My Sleep Apnea has dramatically improved after 2 years of CPAP. My AHI’s are now down to about .60 every night, mostly H’s, some O.A..’s and occasional RERA’s . Lately, however, I a’m feeling more tired and sleepy. I’m 80, in good health and exercise a lot.
I tried different pressure settings over the last two years The most recent one is 12-20. It seems to yield the lowest average AHI’s, except for the unusual sleepiness and tiredness lately.
I am getting feedback from some other people that my Oscar record indicates a flow limitation issue and that I should perhaps change my pressure settings, short of seeing my doctor again if the problem persists.
What would be the appropriate pressure to try? I believe my doctor had prescribed a 10-15 pressure after the titration. Also, I don’t know where to see the flow limitation problem on the graph.
I enclose the latest graph
Thank for your feedback
Franco
Flow limitation issue and pressure
Flow limitation issue and pressure
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Re: Flow limitation issue and pressure
IMO
If the Oscar report you presented is typical (rather low AHI), I would consider other possible causes for the tiredness that you are reporting.
Have you discussed this “tired and sleepy” with your PCP? He may want to order a metabolic blood panel , hematocrit, or other tests.
One of my dear relatives became very tired and sleepy, when she went to her doctor she was diagnosed with leukemia.
Just by the way, the flow limitation graph
Is at the bottom of the snapshot you sent. There is no report on the left side (with the indices), because there is no flow limitation index standard.
If the Oscar report you presented is typical (rather low AHI), I would consider other possible causes for the tiredness that you are reporting.
Have you discussed this “tired and sleepy” with your PCP? He may want to order a metabolic blood panel , hematocrit, or other tests.
One of my dear relatives became very tired and sleepy, when she went to her doctor she was diagnosed with leukemia.
Just by the way, the flow limitation graph
Is at the bottom of the snapshot you sent. There is no report on the left side (with the indices), because there is no flow limitation index standard.
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Re: Flow limitation issue and pressure
Thanks for the feedback
Here is the screenshot including the left column summary with the statistics .
By the way the AHI's for this night ( 2.02) are unusually high .Usually they are well below 1, but the flow limit is always within the same 0.15-0.35 range regardless of the AHI score. If it is not normal, I'd like to understand how this can be determined looking at the graph.
Regarding the suggestion to see my family doctor for more in-depth exams ( blood tests, etc) to detect other possible causes for fatigue, sleepiness, etc, , I have regular checkups and I recently had a thorough blood test for metabolic issues, Everything was normal.
Thanks
Franco
Here is the screenshot including the left column summary with the statistics .
By the way the AHI's for this night ( 2.02) are unusually high .Usually they are well below 1, but the flow limit is always within the same 0.15-0.35 range regardless of the AHI score. If it is not normal, I'd like to understand how this can be determined looking at the graph.
Regarding the suggestion to see my family doctor for more in-depth exams ( blood tests, etc) to detect other possible causes for fatigue, sleepiness, etc, , I have regular checkups and I recently had a thorough blood test for metabolic issues, Everything was normal.
Thanks
Franco
- screenshot-Apr 22 Latest .png (106.58 KiB) Viewed 858 times
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- screenshot-Apr 22 Latest .png (106.58 KiB) Viewed 858 times
Re: Flow limitation issue and pressure
Good to get that out of the way!
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Re: Flow limitation issue and pressure
Your flow limitation graph is fairly active. Not horribly horrible active but fairly active.
See this FL graph...it's boringly inactive.
Is it possible that you are experiencing some nasal congestion?
If so it is possible that the machine is experiencing the reduction in air flow that goes with nasal congestion. Not much we can do about nasal congestion FLs except try the usual OTC stuff we use to help relieve nasal congestion.
The machine will try the more pressure thing but more pressure won't fix FLs that are nasal congestion related.
Now it is possible the the FLs are related to airway issues. Unfortunately the machine cannot distinguish between FLs cause by nasal congestion or airway issues. It treats both the same and usually it will try to increase the pressure a bit because FLs that are airway related are early warning signs that the airway is trying to collapse. Think of them as baby OAs or hyponeas but since your AHI is normally very low they aren't growing up to be full grown apnea events of some sort.
The thing about FLs is they can also cause sleep quality disturbances and anything that messes with our overall sleep quality will also mess with how we feel during the day. If we don't sleep so well (no matter what the reason) then we don't feel so great during the day.
First questions we ask when someone complains of not feeling so great and there's really nothing obvious showing up on the software reports:::
1..So how is your overall sleep quality??? Sleep soundly for the most part or do you find yourself waking up frequently during the night???
2..Medication side effects??? Are you taking any medications and if so, what? Even OTC.
