Recommendations based on sleep data+

[josephnyc]

Hi,

I replaced my machine with a Respironics bi-level a few months ago.

I was hoping someone could read the report and give me their thoughts on how I'm doing on the new machine?

And, if there's any recommendation on settings that might improve things.

But, to proceed I need to figure out a way of attaching a PDF -- could someone please point that out?

Thanks very much!

Joseph

[cflame1]

save it as a jpg and use photobucket to upload. Use the links or the images in photobucket in your posts

[Guest]

check with your doctor.

[ozij]

Take a screen shot (snap shot) of what you wish to post. Make sure the size is readable.
Save the screen shot as a jpeg file. Upload the file to hosting site (I use Photobucket)
Copy the IMG image location code, include beginning and ending IMG bracket, and paste into the body of your post here. Use the preview button to make sure you see the image.

If using Windows XP use the prt scr key to take the snapshot, then paste into Paint program to allow for cropping and save to jpeg file.
If using Vista you can use the Snipping Tool, it allows for taking the snapshot and crop in one step, then save to jpeg file.

If you need further help, just ask.

[josephnyc]

Thanks everyone.

Here's my report -- any advice (other than see my doctor)?

[Slinky]

I'm eating some crow. I do have to admit, whether I like to or not, that I like this EncorePro or EncoreViewer bi-level data graph better than my ResScan bi-level data graph. I LIKE having individual lines for IPAP and EPAP. And I have always really liked Encore's Daily Event Per Hour tables and wished that Resmed's software provided an equivalent.

[josephnyc]

Is it okay to ask for a reading, interpretation or advice on adjusting the settings?

[Pugsy]

Is it okay to ask for a reading, interpretation or advice on adjusting the settings

Here on this forum? Sure, people do it all the time. No doctors here but lots of people with lots of experience to draw upon.

[cflame1]

What was your titration settings originally?

If I was you... I'd slowly move the 4 up (maybe ending up at about a 6). Like 1 cm at a time, 1 week at a time.

That's just my opinion anyways.

[jweeks]

I replaced my machine with a Respironics bi-level a few months ago.

I was hoping someone could read the report and give me their thoughts on how I'm doing on the new machine?

And, if there's any recommendation on settings that might improve things.

Joseph,

Taking a quick glance, your numbers look pretty good. Your leak like looks OK, and your AHI is under 5. The question now is, "how do you feel?" If you feel good, you might want to leave things alone for a while and build on that success. Another option is to go after those snores and the remaining events that you are having. One drawback of an auto is that they are sometimes a bit slow to ramp up because they need to see issues before they can react. The option you have is to turn off the auto part, and leave it at some fixed set of pressures. The trick in that is to find the right pressures to treat the bulk of your remaining events, but not so high as to cause other issues. But if you feel good, you might want to run as-is for a while and settle into a groove & establish a good baseline before making any changes.

-john-

[josephnyc]

I think I'll experiment with upping the 4 to a 5 and check at the end of this month for any changes.

Very glad to hear that nothing jumps out as being bad about these figures.

I can sure verify that those nights when the heated humidifier has water in it, I feel a lot better in the morning.

Unfortunately, feeling good requires a perfect coordination of the stars, only of a thousand is the apnea issue (and many are supposedly completely under my control, like when/what I eat the day/night before sleeping), so it's tough to use that as a sole indicator of best settings.

I think this past month is a reasonable baseline (I got the machine at the beginning of the summer, so it's the 3rd or 4th month with it).

Thanks very much everyone! It's so wonderful to have this forum available.

[old64mb]

Few things.

First, you're running very, very low pressure for a BiPAP, especially with a 90% EPAP of 5.1. As such, I'd suggest seeing what happens if you turn off BiFlex for a few nights. Among other things, I'm not even sure with an EPAP pressure that low that you're actually even getting any advantage from it on exhalation and transition relief since BiFlex really does drop pressure - and I don't think the machine can produce 3 cm.

Second, what's a bit striking is how you are bouncing around on your IPAP pressures from night to night, and to an extent EPAP too (although I suspect you've got a max differential set at 6 or so, so it may be chasing the IPAP). One night it's 11, another 7. (Depending on the mask, your leak rate for that low of a pressure might be a bit high as well.) Can you take a detailed snapshot of a not particularly good night?

[rested gal]

Can you take a detailed snapshot of a not particularly good night?

That's what I'd like to see, too. Instead of the Summary and Trend results, could you post just a graph from one of your "Sleep Therapy Daily Details" pages. The "Daily Details" graphs begins on page 4 of the "Full Details" report -- they won't be in a Summary or Trend report.

I don't care anything about seeing the Events per Hour chart which appears under a Daily Details graph. Just the Sleep Therapy Daily Details graph. please. You can click this link to see the kind of graph old64mb and I are talking about:
http://www.tnlc.com/Lara/laura/osa/BiPA ... 7-2007.jpg

The comment in red was added to the picture by me.

[josephnyc]

Wow, I didn't realize there was such a big range in the 90% IPAP (7-11), nor that it was significant but it does make sense.

Here's 2 graphs: the 11 day and the 7 day:



And:



Thank you!

[old64mb]

I'm going to leave it to those veterans who can interpret data better than I can, but I'd say that's not a particularly clean chart even if the overall summary numbers aren't bad.

The snoring and flow limitations are pretty heavy all things considered. I'm also not sure how to interpret the leak chart and pressure changes; I wouldn't consider those the mountains you really see with crazy mouth breathing (see below, and Rested Gal has some great graphs of it too on another thread), but I'll be interested to hear what others think particularly considering the pressure ramp.

I'd bet that both pressures could use a little bit of a bump, particularly your EPAP, although turning BiFlex off might be enough. You're not bad, just the combination of all of the above along with apneas and hypopneas routinely occurring on both good and bad nights makes me think the base pressure might be a little low.

To help a bit, let me show you my transition:

This was me early on this year, with some pretty bad mouth breathing. Note the 'mountains' of leaks corresponding to several series of events:



This is what I was like after I settled down, started mouth taping, and increased my base pressure. Better, but still not great, and once I started raising pressure and at times experimented with fixed higher pressures I started getting gastric insufflation:



This is what I looked like my first half night on BiPAP, when I clearly shouldn't have been on those pressures since they were too low, and also having it run as a straight BiPAP since I was worried about centrals if it ran up well past my lab study (this is what happens when you self-titrate rather than doing a new BiPAP titration in a lab, which I'll do next year):



And this is what I look like now, after spending a while tweaking pressures, dropping BiFlex completely, and switching to an older tank model:



The whole key, though, is how you feel. Hope that helps, and hope others who are better chart readers than I am can chime in.