OK ... have Encoreviewer and now am totally perplexed!

I cannot figure out what much of the information on these reports mean. Now I'm kind of "borderline" as far as needing CPAP in the first place. I am tired lots during the day, but it is more annoying than life threatening. I had a Stardust II take home sleep test that showed an AHI of 13.4 and a O2 low of 78%. But ......

I've now got a (A)CPAP machine that's set to find where it wants to go between 4 and 20 cm h20. I've tried it for 6 days now. I ran the Encoreviewer 2.0 software yesterday and all it does is give me more questions than answers. Here are a few, if anyone wants to help .....

Leakage: It tells me I have an "average leak" of 20-25 on any given day. No large leaks. Now my mask is secure. The only air that escapes comes from the vents - or is it coming out somewhere else???? Is a leak of 20-25 OK?

Vibratory Snore: is in the 12-15 range. On my test (Stardust II) the meter said I snored about 735 times per hour. Am I snoring less, or is the machine just measuring things differently?

AHI: In the Stardust II test was 13.4 (mostly hypopneas). Now the System one APAP machine has me going from about 1.2 the first night to an AHI last night of 0.3. I guess the question here is there any significance to this? Is the machine measuring things differently than a Stardust II or sleep study would do? I can scan and post either my original Stardust report or any page from this report if someone thinks it would help. But, in general, how reliable is the data I get from this machine??

I could go on and on with questions, but it is not clear whether this machine is doing anything or not - except making it harder for me to sleep hooked up to hoses and masks. I don't feel any less tired during the day. Obviously my Dr. isn't one that is very helpful. I was told to get a machine and see her in October when I've had a chance to use it.

Now the Encoreviewer software along with the System one APAP doesn't do much other than make really pretty graphs showing me that my pressure goes up and down all night (last night average pressure was 7.0 and 90% pressure was 8.1.). Is there anything written that explains what these data actually mean and how to use them? There are good help files with the software, but they presume that you know if a 20-25 leak index is OK or not. And do any of them correlate the data as per collected by the machine with real sleep events. If this machine were only 1% efficient at detection, then it would look to everyone like they were receiving help.

Any information or help on this would be greatly appreciated. It sounds like I should get a better Dr. if I continue with this. I just don't know if I am wasting time on all of it to begin with - as I don't feel any differently than I did before. Thanks again!

The acceptability of a leak number depends on how much of the leak is due to the mask venting. The mask venting rate depends on both the mask and the pressure being used. Here is the data for ResMed masks:

http://www.resmed.com/us/assets/documen ... sa_eng.pdf

For the SoftGel, expected leak is 28 at a pressure of 8, so your leak number seems to be very good.

The data from a CPAP machine is not as accurate as a sleep study because the machine senses many fewer channels of data. But the data from a CPAP is still very useful. Your AHI is lower on CPAP because the CPAP therapy is preventing apneas and hypopneas and thereby lowering your AHI. A general guideline for an acceptable AHI is 5 or lower, but lower is always better.

I'm not familiar with the Respironics scale for scoring snoring (how's that for a rhyme?) but effective CPAP therapy should pretty much extinguish snoring.

If you post your sleep study and the graphs from a night or two, you will get plenty of opinions about your therapy. Note that you must upload the files to a photo sharing site, and paste the IMG link into your post. If you don't know what this means, just ask and more help will be forthcoming.

I don't know what your prescribed pressure is, but if you know how to adjust the machine set the low # at or just below your scripted one, and the higher one about 4-5 above that (i.e. if your script calls for a 10, then you could set the machine at 9 and 13 or so) and it should be more effective that way. Just leaving the default settings of 4 and 20 gives the machine too much trouble!

My tutorial here might help: http://maskarrayed.wordpress.com/2010/0 ... -tutorial/

In general, the data shows that you are doing well with CPAP. You need to understand that the Stardust was a TEST and the CPAP is TREATMENT. So you are supposed to see improvement on things like AHI and hypopnea.

1st, as Jdm points out, your leak rate is fine--no leaks. Resmed and Respironics differ in how they report the leak rate. Resmed reports the leak rate over and above the mask vent rate, but Respironics does not subtract out the mask vent rate. So you have to look up the mask and do it yourself. Another way to tell that your leaks are under control is look for the thick green line above your leak rate chart. As long as it's green, you're leak rate is fine.

