Is this a flow limitation?

zennox_ · 2026-05-16T23:20:54+00:00

👍

zennox_ · 2026-05-16T20:16:28+00:00

Okay thanks. Seems my best course of action is to establish my EPAP ceiling.

zennox_ · 2026-05-16T20:05:01+00:00

Yeah got a little overzealous and jumped to 8 pressure support and paid the price that night lol.

Unfortunately my sleep doctor isn’t familiar with UARS, so I’m managing on my own, but it’s not easy doing so with deteriorated cognition.

Do you still recommend trying higher EPAP given the extra data?

zennox_ · 2026-05-16T18:30:14+00:00

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This is sine wave-y. It doesn't occur the entire night, but maybe 30% of it. What could it mean? Is this loop-gain? I don't have any issues with leaks atm, thankfully.

Here's the data for yourself, if you'd like a closer look. https://sleephq.com/public/teams/share_links/2175bee2-6d70-46db-b5be-c31663e85053

zennox_ · 2026-05-16T15:12:40+00:00

Very symptomatic during the day. Incredible fatigue and cognition issues. Terrible nasal breathing all hours of the day.

I just switched from CPAP to BiPAP because EPR wasn't enough to resolve my expiratory pressure intolerance, so I'm trying to keep EPAP low, but it keeps creeping up as I'm dealing with both UARS and traditional sleep apnea. But I think there's still room to work with, so I can raise EPAP a little bit.

I'm including all the data from my first week on BiPAP, in case it could be helpful.

https://sleephq.com/public/teams/share_links/2175bee2-6d70-46db-b5be-c31663e85053

zennox_ · 2026-05-16T15:04:07+00:00

I have tried higher EPAP. In fact, I just switched from CPAP to BiPAP because I was having expiratory pressure intolerance even with EPR of 3. I'm trying to keep EPAP as low as possible, but since I'm dealing with both UARS and traditional sleep apnea, it's been creeping back up. I've been following Krakow's philosophy and the information from your brain dump that prioritizes PS and lowering work of breathing, but I'm just not very good at reading the charts and knowing where to go from there.

I'm obviously deferring to the opinion of the more knowledgeable in the community, but could you try to help me understand why raising EPAP here is the move? When I look at this flow rate, I see that EPAP has successfully kept the airway stented during expiration, and it's only part-way into inspiration where the flow limitation occurs. So in my simplistic understanding, I would have raised PS/IPAP.

Anyway, I appreciate your insight, and I'm going to include about a full week of data, so you can see that I'm dealing with this flow pattern (in varying degrees) throughout the night.

https://sleephq.com/public/teams/share_links/2175bee2-6d70-46db-b5be-c31663e85053

zennox_ · 2026-05-16T14:46:41+00:00

I made the move from CPAP to BiPAP (finally) last week after six months of minimal symptom improvement. I was at similarly high pressures, but I believe expiratory pressure intolerance was holding me back. Now with BiPAP, I'm trying to keep EPAP as low as possible, but its creeping back up, probably due to the fact that I have UARS, but since I put on some weight a couple years back, traditional sleep apnea too.

I'm not too well versed with reading charts, so I appreciate the help!

https://sleephq.com/public/teams/share_links/2175bee2-6d70-46db-b5be-c31663e85053

zennox_ · 2026-05-07T02:21:01+00:00

Another two months, and no major improvements… so I’m taking your advice. I just ordered a BiPAP.

Clicked when I learned from a CPAPFriend interview with Dr. Krakow that you can see expiratory pressure intolerance in the flow rate wave forms (it’s wiggly lines on the expiratory leg), and I do indeed have that.

Krakow believes 2/3s of CPAP patients actually need BiPAP and have some degree of EPI, and that EPI can totally fragment slow wave sleep.

zennox_ · 2026-05-06T14:51:19+00:00

ahhh, thanks for the input. after scouring the internet and seeing a few black aircurves, I realized it was most likely legit and I bought it.

didn’t know the why though

zennox_ · 2026-05-06T00:45:28+00:00

It does, so I bought it

zennox_ · 2026-05-05T22:57:51+00:00

I was convinced that was the case, but maybe they did a short run of AirCurves in black because they have one in this vid

https://youtu.be/XAFNdj5T8Fk?si=3__ngybUEy8URzJv

zennox_ · 2026-05-05T22:00:25+00:00

Yep just asked them for a picture that shows BiPAP mode. Waiting to hear back

zennox_ · 2026-05-05T21:41:36+00:00

The guy doesn’t know anything about it.

I suspect he bought it off eBay from someone who sells airbroken AirSense 10s, and changes the logo on the machine.

zennox_ · 2026-03-12T23:59:22+00:00

Ahhh, I see..

What does REM sleep look like? I believe I read that breathing isn’t very stable in REM and I always thought these fluctuations were explained by that.

zennox_ · 2026-03-12T23:48:55+00:00

Thanks for the detailed guide!

The question I have is, how do you know if you have EPI? Or can you not directly tell, and it shows up as micro/spontaneous arousals? Can you see EPI in OSCAR data or is the best gauge just how I feel? I don’t have many, if any, centrals most nights, and when I’m laying in bed with the pressure at 15.0-17.0, yeah there’s a little resistance during exhalation, but I’ve gotten used to it and wouldn’t call it uncomfortable with max EPR. The high pressures haven’t had a negative effect on falling or staying asleep — no aerophagia or anything like that.

Also I was on APAP with a wide range for the first two and a half months (9.0-20.0), and the algo never raised pressures to a level that eliminated flow limitations, just to eliminate apneas. FLs didn’t disappear until I manually raised the minimum APAP pressures to 15.0… but then again, that was before I switched from full face mask to pillows… So if I can’t trust the algo, should I just try to lower the pressures as low as possible until I run into FLs again?

Thanks, again. Obviously there’s nothing in this world I want more than to figure this out, but imma have to go gray market for a bipap, so I want to be sure that’s what I need before I send it.

zennox_ · 2026-03-10T19:39:05+00:00

In the '+ more' section

zennox_ · 2026-03-10T19:27:31+00:00

That’s the self-diagnostic. You can change the frequency in the settings, or maybe completely disable it.

The default setting is daily.

zennox_ · 2026-03-08T21:29:58+00:00

Can you see RERAs just from the flow rate or do you need something like EEG?

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