Newbie - Interpreting Encore reports...Alcohol effect

I am in my first month of Bipap usage (13-18 pressure wiht 12 breaths/min), and I just got my encore viewer and card reader in the mail a couple days ago. The results seem to be confusting to me.

Of the 8 days of data on my card (my doc had deleted the previous data at my first followup), 3 of the days I had went to be with a alcolol buzz. On those three nights, the maching read that I had 117, 85, and 70 apneas. On the other 5 nights when I went to be sober, the machine read 271, 247, 323, 238, 243 apneas. The leak rates for all nights were right consistently 46-50, which is in line with mask documentation at my pressure levels.

My questions are...
Should I really interpret that I am having that many Apneas, or are these machines known to "overreport" the actual levels.

Does it make sense that I would have a marked decrease in apneas on the nights that I have had alcohol. I would have guessed the opposite.

I have a respironics bipap S/T

That's an awful lot of apneas......regardless of whether you were "under the influence" or not.
Do you have a copy of your sleep study? What does it say? What is the basis for your using an S/T machine?
By the way, which mask are you using?

I'm not at all familiar with that particular machine, but saw your post sliding down the page with no responses and thought if you could provide more information (including filling out your user profile), then you might get some responses from those who use S/T machines or who are more familiar with any subsequent information you can provide.

I'm guessing there were issues with Central Apneas, so please provide as much information about your condition as is possible.


Den

If I had health concerns, I wouldn't be letting "Alcohol Effects", my ability to get my XPAP treatment the best I could. Jim

You need to find out what your results were from your sleep study. Also what did your doctor say at your follow up? I second getting your cpap treatment down first before you go to bed letting it effect you.

As far as the alcohol, I have been on Cpap since November and just last night had the first two beers since then. I had them early in the evening so most of the aclohol would be processed. Just because you think you are not under the effects of alcohol doesn't mean you aren't. Everything in moderation!

But boy did those two tall cold ones taste good.

Gerry

I had four Spaten Optimators last night ... the most I have had in one evening since before 2000.



Oops ... wrong image



Anyway, I felt like crap this morning so I let the dogs out around 6 am and went back to sleep for a couple more hours and the day improved much.

I'll download the Encore report tomorrow and see what it says about my Friday night Optimating


As for Biott ... you may have some serious issues with your machine settings ... but know one here knows cuz you haven't given us enough information.

Spit it out! Fill out your profile so someone can help you out ... and take it easy on the alcohol.

OK, I have filled out my profile the best I could. My initial sleep study was in December where I had an AHI of 29 (94 of my 112 respitory events were obstructive). During REM, my AHI was 56.

During titration, "The patient was titrated on CPAP, and then switched to Bipap when he complained of too much air. He had repetitive central events that would not abate at a pressure level of IPAP 15 and EPAP 11. The patient had 30 central events and was switched to an ST device". I was titrated to a final BiPAP pressure of 20-13 with a back up rate of 12 breaths per minute. At that pressure AHI was 1.7 events per hour.

In my follow up with my doctor, he could not explain why I was having so many centrals...the stats on my machine were saying that I was only triggering about 75% to 80% of my breaths, and the machine was doing the rest. My initial posting about the alcohol was that the 3 nights I had alcohol, my "Patient Triggered Breaths" were up in the 90% range. The doctor's only thoughts were that the chemistry in my brain must have changed from having undiagnosed apnea for so long, and that hopefully it will change back to normal with night after night of xpap usage.

I guess from reading many of the posts, I have gathered that high pressure may be contributing to some of the central events. So i have an appt tomorrow with an ENT to hopefully help alleviate some of the obstructive issues (I will do anything...only 33, in good shape, will do any surgury they suggest to make it better). My polmonologist said I have a very large uvula and I know my dad needed Turbinate reduction surgury, so maybe it runs in the family. Hopefully after than, the pressure won't have to be set so high, and then we can go from there with the central issues.

Does that sound like the right game plan? As expected, I am finding this a very frustrating process.