Don't worry about the vibratory snores. I get a lot of those too. Sometimes I do snore a little when I'm partially awake, but as long as my AHI numbers are good, I don't concern myself about it. I think the machine has a tendency to overscore VS, but that's just my opinion.

As far as accuracy, I'd say it's accurate enough. My sleep lab uses these machines for home titration, so they must feel that they are getting sufficient accuracy to count on the results. I have an HMO (Kaiser) rather than a private for profit sleep lab, so they have a vested interest in good CPAP treatment because it will save them money on other medical issues in the long run.

But the bottom line is HOW DO YOU FEEL??? You may not feel better right away, but if you have great numbers like that going forward and are not feeling any better over time, then it makes sense to question the data. My suspicion is that you will soon see positive results and gain more faith in your machine.

You may want to tighten up your range of pressures—as has been suggested--once you get a better idea of what’s happening. That may increase your comfort and how you feel overall. But otherwise, stay the course—it looks like you are doing great.

Julie wrote:I don't know what your prescribed pressure is, but if you know how to adjust the machine set the low # at or just below your scripted one, and the higher one about 4-5 above that (i.e. if your script calls for a 10, then you could set the machine at 9 and 13 or so) and it should be more effective that way. Just leaving the default settings of 4 and 20 gives the machine too much trouble!

That's the problem. My prescription is for 4-20 and presumably it is to be "tweaked" later. Like I said, I probably need a new Dr. Seems like I should know enough now to tweak it myself. Let me post my sleep study and report and you can get an idea of what I am doing. My main symptoms are lots of LOUD snoring and daytime sleepiness. I have never been able to spend a single night with my wife! I have been told by others I am pretty bad too. I can live with the daytime sleepiness, but to never be able to sleep one night with your spouse is getting ridiculous. When we travel, we need adjoining rooms (every time!) - or I sleep in the hotel lobby! That's why I wanted to see how my snoring is doing.

I also am curious to know if this is going to do anything at all If not, and snoring is going to happen anyway, I think I will opt for nasal surgery. I have been thinking about it for many years but have waited for the right time and Dr.

Once you find the right pressure for you, you shouldn't have any more snoring at all - but I would verify that by the actual amount of snoring heard, not necessarily based on the VS number (which may be artifact more than real snores).

With such a wide range , far away from your ideal pressure, lots of snores will likely get by.

OK, I am totally technically retarded, but I think I got this right.



Here is a copy of my sleep study - remember it was a machine (Stardust II) study, so the data is minimal ....



And here a page from one night of my Encoreviewer report ......



Thanks in advance.

You are doing great on the machine.

If the time on the machine is set correctly, you didn't go to bed until 3:46 a.m.????

Around 5:45 a.m. you may have had a quick little leak, but it didn't even break the green line at the top which indicates that your mask was well within the right range as far as vent rate--no real leaks to speak of.

Your events were well handled by the machine. If you look at the pressure and sleep therapy flag charts together, you can see those pressure peaks and drops were in response to the hypopneas and the one central you had. The one OA you had at the beginning of the night is no big deal. Some people have that in "transitional sleep".

I would totally ignore the Vibratory Snore events. This does not mean that you are snoring--it just means that the machine is detecting something--perhaps a little "pre-snore" or even just movement in the hose.

You mentioned that your wife has never been able to sleep with you--try it now. I have many more "vibratory snores" on my data, but I don't still snore except a few very light ones when I'm half awake. My husband was sleeping on the couch every night, since the second night of CPAP he's been back in the bed and says he never hears a thing.

Thanks. I am a late night person, as is my wife. Late night people will go to bed late if they can get away with it and sleep late. We've both done it all our lives. Even when I had a "classical job" (9-5), my assistant would call me to wake me and tell me to get myself into work! Even when we travel to Europe (9 hours time difference) we start out on a normal schedule, and then end up on a late night - late morning schedule. I've heard that there is a segment of the population that just is that way. It has a stigma associated with it and people don't like to talk about it.

Anyway ... back on topic ...

How do you compare the "events" as detected by the sleep study (machine) with the events detected by the CPAP? Am I really doing better or are the numbers just lower because the machine is not as sensitive?

I still feel tired during the day - after 1 week.

Someone said - that I should find the right pressure for me ..... should I start raising the min pressure and lowering the max pressure? I did lower the min last night to see what would happen (5.5 to 4.5) - and the net result was not as good (according to the machine). So perhaps raising it to 6.5?

