Flow Limit/Flow Rate Help

[Morgoth]

Hello,

dataq1 didn't give me any advice on adjusting therapy or similar, therefore none of the hopefully future advice that any board member would give me wouldn't contradict what dataq1 wrote to me.

I would love to hear from fellow experienced cpap users what can be improved and if my flow limitations concerns are justified.

Thanks

[ozij]

However, lately, I have been feeling a bit nauseous and tired every time I wake up.

That is cause for concern - you're assuming it has to do with flow limitations, yet you found those with another mask as well.

What do you think I should try to do? Should I increase the maximum pressure, maybe in an effort to break through those episodes of flow limitation?

Machines never "make an effort to break through" anything. They respond after the fact, and the aim is to avoid breathing disruption - if possible.

Your flow limitations (what about snores?) appear when your pressure drops. They look better when your minimum pressure is 10.
You could consider rasinig your mimum pressure gradually, in 0.2 increments.
You don't need a higher max.
Your sleep may be disrupted by the leaks -- try to get a handle on them. Follow mask fitting videos, make sure you fit the masks lying down. ResMed, for one, has troubleshooting videos for their masks, showing which strap to tighten for which type of leak.

[Morgoth]

Hi,

The last graph I posted is the one from my last night sleep and as I said I tried to make the straps on Vitera a bit looser and there were a lot of leaks, in the previous graphs there was small amount of leaks and mostly bellow the maximum usefull limit, but in order to have them under control I have to tighten bottom straps a lot.

I am adjusting mask while lying down, and the fit test is always good, the leaks kick in when I am not aware, probably due to my jaw falling back... I tried with custom oral appliance but couldn't tolerate it, either way I am hard to fall asleep and maintain the sleep, oral appliace was a bonus on the nightmare.

. Those small 5-10l leaks I don't really feel. I just think vitera is not for me, its comfy but it leaks a lot more than f30i for me...

However f30i was waking me up low kwy blowing in my eyes and no leaks were recordes...

Honestly with Vitera I never had that blowing in the eyes or anywhere sensation and for me the leaks are worse.

Yes, I am a snorer, a snorer from hell. However my wife says I am not snoring with the mask off. I do however see some snore here and there on the graph, I can share.

I'll try with incrementing min pressure, thanks.

[Morgoth]

So, I listened to ozij advice and upped the min. pressure a bit, seems to me that flow limit. slightly improved... I'll up it more tonight...

This is my last night sleep. I uploaded this tidal volume and resp. rate graphs that I don't know how to read... I have read that Tidal volume is connected to age, sex and constitution... I am 37 years old male, height - 6.1, (over)weight - 261 lbs... I'll get this Wellue ring soon to monitor the saturation level as well..

[Morgoth]

Seems that this slight increments of the minimum pressure is working. This is last night, I think the flow limitations is less happening now:



The flow rate is still flat topped I think:




My mask is like 5 months old at the moment and either way I never could control leaks totally with it, seems that it's low key leaking a bit all the time...

[ozij]

How are you feeling?

[Morgoth]

How are you feeling?

I feel better today, didn't have nausea when I woke up, but that could be addressed to having a bit longer than usual sleep.

Thanks

[Morgoth]

Hello,

The night before I didn't have time to go to sleep... So I went to bed in the late afternoon around 5PM yesterday hoping that I'll have some good sleep till the early morning, but of course I woke up after 4 hours, and I continued in the night again, waking up few times... This small red-circled piece is me trying my f30i but I just can't tolerate it, I fall asleep and then some movement of the mask bellow my nose is waking me up... However this Flow Rate looks kind of more symmetrical and not flat topped with f30i, I have to say that with f30i I can breathe super nice through my nose, but with Vitera that bulky cushion is somehow putting some weight around my nose, even though I don't tighten the upper straps... I was experimenting with upper straps totally loose and it is always the same, I also read somewhere online that some person was reporting the same issue, that the bulky cushion around the nose made him harder to breathe to the nose...

Ahi is under control. But I'm still waking up. I'll try to get the Wellue ring to check my spo2, and if the spo2 is ok then I'll know my psychological issues may be a bigger problem for me not being able to sustain the sleep. I wasn't able to have a longer than 4h sleep for like 20 years, it is very frustrating. I'm just grateful I don't have a job that is related to human safety in no way, I can't hurt anyone, I won't be able to do that kind of job being like this.

My biggest problem is that my life quality is low, I am de-energized, I can't establish normal sleep pattern, my work is flexible, and my co-workers accept me for what I am, but I have issues with my family and friends, they don't understand that I'm sleeping in 4 hours blocks, for 20 years they didn't believe me I had breathing problems, they thought I'm just snoring and that's it. I don't deny that I may have mental issues and I want to improve that as well, but the fact is that I had untreated severe OSA for at least 20 years now, I'm thinking maybe my body got trained to wake up after 4 hours during the 20 years living with high AHI and low spo2 in the night and that is hard to get in the normal rhythm now.

Please, apart for this leaks, let me know if you see anything regarding breathing and events. I won't be bothering you with graphs any more until I get the Wellue ring, it is not my intention to make this thread my diary.

