newbe question about "flow limit" in dreamstation

[movingon]

I have been reading on how to post my sleepyhead results, but there is one thing I'm stuck on before I can continue. The instructions say one chart to include in my post is the "flow limit" I have arranged the first 5 requirements, event flag, flow rate, pressure, leak rate, and snore. My version of sleepyhead is v1.0.0. I'm not seeing a flow rate. What I do have is: resp. rate, tidal volume, minute vent, insp. time, exp. time, and time at pressure. I tried to compare my charts with the examples given, but no luck. If one of you sperts out there could splain it to me I would appreciate it.
Thanks

[OkyDoky]

I have been reading on how to post my sleepyhead results, but there is one thing I'm stuck on before I can continue. The instructions say one chart to include in my post is the "flow limit" I have arranged the first 5 requirements, event flag, flow rate, pressure, leak rate, and snore. My version of sleepyhead is v1.0.0. I'm not seeing a flow rate. What I do have is: resp. rate, tidal volume, minute vent, insp. time, exp. time, and time at pressure. I tried to compare my charts with the examples given, but no luck. If one of you sperts out there could splain it to me I would appreciate it.
Thanks

Flow limitations show in the Auto mode. Are you using auto or straight cpap mode? If you are using cpap and want to see FL's you can go to Auto mode and set your Minimum and Maximum the same pressure. Another thing to check, in sleepyhead at the bottom of the graphs there is a box on each side. Scroll throw them and make sure they are all green. That turns the graphs and events on.

[Jay Aitchsee]

Also check File/Preferences/Waveforms to make sure it is selected as well as the graph drop down OkyDoky mentioned:

[movingon]

o k, Per okydoky I made sure all the event flags at the bottom of the graphs are in the green. I then went into preferences in sleepyhead and made sure that flow limitations was checked in both the "events" and the "overview", it now has 2 check marks, one on the left side where just about everything is checked, and one on the right side of the colored boxes in both "events", and "overview". Up until last night,1-11-17, I don't remember if the machine was set on auto or not. I did put it into auto this morning and set both the ipap and epap on 13. I've loaded the last few night's info into sleepyhead and I'm still not seeing a graph for flow limitations. Should I try again tomorrow? Bye the bye there are flow limitation tick marks in the event flag graph, just no actual graph for the flow limitations. If I go to the "overview" there is a graph there that shows flow limitations, I'm confused.
Thanks Jay. When I click on 'event flags" at the lower right flow limitations is not showing up. Did I break something? Even more confused.
Was setting both ipap and epap to 13 a bad thing? getting even more confused.

[Jay Aitchsee]

I am not that familiar with the Dreamstation, but I think it has to be used in auto to see a graph. Therefore, if you didn't use it last night in auto (or previous nights), you wouldn't see a graph this morning simply by switching to auto to download the info. Run it in auto tonight and see what you get in the morning. It is possible that Dreamstation doesn't produce the info required for SleepyHead to construct a graph, I don't know, but somebody will come along that does.
In the meantime, don't let the absence of the flow limitations graph keep you from posting your results. A lot can learned from the others.
Setting the min and max pressures to the same value while in auto makes the machine perform as a straight CPAP. It won't break anything. It is a technique used by some who don't need or want APAP, but want the extra data that is produced by some machines in the Auto mode.

[movingon]

Thanks Jay
You stated that setting the min & max settings on my machine will make it work as a straight cpap. I'm not sure that is the way I want to go. I have asthma and I would like to think that using all of the machines capabilities would be in my best interests, if that makes any sense. I feel that lowering the expiration pressure should help me breath better. As a matter of fact I did go back into the machine and changed the pressure settings from 13~13 which was what okydoky had suggested to 11~13, is that defeating the purpose of equal pressures? I was given the machine by the VA and then tossed into the deep end with just a "good luck". I have talked, once by phone, and met with the RCP, once in person. My impression of her is that she has her OWN agenda and I'm going to be doing things her way. I appreciate the fact that the VA gave me the machine, but as has been stated in other posts, nobody cares about my therapy as much as I do. Having said all that I will post what I have tomorrow after running the machine in auto. As of right now "flow limitations" is still not showing up in the event flags at the lower right of the graphs, go figure.