3..Any other physical or mental conditions going on that might be impacting sleep or how you feel in general?
Now while it wouldn't be impossible for the FLs to be impacting your sleep quality and/or how you feel during the day.... I kinda doubt it but you could try just a little more minimum pressure just to see if the FLs reduce and/or you feel any better during the day. Like maybe a 1 cm increase in the minimum pressure. It is something that is easy to try and get an answer to that question. Especially if you are reporting a lot of wake ups during the night.
If you are sleeping soundly during the night with maybe only a handful of wake ups then I really have my doubts as to your fatigue in the day issues being related to airway issues and when that happens we have to look at other possible causes of your unwanted daytime symptoms. Like medication side effects or other physical or mental issues.
There is a miles long list of culprits for daytime fatigue or excessive sleepiness....not everything is airway related and cpap can only fix problems related to airway issues.
I can see where someone might advise a pressure adjustment to deal with the FLs but I am not so sure it will help.
Usually the first thing we might advise is to add EPR to the mix but you are already using EPR set at 3 which is the max so the next thing is add in more minimum pressure. Airway issues that are causing FL graph activity will usually respond to just a little increase in the minimum.
Now if you know you are experiencing nasal congestion....the advice isn't to increase the pressure but instead try to deal with the congestion in the normal standard ways...OTC decongestants, nasal rinses, etc.
To fix a problem we have to first try to identify the problem. I don't know that your FLs are the cause of your unwanted symptoms but it wouldn't be impossible. Hurts nothing to try though.
See this FL graph...it's boringly inactive.
Is it possible that you are experiencing some nasal congestion?
If so it is possible that the machine is experiencing the reduction in air flow that goes with nasal congestion. Not much we can do about nasal congestion FLs except try the usual OTC stuff we use to help relieve nasal congestion.
The machine will try the more pressure thing but more pressure won't fix FLs that are nasal congestion related.
Now it is possible the the FLs are related to airway issues. Unfortunately the machine cannot distinguish between FLs cause by nasal congestion or airway issues. It treats both the same and usually it will try to increase the pressure a bit because FLs that are airway related are early warning signs that the airway is trying to collapse. Think of them as baby OAs or hyponeas but since your AHI is normally very low they aren't growing up to be full grown apnea events of some sort.
The thing about FLs is they can also cause sleep quality disturbances and anything that messes with our overall sleep quality will also mess with how we feel during the day. If we don't sleep so well (no matter what the reason) then we don't feel so great during the day.
First questions we ask when someone complains of not feeling so great and there's really nothing obvious showing up on the software reports:::
1..So how is your overall sleep quality??? Sleep soundly for the most part or do you find yourself waking up frequently during the night???
2..Medication side effects??? Are you taking any medications and if so, what? Even OTC.
3..Any other physical or mental conditions going on that might be impacting sleep or how you feel in general?
Now while it wouldn't be impossible for the FLs to be impacting your sleep quality and/or how you feel during the day.... I kinda doubt it but you could try just a little more minimum pressure just to see if the FLs reduce and/or you feel any better during the day. Like maybe a 1 cm increase in the minimum pressure. It is something that is easy to try and get an answer to that question. Especially if you are reporting a lot of wake ups during the night.
If you are sleeping soundly during the night with maybe only a handful of wake ups then I really have my doubts as to your fatigue in the day issues being related to airway issues and when that happens we have to look at other possible causes of your unwanted daytime symptoms. Like medication side effects or other physical or mental issues.
There is a miles long list of culprits for daytime fatigue or excessive sleepiness....not everything is airway related and cpap can only fix problems related to airway issues.
I can see where someone might advise a pressure adjustment to deal with the FLs but I am not so sure it will help.
Usually the first thing we might advise is to add EPR to the mix but you are already using EPR set at 3 which is the max so the next thing is add in more minimum pressure. Airway issues that are causing FL graph activity will usually respond to just a little increase in the minimum.
Now if you know you are experiencing nasal congestion....the advice isn't to increase the pressure but instead try to deal with the congestion in the normal standard ways...OTC decongestants, nasal rinses, etc.
To fix a problem we have to first try to identify the problem. I don't know that your FLs are the cause of your unwanted symptoms but it wouldn't be impossible. Hurts nothing to try though.
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Re: Flow limitation issue and pressure
Are you asking if it is normal to have the flow limit be independent of the AHI or are you asking if a 0.15-0.35 is a normal flow limit range?
In addition to Pugsey's comments, it might be helpful for you to understand how Resmed evaluates a flow curve to grade (on a scale of 0 to 1.0) what they call a flow limitation. The grading of flow limitations is not without controversy, so if you want to dig deeper help yourself.
However, as Pugsey suggests, your sporadic Flow Limitation excursions is probably not directly associated with your symptoms. Best to rule out other causes first.
