Help with MyEncore data/charts

Hi All,

I have a Remstar Auto with A-Flex (pre-2007) and the Encore Pro and MyEncore software, and have gotten it working.

I am experiencing sleep issues (and some reflux/aerophagia I think). Is there a way in Encore Pro or MyEncore to look at a particular night, hour by hour? I know when the "bad stuff" happens, and would like to look at events and pressures during those hours, compared to earlier in the night.

I don't see an obvious way to do that, even in MyEncore. It looks like the data are always rolled up into a single day. Is there a way to look at the data hour-by-hour?

Thanks much.

Chris

The latest version of EncoreBasic supports detailed wave form data if your machine will record it. You can download the most recent version here: http://www.apneaboard.com/forums/Thread ... s-Machines

The wave form data appears as a symbol on the history tab, right in front of Summary. It is a breath by breath history of the most recent night and displays over 10 pages of PDF output.

Needless to say, you're due for an upgrade. I had 19000 hours on my M-Series Auto when I retired it this past December. The new machines are a lot better in therapy and data.

cby1 wrote:Hi All,

I have a Remstar Auto with A-Flex (pre-2007) and the Encore Pro and MyEncore software, and have gotten it working.

I am experiencing sleep issues (and some reflux/aerophagia I think). Is there a way in Encore Pro or MyEncore to look at a particular night, hour by hour? I know when the "bad stuff" happens, and would like to look at events and pressures during those hours, compared to earlier in the night.

I don't see an obvious way to do that, even in MyEncore. It looks like the data are always rolled up into a single day. Is there a way to look at the data hour-by-hour?

Thanks much.

Chris

All of the "detailed information" is in the Encore Pro "Sleep Therapy Daily Details" reports. (for each night)
It doesn't break down the details like some of the new machines do. It just shows when the events happen during the night or the hours you sleep (if you are generating the Full Details reports when you select and open your download from the "Interactions" list).

MyEncore is just a "data cruncher" to summarize the data in the data base and put it into graphics.
I've used both Encore Pro and MyEncore with my Legacy machines since I started in May of 2005.
Sounds like you have an M Series machine (since you mention that it has A-Flex).


Den

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Thanks Sleeprider. I suspect my machine is too old to be compatible with that software, but will check.

I know my machine is ancient. Going to have to figure out how go about getting a new one. I had a sleep study in 2013, with an AHI of 25.1 at 17 cm, I had a nadir O2 Sat of 66% - scary. Used to have an AHI of 5-6 with treatment, nadir O2 sat in high 80s. They recommended seeing a well-known sleep doc I've already seen (years ago, and he was of no help) at JFK Medical Center in NJ for a BiPAP evaluation.

I had set my REMStar Auto to 17-20 cm, and my AHI is almost always below 4, but I have a sense that something has changed. I wake up feeling awful, terrible anxiety, seems like some aerophagia (conscious this morning of repeatedly swallowing "past" something), and burping and gas. I would love to know if there's a pressure that's causing the aerophagia, so I could back off a bit.

I'd like to attach a .jpg of the AHI vs. Pressure graph from MyEncore - but not sure how?

Thanks,
Chris

Thanks Den,

Just looked at those - they're better than nothing - thanks.

During the problem hours (last 2 this morning) there were more OA events, and it looks like the pressure moved up to 20 cm. pretty quickly. I guess the question I would have is did the OA events cause it to go up in pressure, or did the rise in pressure somehow (aerophagia?) cause the increase in OA events?

Really at a loss here - I'm not lazy, but the thought of embarking on another odyssey up to JFK (or somewhere else) is a little daunting for me right now - pretty anxious and somewhat depressed, high-stress busy job. I guess I'll try to get my PCP to recommend a good sleep doc a little closer to me (Monmouth County, NJ). I also guess with the high pressures, investigating a BiPAP wouldn't be a bad idea.

Any other thoughts?

Thanks,
Chris

cby1 wrote:Thanks Den,

Just looked at those - they're better than nothing - thanks.

During the problem hours (last 2 this morning) there were more OA events, and it looks like the pressure moved up to 20 cm. pretty quickly. I guess the question I would have is did the OA events cause it to go up in pressure, or did the rise in pressure somehow (aerophagia?) cause the increase in OA events?

Really at a loss here - I'm not lazy, but the thought of embarking on another odyssey up to JFK (or somewhere else) is a little daunting for me right now - pretty anxious and somewhat depressed, high-stress busy job. I guess I'll try to get my PCP to recommend a good sleep doc a little closer to me (Monmouth County, NJ). I also guess with the high pressures, investigating a BiPAP wouldn't be a bad idea.

