Encore Pro - not reliable per sleep tech

[Birdseed]

I spoke with a "sleep tech" yesterday for quite awhile about my 3 sleep studies. If I understood the tech correctly, this individual gathers the data generated during your PSG and puts the reports together for the doctor to read and sign off. As we talked, I mentioned that I used the Encore Pro software to monitor my therapy. The tech said "that software program is not very accurate, so you shouldn't use it to monitor your therapy." (Uh huh - yeah right.) This same person said I didn't need the BiPAP ST machine (in their humble opinion -- even though I was titrated with one) to take care of my mixed sleep apnea. The tech also has a misconception about how the ST part works -- mentioning that it's invasive like being on a respirator that breathes for you! Good grief, I'm growing very weary of this entire field of medicine. It's quite evident a support group, like this one, is so much more important than we realize.

(I'm certain there of some wonderful sleep techs who lurk or post here, so please do not take this personnally. Like anything else, there's the good, the bad, and the ugly.)

LB

[msheda]

Sounds like he needs to read the manual on it.

http://global.respironics.com/UserGuide ... 040200.pdf


2.3 Intended Use
The BiPAP autoSV is intended to provide non-invasive ventilatory support to treat adult patients with OSA and Respiratory Insufficiency caused by central and/or mixed apneas and periodic breathing.

[Birdseed]

Yes, it certainly reinforces what this site has always advocated - read as much as you can about your sleep problem and available treatments. Read, read, read!

LB

[Gerald]

Birdseed......

It appears that, like so much in our culture, reality is just the opposite of what is being presented to you.

I think the sleep techs are far less reliable than Encore Pro.

From what I can see, I'd put them on a level somewhere near that of politicians and used car salesmen.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Encore Pro

[Slinky]

Well, I can't say that about my sleep tech, nor the gal who does the scoring of the PSGs - but - when it comes to the RTs at my local CPAP DME's .... yeah, about on a par w/a horse trader, used car salesman, politician, lawyer .... the bottom of the barrel.

[Birdseed]

Don't get me started on the DME. First they issue me this Swift II nasal prong mask and DO NOT even offer me a choice. Had some trouble with mouth breathing and requested they issue a FFM, and they told me I needed a NEW prescription. The original prescription already stated "mask of choice, including FFM" .... but it took me 3 days to discover that on my paperwork from the DME! I didn't have the original prescription since I was JUST learning about this sleep thing. Disturbing - you bet!

LB

[Slinky]

When the timing is right - like when you are eligible for a new mask according to your insurance guidelines (usually every 6 months) you might want to "casually" let your DME's RT know that YOU are aware of Respironics', Resmed's and Fisher & Paykel's policy of replacing FREE OF CHARGE TO THE DME any mask a patient has tried unsuccessfully as long as the DME fills out a form and returns it w/in 30 days. Yeah! Its true. Straight from the horse's mouth of one of the RTs who drops into this forum every now and then.

[Wulfman...]

I spoke with a "sleep tech" yesterday for quite awhile about my 3 sleep studies. If I understood the tech correctly, this individual gathers the data generated during your PSG and puts the reports together for the doctor to read and sign off. As we talked, I mentioned that I used the Encore Pro software to monitor my therapy. The tech said "that software program is not very accurate, so you shouldn't use it to monitor your therapy." (Uh huh - yeah right.) This same person said I didn't need the BiPAP ST machine (in their humble opinion -- even though I was titrated with one) to take care of my mixed sleep apnea. The tech also has a misconception about how the ST part works -- mentioning that it's invasive like being on a respirator that breathes for you! Good grief, I'm growing very weary of this entire field of medicine. It's quite evident a support group, like this one, is so much more important than we realize.

(I'm certain there of some wonderful sleep techs who lurk or post here, so please do not take this personnally. Like anything else, there's the good, the bad, and the ugly.)

LB

The sensors in the machines are NOT as accurate as having a full blown PSG with all the wires and stuff glued to you......but then, who the Hell wants to do THAT? I would even imagine that it over-senses some events and scores false positives.

I'm sure that the manufacturers wouldn't have put this technology out in these machines without testing it in PSG-type conditions to make sure it's at least "close".

Den

[msheda]

Even if it's not 100% reliable, it should be 100% consistantly wrong.

what does that mean?

same as your bathroom scale. You might not really weigh 150 lbs (it might be 148 or 154) but it should consistantly measure you inaccurately so you can plot the trends, am I doing better or worse..

[Snoredog]

I spoke with a "sleep tech" yesterday for quite awhile about my 3 sleep studies. If I understood the tech correctly, this individual gathers the data generated during your PSG and puts the reports together for the doctor to read and sign off. As we talked, I mentioned that I used the Encore Pro software to monitor my therapy. The tech said "that software program is not very accurate, so you shouldn't use it to monitor your therapy." (Uh huh - yeah right.) This same person said I didn't need the BiPAP ST machine (in their humble opinion -- even though I was titrated with one) to take care of my mixed sleep apnea. The tech also has a misconception about how the ST part works -- mentioning that it's invasive like being on a respirator that breathes for you! Good grief, I'm growing very weary of this entire field of medicine. It's quite evident a support group, like this one, is so much more important than we realize.

