Flow Limitations and Pressure, Runaway S9?

AVI, I doubt that anyone who has been here for a week will bother. I know I won't. Your reports are nothing like the OP's and you are giving bogus advice. Again.

avi123 wrote:See this post from 2008 saying the same as I do:

Swift LT vs. Opus 360

by Georgio on Wed Dec 10, 2008 1:33 am

"My Opus 360 has been showing a jagged leak line for a few weeks....tonight trying the LT and hope to get a more controlled leak rate....will let you all know what the data shows"

That proves nothing. The jagged leak line could be from anything and there is no image in that thread to even compare leak lines. It could be from mouth breathing for all we know.

Are you really going to try the Swift FX nasal pillows for 30 days? Did I dream that you posted such a statement?
Why if it is such a horrible mask for men (but okay for women to use) would you even consider doing such a thing?

Nevermind...I know I am on your Foe list but I have lots of good company.

Thank you Liz, AVI, Guest, Todzo and Pugsy for your thoughtful replies.

I believe, considering my now lower levels of anxiety compared to when I first started CPAP 4 months ago, that a self-perpetuating subconscious level of stress may still be affecting my readings and my perception of my therapy. I have an appointment this Monday with the sleep doc himself.......after a little finagleling. This meeting will hopefully put my concerns to rest.

Although, when I first started in PAP Tx 4 months ago my Rx was 10 in straight CPAP....EPR level was up to me, so the tech said. I tried this for 45 days and was unhappy with my AHI's which were less than or equal to 2 and did not really FEEL much better. I know, whoopee. After some thought and research I decided to try APAP mode and have since cut the AHI to usually less than .5 with EPR @ 2( was at 3 while on CPAP) with still feeling about the same, OK, but not as good as I had anticipated. I know that it is totally possible that as I have become accustomed to PAP therapy the AHI may have gone down some anyway.

The mysterious Guest and Todzo, I believe, has some very valid and logical points that I will certainly contemplate on and consider implementing....but the idea of straight CPAP @ 12 even with EPR @ 2, makes me think that I will gag! But then again..............maybe not. Thanks again for all your inputs.

Lou

Guest wrote:

BigLou wrote: Set your machine to CPAP mode with a pressure of 10 cm. with no EPR or to a pressure of 12 cm. with an EPR of 2 (to compensate for the 2 cm. drop on exhale).

In APAP mode with a range of pressures, you have a self-perpetuating cycle (problem). The first flow limitation or snore starts jacking up your pressures. Then, as the pressures increase, you're probably subconsciously reacting to the pressure increases and the machine reads those reactions as additional flow limitation and keeps increasing pressure. This continues until it reaches the maximum pressure and/or you wake up.

.

I would definitely try cpap as the "mysterious" Guest suggests without EPR if possible. I know that roller coaster pressure graph would definitely disturb my husband's sleep. I'd also suggest staying with the same setting for a week or so if tolerable so as not to confuse yourself with too many changes. Been there, done that! Good luck, you'll get there.

I would go straight 10 with no EPR. I think you will be suprised at the effect EPR can have on your therapy.
The drop in the red graph in my avatar is from turning the EPR off.
Some need it, some don't.

Lizistired wrote:I would go straight 10 with no EPR. I think you will be suprised at the effect EPR can have on your therapy.
The drop in the red graph in my avatar is from turning the EPR off.
Some need it, some don't.

I was using the EPR (A-flex on the respironics) with a setting of 2 the other night, and was about to dose off. All of a sudden, I was awakened by a slight snore and immediately realized I had a blocked airway on my exhale. I actually felt that my throat was blocked off while trying to exhale. I guess I had always thought of a blocked airway event as being on the inhale side. So I realize that if I lowered the exhale pressure too much, that I still could have a blocked airway event. So, I set up and turned of the EPR (A-Flex) and went back to sleep.
I'm just wondering if anyone else has had that experience?

BigLou wrote:

Why do I have increased flow limitations with the increase in pressures? Is this normal? Can it cause sleep fragmentations or am I barking up the wrong tree!?
Please also notice the rattier looking flow pattern during these times. My EPR is set at 2. Am afraid to increase the top range due to aerophgia and what not. No events usually slip thru but am just concerned about the sleep quality. I feel OK in the a.m. but not GREAT even with such low AHI's. Was titrated @ 10 straight CPAP 4 months ago. Decided myself to experiment into APAP. AHI's have been lower since.

Back to your original question, that pattern of increased flow limitation with increased pressure is interesting. I haven't seen that before. I like the advice I see of trying a little more pressure with no EPR to see what happens. EPR isn't for everyone, and this isn't a typical pattern. Since increased pressure brings about flow limitation, like the old joke,

"Doctor, it hurts when I press here."
"Then don't press there,"

maybe you should go back to straight CPAP at 10 and collect some data (I don't see that you have posted any) before venturing into uncharted waters. You aren't showing any events (one silly little hypopnea isn't worth mentioning), so I don't see any reason to raise your minimum or maximum pressure higher than 10. If you really want to continue with APAP at this point, from what I've read so far, I like the advice of upping your minimum pressure to 10 and eliminating EPR.

