Where a newbie goes to understand PR1 EncoreViewer 2 reports

[rocksockdoc]

About 6 years ago I started on CPAP and then about 2 years ago I went onto BiPAP using the Philips Respironics System One with a 2 GB SD card.
Recently I installed EncoreViewer 2.0.23.0 which output a 13MByte 24 page file of (probably) interesting graphs and flags and datapoints.

Problem is I don't really know where to start to find the MOST IMPORTANT thing to look for in that graph?
I've been unemployed so I only have catastrophic insurance so there isn't an MD to ask.

I'm sure there must be a tutorial on the web for what most people look for first on those charts/graphs/tables.

I looked in the forum and found this likely source (but there wasn't a description of the EncoreViewer 2 output):
- Where A CPAP Newbie Should Start

I ran a search for "encoreviewer output tutorial" but it found nothing.

Would others who actually know what's important to look for in the EncoreViewer output help point me in the right directioni?

Note: There are "definitions" of the various flags in the report but that's not what I'm looking for, (e.g., P - Pressure, MaP - Minutes at Pressure, % - Percent of Night, FL - Flow Limitation, VS - Vibratory Snore, PB - Periodic Breathing, CA - Clear Airway Apnea, RE - RERA, H - Hypopnea, OA - Obstructed Airway Apnea, AHI - Apnea/Hypopnea Index).

[Pugsy]

Your image isn't showing up.

There is no "Encore for dummies" tutorial out there on the internet that I am aware of.
Mainly we just post our reports along with our questions and someone explains them.

In general we look for AHI less than 5.
Encore Pro defaults to show Unintentional leak. Encore Viewer reports Total Leak which is Unintentional leak plus intentional leak/vent rate.
Large leak seems to be around 90 L/min when reporting Total Leak. We aren't ever told an exact number but I have seen 80 to 85 L/min with no large leak flag but I get a large leak flag at 90.
PB we don't pay a whole lot of attention to unless it happens a lot and a lot every night.
Each night we sleep differently so we don't expect the exact same data every night.

So if you had a specific question we can go into more detail. When posting images..you have to use the IMG brackets with the url address where the image is located and it has to be on the web at someplace like photobucket.

[rocksockdoc]

Your image isn't showing up.

Bummer. I'm pretty familiar with forums but this one is different with respect to images.
On most forums, I just attach the image and then point to it; or I upload the image to an image-sharing site and point to it. For some reason, that didn't work here. I'll figure that out separately. Sorry. It was a screenshot of a portion of the report from Encore Viewer.

There is no "Encore for dummies" tutorial out there on the internet that I am aware of.

Bummer. Maybe we should start one!

Mainly we just post our reports along with our questions and someone explains them.

OK. I understand. I guess I'll do the same.

In general we look for AHI less than 5.

Great. Now I have a place to start!

• AHI (Apnea/Hypopnea Index) < 5

On the last page of my 769-day 24-page report reports the "Auto Bi-Level Summary" Average AHI to be 1.2 while the "Sleep Therapy Statistics" Average AHI is 1.5 (as shown in the image below, if it works).

Encore Pro defaults to show Unintentional leak. Encore Viewer reports Total Leak which is Unintentional leak plus intentional leak/vent rate.

I have Encore Viewer. So I'll be looking at "Total Leak".

Large leak seems to be around 90 L/min when reporting Total Leak. We aren't ever told an exact number but I have seen 80 to 85 L/min with no large leak flag but I get a large leak flag at 90.

Great. Now I have a second figure to check:

• Large leak < 90 L/min

On the last page of my 769-day 24-page report reports the "Auto Bi-Level Summary" Average Time in Large Leak Per Day
to be 8 mins. 20 secs., while the "Sleep Therapy Statistics" Average Time in Large Leak Per Day is 11 mins. 26 secs.

For an actual 'value' of that large leak, I guess I have to look to the past week worth of charts where it shows an "Average Leak = 51.0" (liters per minute?) throughout the night until I actually removed the mask. The night before last, the average leak was 61.0 (presumably that's liters per minute). 60 the night prior. 57, 59, 59, & 53 the prior nights.

PB we don't pay a whole lot of attention to unless it happens a lot and a lot every night.
Each night we sleep differently so we don't expect the exact same data every night.

OK. My "Percent of Night in Periodic Breathing (PB) = 0.2%". I would guess that periodic breathing (whatever that is) is bad (since my number is so low). What is a number to aim for?

• Percent of Night in Periodic Breathing (PB) < ??%

When posting images..you have to use the IMG brackets with the url address where the image is located and it has to be on the web at someplace like photobucket

That's what I did ... but maybe I messed something up. Most forums don't make you construct the IMG brackets yourself and most forums allow the image to be an inclusion into the post itself ... so this forum is different. I'll try to include the supporting screenshots from my report below with the IMG tag and an outside photo-sharing site.