Any other thoughts?

Thanks,
Chris

You would want to look at other things like Snores and in particular Flow Limitations. NO MACHINE will attempt to stop an Apnea in progress (raise pressures). They (typically) only raise pressures on Snores and Flow Limitations.
Using a range of pressures MIGHT contribute to or exacerbate your aerophagia and the changing pressures may contribute to Flow Limitations if you have a subconscious reflex reaction to the changing pressures and the machine interprets it as a Flow Limitation. And, GERD-type conditions have been known to lead to runaway pressure increases. But, at the same time, the pressures you're using would easily justify a Bi-PAP/Bi-Level machine.

As you mentioned, it might be worth looking into.


Den

.

Your machine will work with Encore Basic or the newer Pro but won't show the wave form that Sleeprider mentioned because your machine doesn't collect it to make it available. You would need one of the newer PR System One machines and at a minimum a 50 series full data machine.

Someone has a brand new PR S1 model 460 Pro CPAP for sale including humidifier for $220 I think it is.
That machine will let you do what you want with both Encore showing the wave form and let you use SleepyHead to look even closer at the time frames you are wanting to look at.
It is mainly a cpap machine though with some limited apap capabilities...I think it is still on the first page of the forum.
If you want a full time APAP...I know of a model 560 PR S1 with humidifier for $400. Let me know if you are interested and I will provide further details...it's also brand new.

If you want to show us a report...check this thread for instructions on how to post images so we can see what you are seeing.
viewtopic/t103468/Need-help-with-screen-shots.html
In that thread is a link to how to post images using Imgur photo hosting site...pretty simple to do.
All we would need is an image of the detailed nightly report.

And yes...at your pressures you may find a bilevel pressure machine more agreeable to your needs. I have used bilevels and regular apap/cpap machines...and the bilevels are really sweet at those higher pressures.
They are a little pricier than the others but sometimes really good deals can be found that won't break the bank too badly.

cby1 wrote:Thanks Sleeprider. I suspect my machine is too old to be compatible with that software, but will check.

I know my machine is ancient. Going to have to figure out how go about getting a new one. I had a sleep study in 2013, with an AHI of 25.1 at 17 cm, I had a nadir O2 Sat of 66% - scary. Used to have an AHI of 5-6 with treatment, nadir O2 sat in high 80s. They recommended seeing a well-known sleep doc I've already seen (years ago, and he was of no help) at JFK Medical Center in NJ for a BiPAP evaluation.

I had set my REMStar Auto to 17-20 cm, and my AHI is almost always below 4, but I have a sense that something has changed. I wake up feeling awful, terrible anxiety, seems like some aerophagia (conscious this morning of repeatedly swallowing "past" something), and burping and gas. I would love to know if there's a pressure that's causing the aerophagia, so I could back off a bit.

I'd like to attach a .jpg of the AHI vs. Pressure graph from MyEncore - but not sure how?

Thanks,
Chris

My concern with the high AHI at high pressures is that you may be experiencing central apneas that would be more appropriately treated by ASV or S/T than BiPAP. Bilevel machines can give pressure relief on exhale, but they can't initiate a breath. The pressures you have used SHOULD open any airway. The machine you use only flags apnea as obstructive, even though it might be central.

I'm aware of a high level machine like that available, at a very reasonable cost through another forum member. I'm interested to hear if you sense that you have to consciously restart breathing occasionally.

Sleeprider wrote:

cby1 wrote:Thanks Sleeprider. I suspect my machine is too old to be compatible with that software, but will check.

I know my machine is ancient. Going to have to figure out how go about getting a new one. I had a sleep study in 2013, with an AHI of 25.1 at 17 cm, I had a nadir O2 Sat of 66% - scary. Used to have an AHI of 5-6 with treatment, nadir O2 sat in high 80s. They recommended seeing a well-known sleep doc I've already seen (years ago, and he was of no help) at JFK Medical Center in NJ for a BiPAP evaluation.

I had set my REMStar Auto to 17-20 cm, and my AHI is almost always below 4, but I have a sense that something has changed. I wake up feeling awful, terrible anxiety, seems like some aerophagia (conscious this morning of repeatedly swallowing "past" something), and burping and gas. I would love to know if there's a pressure that's causing the aerophagia, so I could back off a bit.

