Encore Viewer 2 numbers? Assistance for clueless?

[Underdog]

The software arrived in the mail today and I have an appointment with my neurologist tommorrow afternoon. I have not had time yet to read up on what this data really means. (although I plan to). Any clues here? Does anything stand out as out of the ordinary? Any good questions to ask?
When I look at the data from 6/15/10 through 7/24 here's what I see:

CPAP Pressure 8.0
Average % of Night in Periodic Breathing 9.5%
Average CA Index 10.6
Average OA Index 0.7
Average Hypopnea Index 6.5
Average RERA Index 1.5
Average AHI 17.8
Average FL Index 0.0
Average VS Index 1.6
Average % Night in Large Leak 1.3%
Average Large Leak 5 mins. 8 secs.

You can see a difference when the pressure was changed from "6" to "8" on July 8th.

Legend: P - Pressure, MaP - Minutes at Pressure, % - Percent of Night, FL - Flow Limitation, VS - Vibratory Snore, PB - Periodic
Breathing, CA - Clear Airway Apnea, RE - RERA, H - Hypopnea, OA - Obstructed Airway Apnea, AHI - Apnea/Hypopnea
Index

[Underdog]

There is also data for 7 individual days:

[Hawthorne]

I think you need to work on those large leaks. Are you mouth breathing or is it the mask?

Your pressure is possibly a little low as well. What was your titrated pressure? I'm thinking that 10 cm might work better for you with all those CAs.

[Underdog]

I think you need to work on those large leaks. Are you mouth breathing or is it the mask?

Your pressure is possibly a little low as well. What was your titrated pressure? I'm thinking that 10 cm might work better for you with all those CAs.

I think I titrated at 5.7
I called and requested a copy of the sleep study. So I'm just going by my notes which aren't the greatest.

[deerslayer]

agree with Hawthorne,L leak out of control. titrated 5 is like a ramp pressure (training wheels). perhaps a higher range in auto would be worth asking doc once you find a proper fitting mask you can tolerate. in any event Kudos for taking interest in your treatment-- to know is everything, Good Luck !

[Underdog]

Which of the numbers should I be watching with respect to leaks?
The "Average % Night Large Leak" that shows up in the "long term trend" chart at 1.3%?
or
the daily data under "Average Leak" number that show up anywhere from the 20's to 30's ?
What should these leak numbers look like?
Are there any good "sample" graphs from Encoreviewer that I can compare? (I see RESMED charts posted and some of the older EncoreViewer 1.0 charts but those look different).

[Hawthorne]

I look at page 4 of the daily reports for leaks - bottom section "Total Leaks". On the green line line the black indicates a large leak. Also, you "Average large leak". you sholuld try to not have any large leaks. It could be mask fit or mouth breathing though.

You have a high number of CAs as well. It stills looks to me as if your pressure it not high enough but you need to work on leaks as well.

[Underdog]

I look at page 4 of the daily reports for leaks - bottom section "Total Leaks". On the green line line the black indicates a large leak. Also, you "Average large leak". you sholuld try to not have any large leaks. It could be mask fit or mouth breathing though.

You have a high number of CAs as well. It stills looks to me as if your pressure it not high enough but you need to work on leaks as well.

I thought that the "black" large leak on page "4" was when I got up in the morning to use the lavoratory and then returned to sleep until 7:30 a.m. Am I supposed to turn the machine off when I make a break like that? I suppose I could turn on the "auto off" function but the idea of the machine suddenly deciding on its own to cut off my air scares the heck out me.

[Hawthorne]

I don't use "auto off" but I do turn off my machine if I get up to go to the bathroom. I leave my mask on and just disconnect the hose. I have a "quick connect" (available at cpap.com) on my main hose so the wear and tear on the hose is less from disconnecting and reconnecting.

[Underdog]

I don't use "auto off" but I do turn off my machine if I get up to go to the bathroom. I leave my mask on and just disconnect the hose. I have a "quick connect" (available at cpap.com) on my main hose so the wear and tear on the hose is less from disconnecting and reconnecting.

With respect to a potentially leaking mask, I see a long "green" bar that runs along the top of the graph that is called "normal mask fit." I thought that as long as my "total leak" line (dark blue) was below that green line that I was "OK."
What is that "normal mask fit"?

[echo]

Your pressure is possibly a little low as well. What was your titrated pressure? I'm thinking that 10 cm might work better for you with all those CAs.

