improves.

I don't blame you for searching though....I just think that you are looking at the data available hoping for a concrete answer where the data collected wasn't ever really designed for concrete answers.
I think you have "bad" sleep from something not related to OSA itself (any OSA stuff seems to be well treated). Now what it might be...I don't know and have no way to know.

Would PS of 4 be the magic trick? I don't know.
I do know that even with someone using a really high end machine where the breaths can be manipulated so much they all appear "normal" it doesn't guarantee restorative refreshed sleep. They can still have spontaneous arousals and crappy sleep no matter how "perfect" all their breaths are.

I do know that if you decide to rent a bilevel machine....don't go over 5 PS without carefully monitoring results.
PS over 5 can trigger a lot of central apneas in people....so just like more pressure doesn't fix everything...More PS doesn't either.

[gadgetmaniah]

Thanks very much for the reply. There are a few things in my mind right now about how I can proceed. The first would be to get an in lab sleep study done which would let me know my AHI and hopefully my RDI scores as well as my oxygen levels. I think that would be a good place to start to rule out things. I am also waiting for a pulse oximeter that I ordered to see my oxygen levels while using my CPAP.

Also, yes, we do not sleep the same every night, but why I am concerned is that I'm feeling almost exactly how I would pre-CPAP for more than a week now. Even when I was seeing the benefits of CPAP, I never had a day in which I felt I had a completely good sleep without any sleep deprivation during the day.

So, I guess there's no harm in pursuing the possibility that flow limitations are causing the arousals that I experience. The worse would be that they aren't, in which case I could look at other options.

[gadgetmaniah]

Ok today I had a good sleep, like I normally would with the CPAP. Not sure what was causing the poor sleep these past days. I tried changing which side I sleep on, maybe that had some effect. Still can see quite a number of mini arousals in my sleep, and I think if I can figure what's causing them I can make the remaining improvement that I need in my sleep (even on good days I don't quite wake up feeling like I've had a full night's sleep).

I also tried changing the machine to 'Standard' mode rather than 'Soft' mode, perhaps that had some positive effect as well. I also realized that when I was using the climateline tube and set the humidity setting to auto, it was using a lot of water. The humidifier chamber would be almost empty after about 6 hours of sleep. Last night I switched to a standard tube and set the humidity level to 2. I slept for 7 hours and the water level in the humidifier chamber hardly changed. Not sure if this could have any effect on sleep though, probably not.

[gadgetmaniah]

Actually I think you are trying to see things with the data available that it really wasn't ever designed to show.
Assuming facts not in evidence. Trying to see stuff that isn't easily seen and was never expected to be seen with the data the machine gathers.
Now just because we can't see things doesn't mean they aren't there but this data was never meant to be put under the microscope at the level you are attempting.

There is some thought that more PS will help with FLs...but we don't know that FLs are your problem...you certainly aren't having a truckload of them. No one ever has "perfect" breathing during sleep. No one ever has "perfect sleep" either.
Just way too many variables out there.

Would more than 3 PS help....dunno and no way to know unless you try it. I suspect it won't but there are no absolutes when it comes to this stuff.

Even a real in lab sleep study doesn't always give us all the answers we want. Example....while it might show arousals related to the airway...and spontaneous arousals as well...it can't tell us what caused the spontaneous arousals. All it tells us is they happened. Or maybe the in lab study shows alpha wave intrusions...but it doesn't tell us what caused them.
In lab studies aren't necessarily the end all perfect answering all questions that people expect. They come with limitations too...

More pressure doesn't fix everything...wish it were that simple.
If your arousals are spontaneous...no tweaking of the machine or changing machines is going to fix the problem.
More pressure won't/can't fix spontaneous arousals.

Your flow rate breaths do sometimes look like they are flow limited but not horribly...but you do have evidence of a lot of arousal breathing flow rate breaths.
The UF2 flag...the breaths immediately preceding the flag look arousal to me...and of course the flow rate after it looks arousal. Did the UF2 flagged event cause the arousal breathing after...I can't say it did because I saw arousal breathing before the flagged reduction. Those 2 gulps of air prior to the UF2 flag....we don't do those gulps when asleep.
You weren't asleep just prior to the UF2 flag.

My personal opinion...you are wanting the machine to fix a problem that it can't fix...crappy sleep from something other than airway issues at this stage of things. Any OSA itself is well treated but there is always the possibility that you have 2 separate problems....OSA and crappy sleep from something else.
Maybe there is a UARS component involved here...I don't know...wouldn't be impossible but we can't tell for sure with the data available. Just can't know for sure no matter how much we might want to and stretch every little not quite so normal breath.

And of course it might just be that you need to give things a LOT more time to see if anything improves.

I don't blame you for searching though....I just think that you are looking at the data available hoping for a concrete answer where the data collected wasn't ever really designed for concrete answers.
I think you have "bad" sleep from something not related to OSA itself (any OSA stuff seems to be well treated). Now what it might be...I don't know and have no way to know.

Would PS of 4 be the magic trick? I don't know.
I do know that even with someone using a really high end machine where the breaths can be manipulated so much they all appear "normal" it doesn't guarantee restorative refreshed sleep. They can still have spontaneous arousals and crappy sleep no matter how "perfect" all their breaths are.

I do know that if you decide to rent a bilevel machine....don't go over 5 PS without carefully monitoring results.
PS over 5 can trigger a lot of central apneas in people....so just like more pressure doesn't fix everything...More PS doesn't either.

Hello, sorry to keep annoying you, but I finally decided to rent a bilevel machine to see if that improves my sleep. I'm just waking up too exhausted with my current machine and I want to see if it's really flow limitation that is my problem. I got an S9 VPAP ST on rent. I think I know what IPAP and EPAP to keep, but not I'm not sure about the other settings. Should I keep it on 'S' mode? What should my other settings like Trigger, Ti Max/Min, and rise time be? I've set the IPAP to 9 and EPAP to 5 for now. The machine is almost at the end of its life is with 23k+ hours on it, so I'm not sure if that's going to impact its performance or not.