[OkyDoky]

Thanks Jay
You stated that setting the min & max settings on my machine will make it work as a straight cpap. I'm not sure that is the way I want to go. I have asthma and I would like to think that using all of the machines capabilities would be in my best interests, if that makes any sense. I feel that lowering the expiration pressure should help me breath better. As a matter of fact I did go back into the machine and changed the pressure settings from 13~13 which was what okydoky had suggested to 11~13, is that defeating the purpose of equal pressures? I was given the machine by the VA and then tossed into the deep end with just a "good luck". I have talked, once by phone, and met with the RCP, once in person. My impression of her is that she has her OWN agenda and I'm going to be doing things her way. I appreciate the fact that the VA gave me the machine, but as has been stated in other posts, nobody cares about my therapy as much as I do. Having said all that I will post what I have tomorrow after running the machine in auto. As of right now "flow limitations" is still not showing up in the event flags at the lower right of the graphs, go figure.

Movingon,
In my above post I asked if you were in auto or cpap mode. And if you were in cpap mode told you how to use the auto settings in a straight pressure cpap mode. As long as you are in Auto mode you can use whatever pressure you used before and flow limitations should be recorded. Not knowing what your pressures were or seeing any data I didn't suggest a pressure. If you are not sure what your pressure was it will tell you in SleepyHead under your AHI. You don't have to have "Equal Pressures" to record flow limitations.

[movingon]

thanks okydoky
the machine is set on auto I'll see what happens after tonight.
My bad, you didn't suggest pressure readings, I read that into your post.

[Jay Aitchsee]

I'm thinking you won't get a Flow Limitations Graph with the Dreamstation, only the event flags. See the quote below.

viewtopic.php?f=1&t=113456&p=1094816&hi ... s#p1094816

...You won't have a flow limitation graph...Flow limitations are flagged only on the top Events graph with Respironics machines. Now ResMed will give you a graph and not put it on the top Events graph.

If you edit the title of your original post to include "Dreamstation", it might draw the attention of those that are more familiar with the machine.

[OkyDoky]

I'm thinking you won't get a Flow Limitations Graph with the Dreamstation, only the event flags. See the quote below.

viewtopic.php?f=1&t=113456&p=1094816&hi ... s#p1094816

...You won't have a flow limitation graph...Flow limitations are flagged only on the top Events graph with Respironics machines. Now ResMed will give you a graph and not put it on the top Events graph.

If you edit the title of your original post to include "Dreamstation", it might draw the attention of those that are more familiar with the machine.

It appears this is the case. I didn't have a clinical manual and what I did have stated they were reported but it appears the Respironics machines only flag the FL's and ResMed machines graph the FL's.

[movingon]

Spent a couple of hours trying to figure out how to use imgur. I posted a reply, with links, but it seems to have disappeared into computer limbo. So here goes ...again.


thanks
Oh happy days, I'm surprised and amazed!
the second image with an AHI of .60 seems to not be getting enlarged in imgur. I had that result earlier in the year with a pressure setting of 13~20. If anyone wants to see it let me know and I'll bang away at imgur and see if I can stumble onto how to use it properly.

[Jay Aitchsee]

Your recent chart looks pretty good, in my opinion. An AHI of 2.39 isn't bad. Most of that is CA which most often are the result of a disturbance, again my opinion. Most of your CA are as you are falling asleep (Sleep Onset CA) not terribly unusual. Increasing the pressure will not reduce CA and may, in fact, increase them. Your machine is controlling your obstructive events nicely, not needing to the rise past 13.5 in pressure, staying much lower than your max of 17.
I'm not sure about those early CA. If your machine has a ramp function, you might try that. By the looks of your Respiration Rate Chart, you might be awake during those periods, in which case the CA don't count. If they bother you, then they might need work. If they don't, then they are probably of no concern, could be the result of a little anxiety over the treatment.
So, your chart looks pretty good. The big question is, how do you feel?