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Miss Emerita
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Re: Flow limitation issue and pressure
There isn't a quantitative definition of what "heavy" flow limitations would be, and the median/95%/max numbers aren't terribly meaningful. That said, I'd say yours are pretty heavy.
I'm struck by your saying you've started feeling tired recently. Can you look back to see what your FLs were before you started feeling tired? If they were about the same then, then they are almost certainly not the culprit now.
I'm struck by your saying you've started feeling tired recently. Can you look back to see what your FLs were before you started feeling tired? If they were about the same then, then they are almost certainly not the culprit now.
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Re: Flow limitation issue and pressure
Thanks for your input. Good points. Here are my comments.Pugsy wrote: ↑Sun Apr 24, 2022 10:35 amYour flow limitation graph is fairly active. Not horribly horrible active but fairly active.
See this FL graph...it's boringly inactive.
Is it possible that you are experiencing some nasal congestion?
If so it is possible that the machine is experiencing the reduction in air flow that goes with nasal congestion. Not much we can do about nasal congestion FLs except try the usual OTC stuff we use to help relieve nasal congestion.
The machine will try the more pressure thing but more pressure won't fix FLs that are nasal congestion related.
Now it is possible the the FLs are related to airway issues. Unfortunately the machine cannot distinguish between FLs cause by nasal congestion or airway issues. It treats both the same and usually it will try to increase the pressure a bit because FLs that are airway related are early warning signs that the airway is trying to collapse. Think of them as baby OAs or hyponeas but since your AHI is normally very low they aren't growing up to be full grown apnea events of some sort.
The thing about FLs is they can also cause sleep quality disturbances and anything that messes with our overall sleep quality will also mess with how we feel during the day. If we don't sleep so well (no matter what the reason) then we don't feel so great during the day.
First questions we ask when someone complains of not feeling so great and there's really nothing obvious showing up on the software reports:::
1..So how is your overall sleep quality??? Sleep soundly for the most part or do you find yourself waking up frequently during the night???
2..Medication side effects??? Are you taking any medications and if so, what? Even OTC.
3..Any other physical or mental conditions going on that might be impacting sleep or how you feel in general?
Now while it wouldn't be impossible for the FLs to be impacting your sleep quality and/or how you feel during the day.... I kinda doubt it but you could try just a little more minimum pressure just to see if the FLs reduce and/or you feel any better during the day. Like maybe a 1 cm increase in the minimum pressure. It is something that is easy to try and get an answer to that question. Especially if you are reporting a lot of wake ups during the night.
If you are sleeping soundly during the night with maybe only a handful of wake ups then I really have my doubts as to your fatigue in the day issues being related to airway issues and when that happens we have to look at other possible causes of your unwanted daytime symptoms. Like medication side effects or other physical or mental issues.
There is a miles long list of culprits for daytime fatigue or excessive sleepiness....not everything is airway related and cpap can only fix problems related to airway issues.
I can see where someone might advise a pressure adjustment to deal with the FLs but I am not so sure it will help.
Usually the first thing we might advise is to add EPR to the mix but you are already using EPR set at 3 which is the max so the next thing is add in more minimum pressure. Airway issues that are causing FL graph activity will usually respond to just a little increase in the minimum.
Now if you know you are experiencing nasal congestion....the advice isn't to increase the pressure but instead try to deal with the congestion in the normal standard ways...OTC decongestants, nasal rinses, etc.
To fix a problem we have to first try to identify the problem. I don't know that your FLs are the cause of your unwanted symptoms but it wouldn't be impossible. Hurts nothing to try though.
1. Ref. nasal congestion
Yes!!! I have had a chronic nasal congestion for years. It blocks my nasal breathing almost entirely and I normally breathe through the mouth.
My doctor prescribed cortisone spray, but I use it only when the congestion is at its worth. I have learned how to live with it. I hear about a nose-cleansing machine called Navage ( advertised in Canada) . It allegedly cleanses the sinuses and nasal cavities pretty well. I'll have a look at it.
I wonder, though, if the nasal flow limitation is what causes my sleepiness /fatigue, because it is fairly recent, while my nasal congestion has been going on for years.
2. Sleep quality,
yes, I sleep soundly the whole night.
3. .Medication
I have been on medication for a few years for border line A1C ( Metformin) and borderline hypertension ( irbersartan).
In addition, two years ago, my cardiologist put me on betablocker ( Metoprolol) and blood thinner( Eliquis) following a totally unexpected episode of atrial fibrillation when I was about to start my running session. . It never happened before and I didn’t feel a thing. Only the cardio watch picked up a 180 bpm tachycardia at rest and I decided to run to the ER. .