Maybe it's the (ex)scientist in me, but I need some way to figure out if all my "work" trying to comply with this thing is paying off - or am I falling victim to its data reporting. My wife doesn't want to try to move my sleeping into the bedroom until we have a good reason to believe I am going to do more than just wake her up and make her tired too. After all the nonsense I went though years ago with CPAP (and failed) we are both a bit hesitant to say this is helping or not. Do we really know it is????

Oh, and the vibratory sore comments make sense to me. I tend to turn and thrash in my sleep. I bet those events are my turning, etc. I do have less aches and pains in the AM - yes I thrash that badly sometimes. But it just may be a good week or time of year. Thanks again.

Your one night chart you posted looks pretty good to me.

What I needed to do to be confident the hassle was worth it: I didn't feel good at all after just one week, maybe a month. But the clincher was I bought a recording pulse-oximeter, and you could really see that my oxygen was OK all night when on the CPAP. I test myself once in awhile to confirm it.

If it were me, I would raise the minimum (don't lower the minimum) since you spend 90% of your night at 10.5- 11 cm or less. Best to raise it gradually, like maybe 1 cm at a time and leave it for a few nights before raisng it again so that you can adjust. Leave the maximum where it is for now and see where you are. You do not appear to be prone to centrals so the maximum does not matter right now. If you wake up a lot during the night you may want to lower the maximum and make a narrow range of 3-5 cm. A lot of pressure changes may interrupt your sleep (even though you don't wake fully) and make you sleepy during the day.

In your case, as I look at the daily details data, You will want to get that minimum pressure gradually up to maybe 9 or 10 cm.

How do you compare the "events" as detected by the sleep study (machine) with the events detected by the CPAP? Am I really doing better or are the numbers just lower because the machine is not as sensitive?

All I can say is that you are going to have to trust that the machine is handling your events as it is suppose to, that's why you are having fewer events. I went from 78 AHI PER HOUR to less than 7 events PER NIGHT (sometimes NONE), just by using the machine. It works, really it does.

Do you understand how CPAP works? The air pressure splints your airway open so that it does not close off, causing apnea. With an auto machine, the pressure can respond to your body's signals and increase or decrease the pressure as needed. That's what the graphs show your machine is doing, and that's why there is such a difference in events--your machine is preventing the events you saw on the sleep study.

You can do a little test. Turn your machine down to straight CPAP at 4 and sleep with that through one night and then look at the data. You should see a huge increase in events, because you are not getting therapuetic pressures (though it might still be lower than your test because there will be some pressure).

Fatigue can have many contributors in addition to sleep apnea, and even if Sleep apnea is the major cause it may take you a few weeks to really start to feel the difference. Also, I feel less sleepy, but still tired even with CPAP. That's other things going on in my body, though, not the sleep apnea.

Well, I see my pressure is dropping off toward the end - the morning. I also notice that I wake up often sometimes 1 -3 hours before I want to get up. Last night I woke up 3 or 4 times this morning - at a point when I had only slept about 4 hours. Does this perhaps have anything to do with the pressure?

My daily reports mostly show higher pressures for the first few hours, and then it seems to drop overall for the next few hours. Am I adjusting - or is this something that I can change by setting things differently?

The only symptom is that I have less achy muscles in the last week - I have always assumed that this was a result of years of exercise and not enough stretching. Is this something that sleep apnea and low O2 levels can cause - or am I just sleeping better and not tossing and turning as much?

Thanks again.

You might want to use a hose cover in case it's scraping against your headboard or some place else and interpreting it as VS. Padacheek is a forum member who makes a nice cozy one.

Hawthorne wrote:If it were me, I would raise the minimum (don't lower the minimum) since you spend 90% of your night at 10.5- 11 cm or less. Best to raise it gradually, like maybe 1 cm at a time and leave it for a few nights before raisng it again so that you can adjust. Leave the maximum where it is for now and see where you are.

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In your case, as I look at the daily details data, You will want to get that minimum pressure gradually up to maybe 9 or 10 cm.

I agree with Hawthorne. That's what I'd do. Setting the minimum pressure higher gradually, one cm at a time and leaving it there for a few nights, is a good way to go about it.

I'm a little impatient, though. I'd go ahead and set the minimum pressure at 9 or 10 and keep the max pressure where it is. But that's just me.