Flow Limitations and Pressure, Runaway S9?

[jwerley]

Thank you both for your suggestions...I will try them....

[BigLou]

Update......tried straight CPAP @10.4 w/2 EPR and had one of the worst nights, maybe I went to bed too late (no drinking etc.). Felt absolutely awful Sunday morning.........





Went back to APAP (9.8-11.20) EPR 2 last night and felt much better but the machine is still wanting to go higher evidently caused by FL's......is it just blocking events at these higher pressure while I'm in REM? Maybe just ignore the FL's like Pugsy said since no events during these times other than 1 hypopnea. As was stated on some other posts about their S9's "running away" with pressure...if I let the max go to 15, I bet it would touch that threshold without really ever needing to..to prevent an apnea. That's why I keep the APAP range so tight. Any comments would be appreciated. Thanks again for listening.

[Slartybartfast]

That's not a really typical pattern. Usually as the machine increases pressure the flow limitations taper away to nothing. But that's not the case with you for some reason. It would be nice to know what's generating the flow limitations. Some physical anomaly in the soft palate, perhaps. In the meantime, I think you're set pretty well. Too low and you'll have obstructive apneas. Too high and your machine will record centrals. In the middle you'll have a couple of each, or none at all.

[avi123]

That's not a really typical pattern. Usually as the machine increases pressure the flow limitations taper away to nothing. But that's not the case with you for some reason. It would be nice to know what's generating the flow limitations. Some physical anomaly in the soft palate, perhaps. In the meantime, I think you're set pretty well. Too low and you'll have obstructive apneas. Too high and your machine will record centrals. In the middle you'll have a couple of each, or none at all.

Strarty, IMO, the nasal pillows mask is causing the Flow Limitation to rise which makes the S9 drive the pressure higher. What do you think about it? Since you yourself are using a nasal pillows mask and an S 9, what are your graphs showing in ResScan for FL and also for leak?

[Pugsy]

.if I let the max go to 15, I bet it would touch that threshold without really ever needing to..to prevent an apnea. That's why I keep the APAP range so tight.

Here's the deal...you may not think the machine needs to go there but the machine obviously thinks it needs to go there.
It is only doing its job....respond to flow limitations...real or whatever...that's what its job is. Flow limitations are something that the machine sees and says "whoa, this is a warning sign that a collapse of the airway might be happening...I need to stop that from happening".
Now if you want to limit the pressures for whatever reasons you have...then it's a compromise and sometimes compromises are perfectly acceptable choices to make. People make compromises all the time. If the increases in pressure create more problems than it solves then we compromise and just shrug our shoulders when we see the flow limitations.
There's no way to tell from what we have available here exactly what is causing those FLs. Looks awful suspicious for REM activity
in timing but looks like a rather prolonged time (90 minutes in first one starting around 4:30) in REM so maybe some supine sleeping mixed in.

Do you have centrals pop up if you let the pressure go up? Would the variations in pressure disturb your sleep? Some people it does and some people it doesn't. Some people might have some centrals pop up but not everyone will have them pop up with the higher pressures.

I guess what I am trying to say is what are your goals? It's obvious that the FLs bug you but are they bugging you more physically or mentally? It's also obvious that cpap mode at Saturday night's pressure isn't sufficient to prevent them either.
If you want to prevent them then more pressure is needed...either in the form of cpap mode or higher pressures (likely minimum and maximum) in apap mode or a reduction in EPR to offset things a little (maybe).
You have to decide if "fixing" the flow limitations is the goal or is trying to "fix" them going to create more problems than leaving them alone would.

Have you discussed your concerns with your health care provider?

[BigLou]

Thanks for your inputs. I am more affected by this FL pattern mentally. A compromise is probably the best solution. My sleep doc knows less than many of you do about ResScan interpretations. AHI and compliance seem to be the rule with my clinic, after all, I was initially dispensed 4 months ago a PR DS250 brick POS. Maybe if I would have kept it this issue would have never come up.

I think it's time to let this thread go unless anyone else want's to input from their similar situations. I have been looking for another doc.........in the mean time, thanks to all and to all a good night. Hey, I've heard that before!

[Pugsy]

You know you have all the time in the world to decide if you want to investigate these FLs any further. You don't have to do anything right now.

Sometimes we don't always get the clear cut direct black and white answers to a puzzle. Sure would be nice if we did when we wanted them but life doesn't go that way a lot of the time.

I really wish I could offer you a nice black and white answer but I can't. Best I can do is raise questions and get you to think and see what you want to try to do. Sort of throw some stuff on the wall and see if any of it sticks.

[Lizistired]

Hey Lou, See that little icon with the graph and the check mark on it. Just to the right of your machine serial number.
You can get rid of the navigation portion of the screen there if you want more screen space for what you are displaying.