I doubt, though, that my sleepiness and slight fatigue are related to the medication, because they are fairly recent and I never experienced them after going on medication two years ago.
4.Other possible conditions impacting sleep or how I feel in general?
Possibly my weight. I weigh 90 kg at 172 cm height and my weight has been steadily increasing for a few years, in spite of my active life-style ( running, windsurfing, etc. ) and my sensible diet. It could be age-related metabolic slow-down ( I am 80) or also the medication The betablockers seem to be linked to weight gain. .
Disappointingly, I hit a wall, because I cannot shed even one pound, no matter how many calories I burn on the treadmill or running outdoors several times a week.
My GP has now referred me to a dietician, but her guidelines are the same I' ve been following on my own…So I doubt there will be any weight loss..
I’ll book an appointment with my sleep specialist regarding the sleepiness/fatigue and FL issue. The last follow-up I didn’t mention it because it hadn’t come up yet . He just looked at the AHI’s data and said everything was OK.
Thanks
Ittiandro
Re: Flow limitation issue and pressure
Ahhh....the FL activity could possibly be related to any nasal congestion.
More pressure is unlikely to fix that.
Good that you are planning to see your doctor and get his/her help in trying to figure out the problem.
While I know that we all would like it if our problems were always related to the airway so that cpap can fix them. The cold hard fact of life is that it isn't always that easy. I always say that getting the good numbers is the easy part but feeling them is a whole different story.
These unwanted symptoms were sudden and anytime we have a sudden change in something that we can't put a finger on the cause it is always a good idea to get with our medical care team and have their help in trying to sort out the issues.
We have no idea what might have changed in our bodies but something changed.
I wish I could say that something on your report is just standing out screaming "fix me and you will feel better" but I just don't see it. You are sleeping soundly for the most part and you are getting a decent amount of sleep and nothing is screaming "fix me". Time to investigate other potential culprits.
More pressure is unlikely to fix that.
Good that you are planning to see your doctor and get his/her help in trying to figure out the problem.
While I know that we all would like it if our problems were always related to the airway so that cpap can fix them. The cold hard fact of life is that it isn't always that easy. I always say that getting the good numbers is the easy part but feeling them is a whole different story.
These unwanted symptoms were sudden and anytime we have a sudden change in something that we can't put a finger on the cause it is always a good idea to get with our medical care team and have their help in trying to sort out the issues.
We have no idea what might have changed in our bodies but something changed.
I wish I could say that something on your report is just standing out screaming "fix me and you will feel better" but I just don't see it. You are sleeping soundly for the most part and you are getting a decent amount of sleep and nothing is screaming "fix me". Time to investigate other potential culprits.
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Re: Flow limitation issue and pressure
You didn't mention it (or I missed it).....I assume that you are using a full face mask.
The information provided on Cpaptalk.com is not intended nor recommended
as a substitute for professional medical advice.
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Re: Flow limitation issue and pressure
when did you become owner of cpaptalk.com?
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but that's enough about them.
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https://www.apneaboard.com/OSCAR/OSCAR-1.5.1-Win64.exe
Oscar-Mac
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but that's enough about them.
Oscar-Win
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1-Win64.exe
Oscar-Mac
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1.dmg
Re: Flow limitation issue and pressure
@zonker
Just a reminder
Just a reminder
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Re: Flow limitation issue and pressure
_________________
| Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
| Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
people say i'm self absorbed.
but that's enough about them.
Oscar-Win
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1-Win64.exe
Oscar-Mac
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1.dmg
but that's enough about them.
Oscar-Win
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1-Win64.exe
Oscar-Mac
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1.dmg
Re: Flow limitation issue and pressure
Sigh....
Don't you just love it when someone wants to treat you like a stupid child with no common sense or ability to read or think for yourself?? Self appointed forum advice warning police has decided to take up a new hobby I guess.
That statement is at the bottom of the main forum page for anyone and everyone to read for themselves right here.
Every day...all day.
It is also the same statement that is at the bottom of any forum out there where medical conditions of any kind are discussed. I guess some people think that isn't enough and have decided to make it their life's goal to warn everyone because we are too stupid to realize it without it being shoved in our faces.
The thing I hate most is being treated like I don't have a brain of my own and lack the ability to think for myself.
So with all that said....back to being directly on topic without comments about the comments and move on.
It's not worth taking up forum bandwidth space.
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Re: Flow limitation issue and pressure
Regarding Flow limitations, here is an informative thread from last year that may help explain more about the FL event:
https://www.cpaptalk.com/viewtopic/t183 ... ac37d5e329
If your FL events are caused by nasal congestion, increasing the machine's set pressures (currently 12 to 20) is not likely to fix that, particularly if you are a mouth breather.
_________________
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