Encore Pro Report ... What is Happening???

[janp]

Several factors can enter into this......

If the mask (headgear tension) is adjusted for the lower pressures, when the pressure goes up too far, it can lose the seal.

Bed pillow.....if the pillow dislodges the mask (especially when one is sound asleep), the leaking will continue until the person moves to a different position or wakes up enough to rearrange it so it will stop.

Sleeping position.....if the person's airway becomes restricted, it will cause/allow the apneas to take place.


Den

Den,

Thanks for staying with my questioning.

The reports from EP really don't mean anything unless you have some understanding as to what they are telling you. So I keep asking questions.

Pressure/Mask ... my husband sets me up with each mask tested at the maximum pressure that has been set into the machine. This is done with me lying down and "challenging" the seal by rolling my head back and forth.

Bed pillow ... I can see where it could "break" the seal. That's a tough one to check, since I'm a pretty sound sleeper.

Sleeping position ... I sleep on my side. Pretty much "glued" to where I fall asleep.

Staring at the graph, that last 1-1/2 hour could be my breaking the seal intermittenly somehow?

At the 3 hour mark, I notice that the pressure ramps up the way it's supposed to (by steps) with an Auto responding to an apnea event. Of course, a loss of seal would allow an apnea event to happen.

I occurs to me that I was awake the last 1/2 to 1 hour of the report. With the leak going up that high during that time ... wouldn't I have noticed it?

Jan

[Wulfman]

I agree. It's hard to fix something if you don't know what to fix. However, it becomes a process of elimination.
Since you're using a full face mask, that eliminates "mouth leaking". So, that leaves the seal that rides on your face. Strap tension (too tight or too loose) make a difference. Bed pillows definitely make a difference. Sleeping position....body, neck, or anything that can affect the airway and air flow.

Ok, Sherlock.....you get another chance tonight to solve the mystery.....


Den

[janp]

I agree. It's hard to fix something if you don't know what to fix. However, it becomes a process of elimination.
Since you're using a full face mask, that eliminates "mouth leaking". So, that leaves the seal that rides on your face. Strap tension (too tight or too loose) make a difference. Bed pillows definitely make a difference. Sleeping position....body, neck, or anything that can affect the airway and air flow.

Ok, Sherlock.....you get another chance tonight to solve the mystery.....


Den

Den,

Thank you for your help ... it's much appreciated!

Jan

[Chris61]

Here is another thought as well, The mask you are using might not be the right one for you. Everyone is differant. It took me about 3 masks to find the right one. That would fit and not leak. Also I would talk with your doctor about this and see what he has to say about the leaks.

Chris

[janp]

I just wanted to jump in and thank all those that offered comments ... for taking an interest and the time to respond!

There's a great willingness to try to help others.

That's what makes this Forum so unique.

Thanks all.

Jan

[Wulfman]

I just wanted to jump in and thank all those that offered comments ... for taking an interest and the time to respond!

There's a great willingness to try to help others.

That's what makes this Forum so unique.

Thanks all.

Jan

Soooooo.......how did it go last night?

Inquiring minds want to know.....

Den

[janp]

I just wanted to jump in and thank all those that offered comments ... for taking an interest and the time to respond!

There's a great willingness to try to help others.

That's what makes this Forum so unique.

Thanks all.

Jan

Soooooo.......how did it go last night?

Inquiring minds want to know.....

Den

Den,

I'd say not as well.

My husband re-tightened the mask last night (I tried harder to break the seal).

It started earlier and lasted longer.

To me it seems as though the APAP setting is OK ... aren't those little spikes (pressure) early on during the night the machine responding to and controlling apnea?

Jan

Last night graph:

[Wulfman]

I would strongly suggest that you limit your top pressure to 7 or go with a single pressure of 6 or 7 and see how that works.
In those first couple of hours, the APAP isn't responding to anything (meaningful) with the pressure bumps. There are no Flow Limitations and only about one Hypopnea showing on the report before things go haywire.
It isn't until your pressure goes up past 7 that things get decidedly worse. It's not clear which is the chicken or egg in this situation with the leaks/events/pressure increases. There were still none marked as Non-Responsive, so that leaves Obstructive as the culprit (IMO).

If you limit the pressure CPAP or APAP (tiny range) and you STILL have those events occurring at around that time, then I would suspect something "positional".


Den

[janp]

I would strongly suggest that you limit your top pressure to 7 or go with a single pressure of 6 or 7 and see how that works.
In those first couple of hours, the APAP isn't responding to anything (meaningful) with the pressure bumps. There are no Flow Limitations and only about one Hypopnea showing on the report before things go haywire.
It isn't until your pressure goes up past 7 that things get decidedly worse. It's not clear which is the chicken or egg in this situation with the leaks/events/pressure increases. There were still none marked as Non-Responsive, so that leaves Obstructive as the culprit (IMO).

If you limit the pressure CPAP or APAP (tiny range) and you STILL have those events occurring at around that time, then I would suspect something "positional".


Den

Den,

My original prescription (from titration study) was CPAP at 6 cm. It didn't work ... a very high fatigue level has stayed with me. Enough that I don't dare drive for now (I almost drove off the road a few weeks ago).

I'm not sure how much the influence, but the tests were done at 500 feet elevation ... I live at 4100 feet elevation. Lower oxygen level for starters.