I'd like to attach a .jpg of the AHI vs. Pressure graph from MyEncore - but not sure how?

Thanks,
Chris

My concern with the high AHI at high pressures is that you may be experiencing central apneas that would be more appropriately treated by ASV or S/T than BiPAP. Bilevel machines can give pressure relief on exhale, but they can't initiate a breath. The pressures you have used SHOULD open any airway. The machine you use only flags apnea as obstructive, even though it might be central.

I'm aware of a high level machine like that available, at a very reasonable cost through another forum member. I'm interested to hear if you sense that you have to consciously restart breathing occasionally.

Regarding the Legacy and M Series Autos AND Encore Pro, with suspected "Central Apneas" they're noted on the Full Details report as "NR" (Non-Responsive) events.

But, yeah, the OP has some issues that are apparently being investigated with another sleep study and referral to another sleep doctor. "Treated" levels are still (theoretically) within an acceptable range.


Den

.

Wulfman... wrote:Regarding the Legacy and M Series Autos AND Encore Pro, with suspected "Central Apneas" they're noted on the Full Details report as "NR" (Non-Responsive) events.

No, they aren't necessarily noted as Non Responsive.
I talked directly to a Respironics software engineer about what the machine did when it thought it had centrals (because we knew it wouldn't respond so it sensed something) and was told that centrals got dumped in with the OAs and hyponeas and that's why we often saw reports showing solid blocks of hyponeas or OAs and the machine wasn't doing what we thought it would and people subsequently found out that they were centrals and ended up on ASV. I think if I remember right Bleeping Beauty was one of those people.
Non Responsive didn't automatically equal central in those M series and Legacy machines.

If someone has a low AHI on a M series or Legacy series machine it is unlikely that centrals are an issue...wouldn't be impossible but highly unlikely as long as the AHI is low because the centrals would be going into the OA or hyponea category of they were present.

Pugsy wrote:

Wulfman... wrote:Regarding the Legacy and M Series Autos AND Encore Pro, with suspected "Central Apneas" they're noted on the Full Details report as "NR" (Non-Responsive) events.

No, they aren't necessarily noted as Non Responsive.
I talked directly to a Respironics software engineer about what the machine did when it thought it had centrals (because we knew it wouldn't respond so it sensed something) and was told that centrals got dumped in with the OAs and hyponeas and that's why we often saw reports showing solid blocks of hyponeas or OAs and the machine wasn't doing what we thought it would and people subsequently found out that they were centrals and ended up on ASV. I think if I remember right Bleeping Beauty was one of those people.
Non Responsive didn't automatically equal central in those M series and Legacy machines.

If someone has a low AHI on a M series or Legacy series machine it is unlikely that centrals are an issue...wouldn't be impossible but highly unlikely as long as the AHI is low because the centrals would be going into the OA or hyponea category of they were present.

I didn't SAY that they're automatically equal to centrals!
A "non-responsive" event is just that.......non-responsive.

But, here is the text regarding Non-Responsive events from the .xml file for the AutoAlgorithm demonstration program which Respironics put out back then.

Den
.

NR = Non-Responsive Apnea/Hypopnea event

Above 8 cmH2O pressure, the pressure increase for sustained apneas/hypopneas is limited to 3 cmH2O above the pressure setting at the onset of the apnea/hypopnea sequence.
The pressure setting at the onset of the sequence is called the "Onset Pressure."
The pressure 3 cmH2O above the "Onset Pressure" is called the "NRAH Threshold."
"NRAH" is an acronym for "Non-Responsive Apnea/Hypopnea.

An apnea/hypopnea x2 event detected after reaching the NRAH Threshold is considered to be non-responsive.

A special case of Non-Responsive A/H is when the events are hypopneas only, with no apneas.

After seeing two Hypopneas, the algorithm increases the pressure by 1 cmH2O, and the Onset Pressure resets to this new pressure level.

However, the Onset Pressure can not be raised above 12 cmH2O by a sustained string of Hypopnea-only events.
This does not imply that the Onset Pressure value can not be set above 12 cmH2O. It only states that the Onset Pressure can not be <b>RESET</b> above 12 cmH2O due to a string of Hypopnea-only events.
The maximum NRAH Threshold due to a sustained string of Hypopnea-only events will be 3 cmH2O above 12 cmH2O.