[movingon]

Thanks jay
So, how do I feel? I feel like I still want to dial in my therapy settings so that I can see AHI that are consistently lower. I have read the posts saying that this is all a process, I get that. Since December when I was reluctantly given a nasal pillow my AHI has been consistently inconsistent. I am feeling more rested, but I still do get drowsy in the afternoon. Is that age related? maybe. I also still continue to wake up at around 5 am. Is that also age related? maybe. But there have been times when I slept for 8 hours, I'd like to that again, if it is dependent on my therapy settings. Having said all that I am still very much interested in exploring the possibility of improving my sleep by tweaking the therapy settings with regards to the asthma that I deal with. To that end I'm asking if lowering the epap would be of any help? I'm hoping that there are others who also deal with asthma who have "been there done that" and can save me from floundering around trying to re-invent the wheel. Nuther question; does it matter if the ipap is at 17, if the machine is not going there during the night?
thanks for the help

[Jay Aitchsee]

I can't say about your asthma. No, if your machine isn't reaching the upper limit setting, it doesn't really matter what the setting is.

You must realize that your AHI is fairly low now and tweaking to try and lower it may be counter productive. In the last chart you put up, you had a cluster of CA at the start of the night. I think those could be discarded as an anomaly. If they were discarded, your AHI for the night would have been about 0.75, consisting of hypopneas only.

CPAP can only fix sleep disordered breathing. It can not fix poor sleep due to other causes. Once AHI has been brought under control by CPAP, if non restorative sleep persists, one must look elsewhere for the cause; diet, exercise, meds, etc. This can be much harder than fixing AHI. It takes dedication, a bit of detective work, and patience. A good place to start is with Chicago Granny's checklist:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems
CG

Do these things, all of them, don't just give them lip service, and I can almost guarantee your sleep will improve. Don't accept age as an excuse for poor sleep.

In the meantime, if you feel you must tweak your settings, go slow. Do one thing at a time and give it several days (at least three) to see a trend in the result. Personally, I feel the lower the pressure the better (less disturbing) so, to that end, I would start by lowering EPAP as you suggested. Watch for hypopneas to develop. Depending upon your machine, you may have to adjust other setting as well, flex, and or IPAP to accomplish that. See your clinicians manual. If you don't have a clinicians manual, go to http://www.apneaboard.com

Getting back to those CAs. You mentioned a nasal mask in your last post. Sometimes with a nasal mask, people breathe through their mouths. Doing so will confuse a machine because it can not detect flow through the mouth and false apneas are often scored. This could be the source of your CA and inconsistent AHI. Nothing really to fix, just be aware. And when your AHI is inconsistent, what is changing? Is it CA, OA or H? Knowing that can help determine the cause.

[movingon]

Thanks Jay
ChicagoGranny nailed it! I woke up this morning at 3 something and I had had just a little over 4 hours of therapy. As I lay in bed it came to me that I do know this about me, I react to stress by losing sleep. That is not apap's fault. I need to keep reminding myself that this process is going to take time. I have read enough posts by now to realize that that is what EVERYONE keeps saying.To make changes gradually, and give myself time to see if there is a trend appearing. ChicagoGranny did point out some bad habits that I am guilty of...buummmer! So deep breath, try to relax, and enjoy the ride, and resolve to make the necessary life changes, another bummer, I happen to like all of my bad habits . Thanks for the reassurances, and the reminders that this is going to take some time. I am considering starting a new thread to ask the collective mind what it's thoughts are on the relationship between therapy pressures and asthma. My original post here was to ask about flow limits in dreamstation, that question has been answered.
Thanks again