Flow Limit with No AHI's no OA's

[ittiandro]

Historically, over the more than 2 years BPAP treatment my AHI’s average has been below 1, ranging from 0.00 to 0.81. with O.A.s events ranging from 0 ( very often) to 0.30.
The reason of my post is that for the last few months I have not been feeling as refreshed at wake up as I used to . Sluggish and “ without pep” well into the day.
I tried to see if there was an improvement by changing over time the original 8-15 cm H2O setting prescribed by my doctor two years ago to as high as 16-20, going through a number of intermediate ranges.
Unfortunately, I couldn’t see any change in the recorded data, neither do I feel any change subjectively.. The OSCAR data show no clear correlation between IPAP-EPAP settings and the number of AHI’s/OA’s recorder on OSCAR.
My attention has been however drawn lately to the Flow Limitation issue.
The Flow Limit readings are low (average of 0.10-0.15 /night ( 95%) but I noticed Incidentally, that the max FL values are considerably lower in the OSCAR summary than in the exploded graph. In other words, when the summary shows a max FL value of, say, 0.48, the graph shows 0.70 or more at some points. I wonder if this is not the smoking gun…

I don’t know what to make of the FL issue. My doctor only goes by the AHI’s readings and consider the therapy successful, but I wonder if there isn’t more to it.
I should add that I am 80, in excellent shape. No alcohol, no smoking, I eat sensibly and exercise regularly.

[Miss Emerita]

The 95% and and 99.5% values in Oscar ignore small numbers of high readings, because they might distort the overall picture.

Given that you're not seeing change in your AHI with different pressure settings, I'd suggest using the minimum and maximum that are most comfortable for you. But for flow limitations, it's your pressure support that can be most helpful. What is your PS setting now?

[ittiandro]

Thanks
After the inital settings prescribed by my doctor two years ago( 8-15) I have tried a wide array of values ranging from 10 to 16 EPAP and 10-20 for the IPAP, in various combinations, taking care to keep in the average a 4 cmH20 difference between EPAP and IPAP. I would keep each new setting for a few weeks.THere never has been a specific setting I'd been more comfortable with. They all felt OK., even though sometimes I'd wake up with a slight head ache or sweating.

Right now I have been on 16-20 for a few days. If I see or feel no change, I'll go back to the old 8-15 settings, because I pretty much tried all the possible settings without seeing much pf a difference both in the AHI's/OA's readings and on the FL. .I will add that when I first saw my doctor for a titration exam, he found that my airway ( the trachea, I suppose) is narriower than the average. This might have an impact on the Flow limit readings.
I tried to post the latest Oscar report, but for some reasons, I am unable to.
I print the page as a PDF file, but when I drag the saved file on the post it says file with invalid ending. I tried twice, both with a PDF ending and a PNG ending.

Bottom line Is a 0.10 FL reading at 95% normal?

Thanks againn for your input

Ittiandro

[zonker]

I tried to post the latest Oscar report, but for some reasons, I am unable to.
I print the page as a PDF file, but when I drag the saved file on the post it says file with invalid ending. I tried twice, both with a PDF ending and a PNG ending.

alas, the forum has a problem in that it's "full" and can't take anymore images.

try uploading your image to a hosting site (imgur.com is very solid and FREE!) then post a link here.

if you need any help, just ask.

good luck!

[lynninnj]

Thanks
After the inital settings prescribed by my doctor two years ago( 8-15) I have tried a wide array of values ranging from 10 to 16 EPAP and 10-20 for the IPAP, in various combinations, taking care to keep in the average a 4 cmH20 difference between EPAP and IPAP. I would keep each new setting for a few weeks.THere never has been a specific setting I'd been more comfortable with. They all felt OK., even though sometimes I'd wake up with a slight head ache or sweating.