The doctor had agreed that the therapy wasn't working and had just changed it to APAP, 6 to 10 cm.

I'll try lowering the upper limit as you suggest to see what happens ... but my husband suggests that we do it "by steps" ... going down 1 cm at a time to see what happens.

If I can get the entire night to go the way the first half does ... I'd be very happy with my therapy!!!

Jan

[Wulfman]

With all due respects to your husbands thoughts, I'd go the other way.......set the upper pressure to 7 and THEN see if you want to try going upwards in 1 cm. increments......cause this range ain't workin' for ya.


Den

[janp]

With all due respects to your husbands thoughts, I'd go the other way.......set the upper pressure to 7 and THEN see if you want to try going upwards in 1 cm. increments......cause this range ain't workin' for ya.


Den

Den,

Wouldn't the start at 7 cm put it close enough to the lower 6 cm that it would be pretty much the same as my original CPAP setting?

Question - can I gather anything from the "Daily Events Per Hour"? The 90 percent column (at 10 cm) shows a big reduction in OA from the night before. 72.8 to 49.7.

Thanks.

Jan

[Wulfman]

With all due respects to your husbands thoughts, I'd go the other way.......set the upper pressure to 7 and THEN see if you want to try going upwards in 1 cm. increments......cause this range ain't workin' for ya.


Den

Den,

Wouldn't the start at 7 cm put it close enough to the lower 6 cm that it would be pretty much the same as my original CPAP setting?

Question - can I gather anything from the "Daily Events Per Hour"? The 90 percent column (at 10 cm) shows a big reduction in OA from the night before. 72.8 to 49.7.

Thanks.

Jan

YES! And, that's where it appears you need to be from your reports......6 with a max at 7.

You can still gather "Daily Events Per Hour" with whatever pressure settings you have set in APAP mode. You can even set the minimum and maximum at the same pressure and see whether there are any NR's or FL's, too.

Your OA was about 0.2 for the first two hours on both nights. It wouldn't be 72.8 or even 49.7 if you would keep your pressure from running away in APAP mode.


Den

[janp]

With all due respects to your husbands thoughts, I'd go the other way.......set the upper pressure to 7 and THEN see if you want to try going upwards in 1 cm. increments......cause this range ain't workin' for ya.


Den

Den,

Wouldn't the start at 7 cm put it close enough to the lower 6 cm that it would be pretty much the same as my original CPAP setting?

Question - can I gather anything from the "Daily Events Per Hour"? The 90 percent column (at 10 cm) shows a big reduction in OA from the night before. 72.8 to 49.7.

Thanks.

Jan

YES! And, that's where it appears you need to be from your reports......6 with a max at 7.

You can still gather "Daily Events Per Hour" with whatever pressure settings you have set in APAP mode. You can even set the minimum and maximum at the same pressure and see whether there are any NR's or FL's, too.

Your OA was about 0.2 for the first two hours on both nights. It wouldn't be 72.8 or even 49.7 if you would keep your pressure from running away in APAP mode.


Den

Den,

Looks like tonight I try the 6 to 7 setting! We'll work up from there if need be.

Since the mask has been adjusted and "tested" to 10 cm, I would hope that it could withstand some "pillow abuse" at the lower pressures.

Your comments about the 6 cm range had my husband look back over an earlier report with CPAP. There weren't any issues until the same kind of hash towards the end of the night. I may be trying to take the mask of in my sleep!!!

The only problem with 6 cm, is that I'd been on 6 cm (CPAP) for few months and still have a problem with severe fatigue. My husband is a light sleeper and would watch me sleep ... apparently I'd still been stopping breathing in the early hours. That's why ... other than the fatigue ... I said earlier that the 6 cm hadn't worked.

Thanks for all the insight!

Jan

[BlueSky72]

Hi Jan, I'm pretty new to things too, and I have no experience with the software, but I have a couple of questions:

If you found 6cm insufficient to prevent apneas, why not set yourself 7-8cm, or just 7cm and see how you go for a night.

Are you certain that you never change position during the night. Did your lab studies show any position changes.

Best of luck.

[janp]

Hi Jan, I'm pretty new to things too, and I have no experience with the software, but I have a couple of questions:

If you found 6cm insufficient to prevent apneas, why not set yourself 7-8cm, or just 7cm and see how you go for a night.

Are you certain that you never change position during the night. Did your lab studies show any position changes.

Best of luck.

Hi,

Thanks for posting. And welcome to the Forum.

You may be new to all of this ... but all opinions are welcome. That's what I think the Forum is all about.

I'm going to try the 6 to 7 range suggested by Den and see what happens. Then I'll move the range up by 1 cm at a time if/as needed.

One thing that I've come to realize after my last sleep doctor's appointment ... it's really a guessing game for the doctor too! After they've come up with a number from the sleep study, (testing plus calculations) ,,, it becomes a process of trying different settings.

Actually the lab studies showed that I pretty much stay on either my left side or right side for long periods ... unlike my husband, who sleeps like he's on a rotisserie.

I will tell you that the software is an invaluable tool. The first thing it showed me was that I had quite a bit of mask leak. I didn't have a clue! Leaking air just eliminates any therapy (at any setting) that you think your getting.

Jan