It might be you can't tolerate pressure changes, or that you have some anatomical anomaly that is causing this odd phenomenon. You _might_ be one of the relatively rare people that straight CPAP was made for.

I'd also like to see what those periodic spikes on your flow chart look like when you zoom in on them.

And Woodworkerjunkie (I share your addiction), check out the patterns in the charts in this article http://www.ersj.org.uk/content/9/10/2116.full.pdf. Expiratory flow limitation flow patterns look sort of like a chair, whereas inspiration flow limitation are flat-topped flow peaks. Try eliminating or decreasing your EPR setting.

Update..... I tried straight CPAP of 11 and an EPR of 1 last night(somewhat of a compromise of what was previously suggested). Woke up at 0230 feeling like I could not breathe.....not fun at all. I proceeded to change my settings, in my slumber, to 10.6 CPAP with EPR of 2. Slept fine after that until 0730 but felt tired of course. Will post the results later. My conclusions are that I need exhalation relief at therapy pressure levels and I don't like pressure changes. By the way, the AHI was .1 last night, but I have not looked at the details yet and don't know how much value I will give them, considering I really don't know how much of the night I was actually "awake".

I chose the 10.6 CPAP (EPR 2) because this value is the exact middle of my previous APAP range and just a bit lower than my 95% pressure on ReScan. I was able to breathe out OK with this combo. If I had started at 10 CPAP with no EPR, I believe I still would have not been comfortable. The first 45 days of therapy were at 10 CPAP with EPR at 3......I was having several OA's and some (as a Newbie) CA's with an overall average AHI of 1.8 ish. I wanted it to get it lower and I also wanted to feel better, hence the switch to APAP as I thought this would improve my numbers (I know it's not all about numbers)............it did reduce the AHI quite a bit but I have felt about the same. I will duplicate the setting from last nights second half tonight from the git-go and see what happens. Thanks for your attention. Any comments are welcome....I know, the graphs would help.

Lou

Here it is. Don't know what caused the FL's at 0500 though other than possibly the CA?

The period from just before 0500 to just after 0600 might have been REM sleep. Your flow chart and minute variation charts really jump around then, and earlier, just before you awoke to change the settings. During REM sleep you can expect to have more events including flow limitations. The fact that you ARE getting some REM sleep is encouraging, but your sleep doc should confirm that, because we can only infer it from your the pattern of your flow and minute variation traces that REM sleep might be occurring.

Regarding your pressure, there's nothing wrong with having a couple/few obstructive events during the night. If your pressure is too low you'll have more than one or two. If your pressure is higher you will have more CAs and leaks and you might not sleep as well. As you are aware, low AHI doesn't automatically mean good sleep. It's probably the other way around.

It looks like maybe you ARE one of those folks that do best on constant pressure.

I would like to know if my flow limitations are normal....I do have nocturia and daytime sleepiness....I have been trying to solve this for years with no luck....I have resigned myself to just living with it.

Any help will be much appreciated...Thank you!

Janice

Looking good, Lou.
May take a little tweaking to find the pressure and settings where you don't feel like you're suffocating, but I think you're close.

Hang in there.

.

Hi Janice, I suggest you start a new thread you you an Lou don't get mixed up here.
There is a link for a video tutorial for Resscan link in my signature, that will show you how to get your flow data on your screenshot.

jwerley wrote: I would like to know if my flow limitations are normal....I do have nocturia and daytime sleepiness....I have been trying to solve this for years with no luck....I have resigned myself to just living with it.

Any help will be much appreciated...Thank you!

Janice

Hi Janice.

A couple of things that come to my mind are to tweak the pressure (maybe up a little) and/or try different humidifier settings (maybe lower it if you're using a higher setting).

.

jwerley wrote:
I would like to know if my flow limitations are normal....I do have nocturia and daytime sleepiness....I have been trying to solve this for years with no luck....I have resigned myself to just living with it.

Any help will be much appreciated...Thank you!

Janice

Reply,

Yes, you have Flow Limitation. Have you seen the Treatments in the report that I have posted on Pg #2?

Also, if any of your nose sides collapses during inhalation as my do (when holding the other side closed with your finger, and looking in a mirror) then using nasal rinses could help, such as:

Nasal Mist by Walgreens.

Waterpik SinusSense.

Besides the arousals that FL causes during sleep I think that it also continues to affect respiration during the daytime. There are some nose inserts or using the Breathe Right tape over the nose, for daytime use.