Here are the four screenshot URLs:
http://picturepush.com/public/7735557
http://picturepush.com/public/7735559
http://picturepush.com/public/7735560
http://picturepush.com/public/7735561

I'm going to surround each of those above with IMG tags below to see if they show up properly:

[rocksockdoc]

I noticed the images don't show up even though there is nothing wrong with the URL and there is nothing wrong (from what I can see) with my constructed URL surrounded by img tags (with the / on the second tag).

Would someone kindly try to show those four images to check if it's just me?

TIA

[Pugsy]

Copy the hotlink to forum (1) line address in the box..then paste it on thread page.
That is all you do because the IMG brackets are within the address. Copy/past3...that is it.

[Pugsy]

PB Periodic breathing. Happens to us all but a reason for panic. We look for how much and how often. Minimal to none is best. Yours is well withing normal limits.

Large Leak is around 90 L/min.
It is hard to see just how high your leak went using Viewer. If you were to use SleepyHead the graph scale is higher and you get more up close detail.
Your leak needs some serious work but I suspect you already know that.

The long term trends I don't pay much attention to unless I am looking for something very specific like a pressure averages vs 90% vs max reached.

On the last page of my 769-day 24-page report reports the "Auto Bi-Level Summary" Average AHI to be 1.2 while the "Sleep Therapy Statistics" Average AHI is 1.5 (as shown in the image below, if it works).

I see this....rather odd. but from this I can't figure out why the difference unless it happens to be a rounding off thing.. I will check with my ENcore to see if I see a similar difference.
Respironics is not know for their math skills.
EDIT;;;just check Encore..same page..same data off a bit. For me one section says AHI 2.0 and the bottom section shows 1.9. Have no idea why they are different.

In general the only thing that needs work is your leak.

[rocksockdoc]

PB Periodic breathing.... Yours is well withing normal limits.

Thanks. I do appreciate your help as I realize nobody has to help me.

If you were to use SleepyHead... you get more up close detail.

Great advice! I had never heard of SleepyHead. Googling, I see it's OpenSource software:

• http://sourceforge.net/projects/sleepyhead/[/quote]
  
  That's good because I'm on Linux most of the time. I'll install it and report back on what it says.
  

  Your leak needs some serious work but I suspect you already know that.

  Actually, I did NOT know that. I'm not even sure which 'leak' figure you are pointing me to.
  May I ask: Which leak needs serious work?
  
  I guess, if there is any leak, it means the mask is slipping off my face at night, which is causing a leak. Is that the normal cause?
  

  In general the only thing that needs work is your leak.

  What is the typical cure for a leak? Is it a better fitting mask?

[Pugsy]

The fact that your reports show any time in large leak % means your mask is leaking pretty badly at some time. It takes a pretty massive leak to be called a Large Leak. Either that or you are mouth breathing and the pressure is exiting the mouth. Do you have dry mouth by chance?

Your leak line is all over the place...you want to stay as far away from the 85 to 90 L/Min line as you can get. Ideally a little smoother line would be nice but not critical..but without going quite as high as it goes. I thought you knew you were leaking because you mention awakening and I assumed the leaks were waking you up...my mistake. I misunderstood something you said.

Now at your pressure your mask is going to have a higher vent rate so we don't expect a low, low baseline vent/leak line. The vent rate at 20 cm pressure for the Swift FX is 49 L/min.
Looking at the leak line on the one image here..see the tiny starting point leak line...right below 50 L/min line? That's a normal venting line number to sort of eyeball for reference.
These machines aren't exact and the masks may vary a bit but that is a good general starting point for you to base your baseline starting point leak line on.

When an Encore leak line looks ugly is usually is pretty ugly because we see it from far away.
When you see the same line in SleepyHead it will be a closer look and probably look even worse.

Don't obsess over the leak line's looks though....just look at the maximum high points and try to avoid nearing 80 L/min because that is awful close to large leak territory and when we reach large leak territory then we can't trust the numbers because pressure effectiveness is diminished and also machine sensing ability.

With time and experience the leak line will stabilize somewhat.

Most common causes for leaks? With nasal pillow mask...the pillows slip out of the nostrils a bit with movement.. Sometimes people actually leak more because they have the nasal pillows too tight. They shouldn't hurt at all. You might try some Lansinoh ointment. It is found in the baby section of Walmart. It helps with tenderness and it also is a bit tacky so a little bit helps seal. Don't use too much or your body heat will melt it and then the pillows slide around too much. You might also experiment with different nasal pillow sizes.
Finally...mouth breathing leaks. Normally when these are an issue we see prolonged times in large leak territory and while you are close with this report here...you didn't reach it for a prolonged time because the machine didn't flag a large leak. Even a short lived spike into large leak territory is not the end of the world.

With your pressures you are going to have more of a challenge with leaks no matter which mask you use. Leaks are a battle we never truly win. They are always there lurking in the background to give us a bit of trouble.

Take a look at this thread of mine. I have an example of a good leak line and a bad leak line.
Disregard the baseline starting point as being so much lower than yours. This is a Encore Pro software report and I have it set to show only unintentional leak which is excess unwanted leak.
Your Encore Viewer is showing total leak (vent rate plus excess leak). so don't look at the baseline number...just look at the line itself.
viewtopic.php?f=1&t=67883&p=631376&hili ... mb#p631376

BTW that really good straight leak line...it is not something I get every night.