Hi Hawthorne, what am I missing in your reasoning to increase pressure to combat Central Apnea's? In most cases a higher pressure actually induces the CAs, so I would be inclined to suggest reducing the pressure. On the OTHER hand Underdog, you seemed to get a fair amount of CAs at both 6cm and 8cm. I wonder if those aren't related to arousals and/or leak problems. Oooor you are prone to CAs! What, if anything, did they say about CAs during your titration?

Therefore, leaks need to be worked on first. Agreed that without reliably low leak rates, it's hard to troubleshoot. Your last leak rate on the 20th was fairly OK, and it's difficult to conclude anything from the Large Leak montly overview on the first graph since they're probably due to the bathroom breaks.

[Hawthorne]

Here is my page 4 from last night. I have an auto and it is set at 10.5 cm to 13 cm. You can see that I have no large leaks and there are no spikes in my leak line. This is a fairly typical night for me.

I had 2.5 CAs last night and that's about normal for me. They mainly happen when I am awake, which may be anothe clue in your situation, Underdog.

Echo - I am suspicious that his current pressure is not handling CAs. That's why I suggested a higher pressure. Yes, higher pressures can induce CAs but sometimes the pressure is not high enough to catch them. Which is it in this case? I don't know for sure and controlling the leaks may tell us more.

Certainly, the leak situation has to be addressed first. As my chart shows, I was up to the bathroom once last night and there are no black marks (large leaks) showing when I was up. I always turn the machine off when I get up to the bathroom with the quick disconnect on my main hose. In fact, I have no large leaks at all and very, very rarely have them. The large leak's on underdog's chart may be from leaving machine on while he was up. I've never done that so can't say for sure.

When I was using the M Series, I expect I was getting some CAs (a couple a night are normal) but Encore Viewer 1.0 did not show CAs. My AHI with the M Series, was almost always below 1 but, with this software showing CAs, I see them and my AHI is just the CA number higher than I had on the M Series.

Leaks need to be addressed and then underdog can maybe get that AHI, which is mainly CAs, down.

Underdog - by "normal mask fit", I suspect you mean the mask vent rate, which is the leak that the machine will compensate for at your pressure setting. You need to find the leak/vent rate chart in your mask manual to tell you that. Your leak rate is lower than mine but I am at a higher pressure setting. So yours is too high for your pressure. The machine will compensate for more leak at my pressure setting(s).

I'm not sure I am explaining this well but maybe someone else will jump in too!!

[echo]

Explanation sounds ok to me! I'd add that the 'normal mask fit' green line probably should not be read as the limiting leak rate. It looks more like a visual representation of normal mask fit versus large leak, see graph from 7/19. As Hawthorne said you should check your mask's vent rate at your pressure, and try to stay as close to that as possible. Example: I'm usually within 6 liters/min from the mask's normal vent rate.
But anyway I'm no expert on the Respironics graphs so I could be misinterpreting the green line.

As for the CAs.... Central Apnea's are not caused by a collapsed airway, so no amount of pressure can 'dislodge' that, so to speak. It is a neurological problem (related to CO2 retention etc etc, many threads on the real explanation), so I doubt that a higher pressure will help... UNLESS he is waking up because the pressure is insufficient or there's leaking, and as he's waking up or falling back asleep he has a CA.

The waking up/falling asleep CAs are quite normal and are no cause for concern. So I too would like to see a flat leak line before we start chasing CAs.
On the other hand, if CAs were noted on the PSG, then it is very well a reason to have concern. I'm sure you've posted this info before Underdog, but I'm not being very thorough at the moment and looking it back up. Sorry!

I suppose different machines mark CAs differently, especially the newer ones. I don't really follow those discussions here so I couldn't tell you why you might get different scores.. but one or two per night vs. none or one is not cause for concern either. Sometimes they're just artifacts anyway, like when we hold our breath as we take a different sleeping position.

[Hawthorne]

Echo - you are correct about the CAs. They may well be happening when Underdog is awake. That's when mine happen. A brief awakening in the night, even if I don't get up and I fall back to sleep fairly quickly, will register a CA so that could be the case here too.

We still have to many variables and unknowns but things will sort out as we proceed!

Leaks first!

[Underdog]

This is very helpful. I will compare my CA's with the sleep study when I get that report. I am also going to try the "tennis ball" trick to see if I can quanlify that impact. I start out sleeping on my side stomach but I have no idea if I stay that way. I may hook up a video camera and leave a light on.