After reading your last post, I'm concerned why they put you on the fast track on a high pressure with BPAP ST.
I am not knowing in this area, but I would be wanting to try to get the obstructive event controlled at the lowest pressure needed, and then work on remaining problems. They may have had a reason but I would have tried the cheapest route first. Jim

My polmonologist seemed to agree. His quote..."I really hope you dont need this machine at the end of the day". He lowered my down to IPAP of 18 from 20 that I was first set up with. But per my first post, the machine is still reading that I am having upwards of 250 "apneas" a night. What I am wondering is if every breath I take that was initiated by the machine is being called an apnea, even if the apnea was essentially avoided b/c of the machine.

Do you have Encore Pro and the reader yet, that would be number 1, then maybe some that use that type of machine would have suggestions, from your posting of the Dailies. Jim

Although I'm not as familiar with Bi levels, I agree with Jim, you need to be collecting some data to help track what is going on. At hose high pressures your mask could be leaking and blowing your whole treatment out the window.

There are a couple of very knowledgeable members and hopefully they will chime in ... SAG ... where are you?

Long Answer

How much alcohol did you have to get an "alcohol buzz"? Is that the usual % of Nights (37.5%) that you go to bed with an "alcohol buzz"?

The decrease in apneas seen with an "alcohol buzz" could be explained by a decrease in the arousal threshold, which, if the major underlying issue is now the appearance of central apnea, would dampen that tendency.

"Overreporting" would not be the correct assessment. You would be either "undertreated" or "overtreated". With those pressures and back-up rate, my opinion would be that it's the latter, and the S/T is just merrily sending in breaths irrespective of what you actually need. The underlying NPSG showing REM dependency would lead one to believe that CompSAS is not a cause of all the centrals (there's a difference between "the appearance of central apneas during the course of normal titration" and "cranking everything up so high that you're generating centrals in just about everyone").

If the only reason to switch to BiPAP was that you "complained of too much air", but the CPAP titration was otherwise successful, then perhaps time and effort would be better spent getting used to plain ol' CPAP, since apparently everything just went down the tubes when the decision was made to go to BiPAP, and then the treatment needed treatment.

I think you should get and post the complete results of the sleep study including all the graphics, as well as the complete Encore reports to try to gain a better understanding of what's going on. The "optimal pressure" ("BiPAP pressure of 20-13 with a back up rate of 12 breaths per minute. At that pressure AHI was 1.7 events per hour.") may only be representative of a very tiny window of specific variables and/or during a period of stable sleep when there wouldn't be any events anyway (like N3, for instance).

If the answer to "How much alcohol did you have to get an 'alcohol buzz'?" is "greater than 6 whatever", then the

Short Answer

is get a ResMed AdaptSV and set EEP to control obstructive events during "buzz" periods (right, back to the lab with a bottle of "Jack"). That might give you the best shot at accounting for the severe swings in therapy that might be required given the largely unpredictable effects from that variable (including worsening of obstructive events).

Best Guess In The Pool

In addition, your underlying sleep architecture is probably askew.

SAG

Thanks for the help/advice. I will get a few more nights in on the card and post my encore results & sleep study to see if anyone see's anything unusual.

I am in a bowling league once a week, and might still have the residual effect of a couple beers left in my system when I went to bed, which seems to be just enough to lower the central apneas.

In any event, had appt with ENT today...said I had severe deviated septum, a large turbinate polyp on my good nostril, and overall large turbinates that he plans on reducing. CT scan tomorrow AM, then I will schedule surgury ASAP after that. Hopefully after having everythign cleaned out and straightend in there, I might not need so much pressure to clear the obstructive apneas and we can go from there on recalibrating or switching machines.

I somehow feel that I have went thru this process bacwards - wish I had went to ENT first. Waited way to long.

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I was just going to mention how impressive it was that people were focusing on the numbers, and not chastising the OT for having a few beers. Unfortunately, someone just had to troll.