Let me know if something else needs clarification. This is why it is hard to have a "Encore for dummies"... It is so hard to have something that covers all possible scenarios.

BTW unless you are a serious mouth breather... I would stick with the Swift FX. Less surface to have to try to seal...when you get the larger masks with more surface..the physics of it means you have more areas to have to worry with. Even if you were a serious mouth breather I would add something to keep mouth shut before I went to another mask. At your pressures...you would likely be trading one leak for another and a whole lot more work.

[rocksockdoc]

[/quote]your mask is leaking pretty badly at some time.[/quote]
I had not prior realized this!

Do you have dry mouth by chance?

Nope. I don't even put water in the humidifier because dry air doesn't bother me.

Your leak line is all over the place...you want to stay as far away from the 85 to 90 L/Min line

This is the kind of targeting information I need to know!

I thought you knew you were leaking

I did not realize I was leaking before you told me.

The vent rate at 20 cm pressure for the Swift FX is 49 L/min.... that is a good general starting point for you to base your baseline starting point leak line on.

Thanks for that advice. That's what I'll do. I'll assume something like 48 or 49 as the baseline leak to aim for.

... an Encore leak line looks ugly ... because we see it from far away. When you see the same line in SleepyHead it will be a closer look and probably look even worse.

I had never heard of "SleepyHead", so I tried (and failed miserably) to install it on Linux (Ubuntu 10.04) but it did install easily on WinXP. I'm just starting to get used to it but the graphs do seem nicer.

Here's a recent Encore Viewer leak graph:
http://picturepush.com/public/7759499
Attempt at surrounding that URL with IMG tags -->

And here's my first SleepyHead leak graph:
http://picturepush.com/public/7759501
Attempt at surrounding that URL with IMG tags -->

Don't obsess over the leak line's looks though....just look at the maximum high points and try to avoid nearing 80 L/min

Thanks. That's the kind of real-world experience I don't have.

With nasal pillow mask...the pillows slip out of the nostrils a bit with movement.. they have the nasal pillows too tight...might try some Lansinoh ointment... experiment with different nasal pillow sizes.

Thanks for the advice. I loosened the nasal pillow mask headgear as the first thing to try.
I hadn't realized you can change the size of the pillow on the plastic mask. Can you?
That is, given any particular mask plastic is a certain size, can you change the size of the attaching rubbery pillow?

Leaks are a battle we never truly win. They are always there lurking in the background to give us a bit of trouble.

I had never even known I had to fight this battle - but I'm all for 'better' quality sleep!

Take a look at this thread of mine.

Wow. That's quite an improvement!
http://picturepush.com/public/7759566
Attempt at surrounding that URL with IMG tags -->

it is hard to have a "Encore for dummies"... It is so hard to have something that covers all possible scenarios

What I'd like to try to start is a basic tutorial for just the basics of what to look for, in order of import.

I would stick with the Swift FX. Less surface to have to try to seal...

I've been using whatever mask the supplier gave me. But I'm unhappy with it because it breaks in travel and the rubber pillow often comes off. It's a "ResMed Mirage Activa LT". I see the Swift FX is a nose thing that sticks two prongs in the nose. As you said, that seems like an entirely different sealing dynamic.

Thanks for your advice! I realize you do not have to help me.

What took me so long to respond was I spend a few days trying to install SleepyHead on Ubuntu as explained in this failed forum post
TITLE: Tutorial for installing SourceForge SleepyHead CPAP/BiPAP (Sleep Apnea) software
URL: http://ubuntuforums.org/showthread.php?p=11750511

[Pugsy]

I hadn't realized you can change the size of the pillow on the plastic mask. Can you?
That is, given any particular mask plastic is a certain size, can you change the size of the attaching rubbery pillow?

Nasal pillow masks like the Swift FX, Swift LT, Opus 360, etc...all have other sizes of pillows available from XSmall to Large. Mainly the pillow rim which rests against the nostril..the inner cones and the size of the inner cone options. Normally the nasal pillow masks are supplied with 3 sizes. Either XSmall, Small and Medium or Small, Medium and Large. If yours didn't then the DME removed them (probably to resell for an additional profit).
I happen to be able to use the XSmall and Small with equal success. The medium is a bit too large because the inner cones aren't comfortable.

If the inner cones aren't large enough to seal inside the nostrils the mask can move around a bit and cause leaks. If they are too large they can't seal well either.

I have no idea how to do the Ubuntu thing. So I am zero help there.
Your links pointed to instructions dated from last August and those were way early in SleepyHead's development. All I know is there there are workable Windows and Mac versions available without any need for additional work to make SH work.

To post images so they show directly like this one below. just copy the Hotlink for forums (1) address line..then paste the address into forum post..no need to use the forum editor at all.
So point to that address line...copy...come to blank page for composing...paste...the address will show up in code but when you click on preview or submit the image is there without the link.