When the device encounters a non-responsive apnea or hypopnea, it will decrease pressure by 2 cmH2O and hold the pressure for 15 minutes.
During this 15-minute "NRAH-hold" period, the pressure will be changed only in response to detection of a sequence of vibratory snore events.
The reason for this increase in pressure followed by a decrease in pressure when an apnea/hypopnea is not responsive is to allow the device to respond appropriately to an event that is not treatable by increases in pressure, such as a central apnea.

.

Edit to add the following.

And, from another Respironics document I found in my saved archives:

NON RESPONSIVE APNEA/HYOPNEA EVENT OR CENTRAL PREDICTOR

• NR Events differentiated from obstructive apneas & hypopneas
• Above 8 cm., pressure increases for a sequence of sustained apneas/hypopneas will be limited to a 3 cm increase
• If detection continues a 2 cm decrease in pressure and a 15 minute hold period is engaged
• In theory, we are assuming central events {goal: not to significantly increase pressure when this condition is detected
• Logged as NR on SmartCard
• If snoring occurs, pressure increase +1 cmH20, Ptherapy state re-initiated


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Wulfman... wrote: I didn't SAY that they're automatically equal to centrals!

and I didn't SAY that you said that. I should have started a new paragraph...my only comment directed about what you said was that very first line...NR's aren't necessarily centrals because you pretty much said "

Wulfman... wrote:with suspected "Central Apneas" they're noted on the Full Details report as "NR" (Non-Responsive) events.

and that's not where they normally go. Now they might go there but it isn't a given that just because someone doesn't have any NRs that they aren't having centrals.

My apologies if you thought that was what I was inferring that you thought NRs were equal to centrals... It was just a generalized statement because a lot of people think non responsive automatically means central and it doesn't.
The software engineer that I spoke to specifically told me that centrals went into the OA and hyponea bin...that non responsive was something totally different.
Probably explains why those older machine reports from people like Bleeping Beauty didn't show NRs but showed a truckload of hyponeas and OAs.

It took me some time and effort to finally get to one of the software engineers that actually understood my question.
Now maybe he was all wet. Wouldn't be the first time someone told me something that turned out to be a big mistake.

Thank you both for the information. When I have a bit more time, I need to post some images of the reports, per the URL above.

When I talked earlier about the OAs going up with higher pressure:

> During the problem hours (last 2 this morning) there were more OA events, and it looks like the pressure moved up to 20 cm. pretty quickly. I guess the question I would have is did the OA events cause it to go up in pressure, or did the rise in pressure somehow (aerophagia?) cause the increase in OA events?

I neglected to mention that the Hypopneas went up as as well. Still wondering if the pressure is increasing in reaction to increased events, or if the increase in pressure is somehow *causing* more events.

Can high pressures *cause* centrals? (I suspect this is a controversial area, but it seems to me I've seen something about that somewhere).

Thanks,
Chris

cby1 wrote:Thank you both for the information. When I have a bit more time, I need to post some images of the reports, per the URL above.

When I talked earlier about the OAs going up with higher pressure:

> During the problem hours (last 2 this morning) there were more OA events, and it looks like the pressure moved up to 20 cm. pretty quickly. I guess the question I would have is did the OA events cause it to go up in pressure, or did the rise in pressure somehow (aerophagia?) cause the increase in OA events?

I neglected to mention that the Hypopneas went up as as well. Still wondering if the pressure is increasing in reaction to increased events, or if the increase in pressure is somehow *causing* more events.

Can high pressures *cause* centrals? (I suspect this is a controversial area, but it seems to me I've seen something about that somewhere).

Thanks,
Chris

Well, the answer is a qualified "Yes". According to statistics, there is about 15% of the folks who MAY be subject to "pressure induced Centrals". This is one of the reasons that the previous generations of ResMed Auto machines (S8 and prior) used the "A10" algorithm.......which was designed to not aggressively pursue apnea events above the pressure of 10 cm.
The manufacturers had different algorithms to try to avoid pressure induced Centrals, but that was ResMed's answer.


Den

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cby1 wrote: Can high pressures *cause* centrals?

Yes it definitely can but higher pressures don't always cause centrals. The % of people who have it happen is actually relatively small. Last I read 10 to 15 % of cpap users.
I myself have seen pressures upwards of 20 often without any or maybe only one or two centrals happening. So my higher pressures didn't cause me to have central issues. Plus there's a lot of bilevel users with pressures constantly in the 20s without problematic centrals.
It's not as common as some people might think.

Actually centrals can be caused by as little as 6 cm pressure so it doesn't always have to be "high" pressure.
Everyone tends to think about the higher pressure risk but it can happen at the lower end also. It can happen at any pressure.