Right now I have been on 16-20 for a few days. If I see or feel no change, I'll go back to the old 8-15 settings, because I pretty much tried all the possible settings without seeing much pf a difference both in the AHI's/OA's readings and on the FL. .I will add that when I first saw my doctor for a titration exam, he found that my airway ( the trachea, I suppose) is narriower than the average. This might have an impact on the Flow limit readings.
I tried to post the latest Oscar report, but for some reasons, I am unable to.
I print the page as a PDF file, but when I drag the saved file on the post it says file with invalid ending. I tried twice, both with a PDF ending and a PNG ending.

Bottom line Is a 0.10 FL reading at 95% normal?

Thanks againn for your input

Ittiandro

I know some folks really love thier oscar but I love sleephq.com

I will see if i can add onto this post the short youtube that shows you how.

https://youtu.be/YJojSMC4zQc

then to create a link open your data page on your day of choice. On the bar to the right of the date are three little dots. click them then share and then touch link provided to copy it and paste it over here.

hth

[Pugsy]

Bottom line Is a 0.10 FL reading at 95% normal?

It means that you were AT OR BELOW that 0.10 for 95% of the time.
I don't know that it is necessarily "normal" but I wouldn't give it a second thought and certainly not bad enough to worry about.
0.10 is not much at all.

Here below is mine...95% number is 0.12...and essentially my FL graph is boring and doesn't show all that much activity and this one is probably one of my "worst" ones. Usually my 95% FL number is 0.0.



Now this one....it's one of the worst I have ever seen....and not mine.

[Miss Emerita]

Pugsy, if I'm reading the sample chart right, the 95% value is 0.00. OP's 95% value is generally .10 or more. This could mean nothing, of course, and it could be making no difference to the quality of sleep. (I've learned that from you!) On the other hand, that value might signal just enough of a problem to deserve experimenting with PS.

My own thought would be to go up bit by bit from PS of 4, advancing by .2 increments at weekly intervals unless a bunch of CAs start appearing or the quality of sleep deteriorates. In my own case, the difference between PS of 4 and 5 was pretty dramatic, both by the numbers and by my subjective experience.

[Pugsy]

Pugsy, if I'm reading the sample chart right, the 95% value is 0.00. OP's 95% value is generally .10 or more.

Well crap. I snagged the wrong image.....again. I assume you are talking about my first image???
Let me see if I can find a better example. It's hard in my reports because I don't really have FLs at all. Never have had them to speak of in any number that might indicate a problem.

I was just trying to answer the question though. I would have to see actual reports before offering any ideas as to doing or attempting to do anything about any FLs. Also would need to know if a one off "bad" night or something that happens on a nightly basis.

I hunted and this one below showing 95% FL number of 0.20 is the best I can come up with. Pretty much 99% of my FL graphs show 0.0 as a 95% number. Obviously it's a one off "bad" night for me...and even then it sure isn't a horrible result and I wouldn't do anything about it at all. Wouldn't even bat an eyelash.

[ozij]

Historically, over the more than 2 years BPAP treatment my AHI’s average has been below 1, ranging from 0.00 to 0.81. with O.A.s events ranging from 0 ( very often) to 0.30.
The reason of my post is that for the last few months I have not been feeling as refreshed at wake up as I used to . Sluggish and “ without pep” well into the day.

Did you see any difference in your flow limitations? Does your air flow graph look in any way different from what it looked like when you were feeling better?

If your sluggishness is related to sleep disordered breathing you see it in your breathing patterns, in the flow. A disordered flow means you're having more arousals.
You should see your machine raising pressure when it runs into a flow limitation -- that is so very clear in Pugsy's graph of her own therapy:



Another thing, clear in Pugsy's graph is that the flow limitations are occasional: they come, the pressure responds to them, and they're gone. For more than half the night, Pugsy has no flow limitations at all.

In addition to AHI, Oscar can also report RDI (Respiratory Disturbance Index) you change that in the options. Do you see a different RDI between when you were feeling better and now?

Are you having more leaks? When did you last change your mask?

[Miss Emerita]

I agree that it could be really helpful to see a typical chart from the OP. I also think there's sometimes value in trying something that won't hurt and might conceivably help.