Thanks

[Miss Emerita]

Bystander here. My impression is that the only leaks you really need to worry about are the ones that wake you up or keep you awake. I'm also suspecting that raising your minimum is not strongly correlated with a reduction in flow limitations. But there's no harm in continuing to raise the minimum if it's comfortable for you and doesn't lead to a bunch of CAs.

Your FLs are somewhat clustered, which leads me to wonder whether there's a positional element there. Do you sometimes tuck your chin down toward your chest or roll onto your back?

As I know you know, you do need to work on getting a more regular sleep schedule. Skipping a night and then going to bed at 5 p.m. is not a good idea! But I don't think you necessarily need to work toward staying asleep for 7-8 hours at a stretch. Some people just naturally sleep in two segments, and perhaps you are one of them. When the first segment is over, you could get up and do some things that don't get you all riled up. Read for pleasure, perhaps, or do some non-stressful work. Then when you feel sleepy again, go back to bed.

What you do need to work on is going to bed and getting up at roughly the same time every day. This will help you train your body to sleep better.

[Morgoth]

Bystander here. My impression is that the only leaks you really need to worry about are the ones that wake you up or keep you awake. I'm also suspecting that raising your minimum is not strongly correlated with a reduction in flow limitations. But there's no harm in continuing to raise the minimum if it's comfortable for you and doesn't lead to a bunch of CAs.

Your FLs are somewhat clustered, which leads me to wonder whether there's a positional element there. Do you sometimes tuck your chin down toward your chest or roll onto your back?

As I know you know, you do need to work on getting a more regular sleep schedule. Skipping a night and then going to bed at 5 p.m. is not a good idea! But I don't think you necessarily need to work toward staying asleep for 7-8 hours at a stretch. Some people just naturally sleep in two segments, and perhaps you are one of them. When the first segment is over, you could get up and do some things that don't get you all riled up. Read for pleasure, perhaps, or do some non-stressful work. Then when you feel sleepy again, go back to bed.

What you do need to work on is going to bed and getting up at roughly the same time every day. This will help you train your body to sleep better.

Hello,

Unfortunately that wasn't my idea, that was the deadline of the project that had to be finished, the curse and the blessing of being an entrepreneur, there are no working hours, but there are impossible deadlines.

I had moderate success with lying down and getting up in the same time, it does help to a certain extent.

I don't sleep on my back, I am a side sleeper, however my chin may fall back or something, I don't know, I do tend to sleep restless and to move a lot...

Prior the OSA diagnosis and CPAP treatment, I was seeking psychiatric help, the've said I had something like neurosis based insomnia or something like that and they've put me on antidepressants, I was using the therapy for like 2 years and while it had toned down my stress levels it did nothing for my sleeping problem... My next move would be to check my spo2 levels and if that turns out ok go to a psychiatrist again...

Sleeping in two blocks would be ok if I could get the second block every night... Also I almost always wake up with slight nausea and I feel tired and yawn all day all the time, so I guess, despite low AHI, something is still not right.

Thanks

[Pugsy]

prior the OSA diagnosis and CPAP treatment, I was seeking psychiatric help, the've said I had something like neurosis based insomnia or something like that and they've put me on antidepressants, I was using the therapy for like 2 years a

So exactly what medications are you taking? Name, dosage, etc.

[Morgoth]

prior the OSA diagnosis and CPAP treatment, I was seeking psychiatric help, the've said I had something like neurosis based insomnia or something like that and they've put me on antidepressants, I was using the therapy for like 2 years a

So exactly what medications are you taking? Name, dosage, etc.

At the moment I'm taking:

- bisoprolol 2.5mg a day for my fast heart rate prescribed by my cardiologist, my blood pressure is normal and always was, I don't have any other heart conditions
- 2.5 mg of lorazepam only if needed, also prescribed by my cardiologist. I tend not to use it every day, maybe once or twice a week when I can't sleep, and taking it is really making me concern that it can mess with my cpap therapy somehow...
- 1 dose a morning and 1 dose a night of Foster to control asthma, prescribed by my pulmonologist
- 1 dose/day of Mometasone for rhinitis, also prescribed by my pulmonologist

Back then while I was on antidepressants I was using 5mg of Zoloft a day.

[Morgoth]

So hello once again !

I obtained the O2ring to check my saturation levels etc... And this is what happens,my saturation levels are fine, but I am really concerned with this 150 pulse rate in my afternoon nap, is that normal ?

Also, on the longer graph there is a pulse spike right when I woke up, I usually wake up with racing heart, that's why I was visiting cardiologist, and that's why I got betablocators prescribed...

Here are the two graphs from last night and today, I would appreciate any opinion and help, and should I go see the cardiologist with these results. Thanks

[Pugsy]

Call your doctor NOW and tell him/her what you are seeing.
You might need a Holter Monitor of some sort to evaluate the heart rate longer term.
We don't mess around with the heart. God only gave us one to use and it's hard to get another one.

[dataq1]

FWIW:
looks very similar to my wife's paroxysmal Afib. In any event, have it checked by your cardio. If it is paroxysmal, you will probably need a holter to diagnose. BTW, sometimes my wife can tell if she's in afib, and sometimes there are NO physical symptoms other than a unexplained heart rate above 110. Only a monitor can tell.

Good Luck