(I'm certain there of some wonderful sleep techs who lurk or post here, so please do not take this personnally. Like anything else, there's the good, the bad, and the ugly.)

LB

I would have to agree, the software is not going to be as accurate as the lab, they have multiple sensors to look at, microphones on your throat, sensors everywhere, a belt around your chest, sensors to measure airflow.

But it should NOT be used to monitor your therapy?

I disagree with that. The sleep tech is threatened by autopaps, they are just covering their butts. Who wouldn't?

But as we have seen here, your PSG is only 1 night snap-shot. Even with all those sensors attached to you they still get it wrong. When you use that autopap machine it monitors you night after night, it adjusts if you are on your side or on your back. All the lab can do is give you 1 pressure to use and it will be there for the worst case seen during that "one" night at the lab. It is why they get it wrong so often.

But the machine is a flow-based machine, it can only measure your breathing based upon airflow pressure. Then has to do that from the end of a 5 or 6 ft hose, so yes, it won't be as accurate as all the sensors they have you hooked up to at the lab. But are you going to wear that harness to bed every night? No.

But the fact is the machine doesn't have to be accurate to monitor your progress. If your speedometer in your car is off by 5 MPH and you drive 55 MPH through a 25 MPH school zone is it going to matter when they write you that ticket?

The point is the AHI and other information given off by the machine/reports doesn't have to be accurate to use it to monitory your therapy. If things are under control, that data will be lower. If things aren't going so well that data will be higher. What is the difference between a AHI of 11 and a AHI of 9? What is the difference between 9 and say 2? Well you know that 2 is an improvement over 11, many can get theirs to zero.

So I agree with the sleep tech their monitoring is more accurate, but I disagree on using the machine's reports to monitor your therapy results. Those same results can be used either to send you back to your doctor and lab just as easy as keeping you away, as a patient you at least know where you stand.

[goose]

It's so inaccurate that Doctors, DME's and RT's use it worldwide to monitor our treatment (when they even bother).

It will not be as accurate as a full PSG, no. I wouldn't expect it to be, but as Snoredog said, "Do you want to wear that harness to bed every night??". Not me!!!!!

The one night snapshot that you get during titration is not a sure bet either. I titrated at 5cm H2O. That's barely enough to allow me to breathe!!!! I am presently at 10cm and I'm about to change it up one to 11. (I've been at 10 for about 6 weeks and am consistently at about 2.5 AHI. So it's time to raise it a tad).

Obviously this particular RT has not done his homework!!!

cheers
goose

[geoDoug]

It sounds to me like the tech is conceited about the technology they are immersed in. Their opinion is that if you aren't gathering the best data possible, then the data is completely worthless. You see this all the time with techy types in many fields. (My apologies to the techy folks here. I know that not all of you are like this.) It's human nature to be influenced by what you do. You have to be vigilant that when you get too close to something you don't lose perspective.

And I agree that as long as the software and/or hardware is consistently wrong that's fine with me. An absolute number like, for example, a 0.0 AHI is nowhere near as important as the trend.

Doug.

[WxMan]

"that software program is not very accurate, so you shouldn't use it to monitor your therapy."

Huh?? What's the alternative? This suggests that no monitoring is better than an APAP. Who uses a Polysomnogram for monitoring on a regular basis? Few would argue that a polysomnogram is not more accurate than an APAP. That's why it is used for diagnosis. However, once that diagnosis is made, how do you monitor therapy? The implication here is that it is not necessary. I would argue that any serious medical condition requires monitoring. Who hooks themselves up for a polysomnogram on a nightly basis?

Diabetes represents a good analogy in my opinion. Initial diagnosis is made with a lab and a blood test. However, to allow home monitoring urine strips were developed. Not very accurate...just hopefully indicated if sugar was running high. Later, home blood tests were developed. Not as accuracte as a lab but pretty good. Neither are as accurate as a lab and urine tests were extremely inaccurate. However, no doctor suggests that an individuals diabetes should not be monitored because these tests were not up to lab standards. Indeed, testing was mandated.

I've used Encore Pro for two weeks now...had the machine longer but 1.8 wasn't easy to get. I'm glad I got it. I know for a fact that I get false events while awake per post elsewhere on this board. However, I still can use the information to calibrate the results while sleeping where results are more accurate and where my concern lies. I don't care what happens during sleep onset as I know when I'm awake and discard those flags. I f one uses trends and averages much information can be determined...in a relative sense. The effects of medication, a different pillow, a late meal, on and on. None of those issues were addressed in a sleep lab.

Absolutely, utterly, completely disagree with the sleep tech.

[msheda]

Add to that, sleeping in a strange setting while in lab, sleeping while wired up in a possibly stranger position than you normally sleep in, etc...

There is a time and a place for both ways.

[Slinky]

So far no one has allowed for the fact that all the data collected by all the PSG equipment is only as good as the tech doing the scoring of the data!! And then you gotta allow for the doctor's interpretation of that tech's scoring.