I could use some advice on my Encore data, please?

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Gregg
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I could use some advice on my Encore data, please?

Post by Gregg » Sat Jul 26, 2008 8:19 pm

I'm posting four days of data. The first day was a clear headed and healthy day. The next three were quite bad. Headache, fatigue, anxiety, depression. Really hard to endure. I'm only posting this data because I'm quite upset today. I didn't expect days like this with the bipap set up the way it is.

I'm on bipap setting 3, for easy breathing. Epap min is at 11 if I recall. Ipap max is at 16. I'm using a full face mask.

I see a couple of correlations between the bad days and the good one. But when I look at previous data from a few weeks ago, I can't make the same confirmations.

Also, I am assuming that this data clearly indicates that I have apnea. After all it wouldn't be ramping up for long periods of time if I weren't having episodes of apnea?

I'd really like to hear if there is anything you see here that would give an indication as to why the last three days have been so bad.

Here we go, starting with the first good night's data, followed by three bad.

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mindy
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Post by mindy » Sat Jul 26, 2008 8:36 pm

Gregg,

Take what I say with a tablespoon of salt - I'm sure others will pop in with more knowledgeable comments. One thing I did notice is that in the first set the pressure stayed below the max line whereas in the reamining ones there were periods of time when the pressure was right at max. I'm only familiar with APAPs so am not sure if this is an issue in your case. For my APAP, I'm under the impression that it means that my max pressure isn't high enough.

Good luck!
Mindy


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bap40
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Post by bap40 » Sun Jul 27, 2008 7:27 am

The leaks seem pretty high.
Brooke

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Hawthorne
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Could use some advice on data

Post by Hawthorne » Sun Jul 27, 2008 8:11 am

I am far from an expert but here goes! Your AHI is not bad any of the nights. Your IPAP and EPAP are bumping up against the highest pressure in the 3 bad nights. Even on your good night that happened once anyway. Your leak rate is going up (slightly) each night, as is your vibratory snore rate. While your AHI went up (slightly) each night, on the last night you posted it was down again.
This is what I notice BUT I don't much about bipaps. I see you are using a full face mask.
One question comes to my mind ---How old is your mask? Another --How long have you been at that setting? New mask? Up settings slightly?
I wish, when the real experts reply, they will say something about my observations as well, so I know I'm on a bit "on track".


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GumbyCT
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Post by GumbyCT » Sun Jul 27, 2008 9:35 am

The leaks are high which is causing the pressure to bump up. Find out why your leaks are so high. Do a search for Rested Gal's panty straps to see if those will help you, They did for me.

RG's straps helped me bc they don't push in but keep the mask from moving away when the press goes up. Do you have your mask too tight? The UM design helps the mask to seal best when you pull it away from the face & allow the seal to fully inflate. Try these things out before you get ready for bed, until you have it down.

fwiw- I feel best when my ahi + FL's is below 1. you may find the same thing.

Good Luck,
GumbyCT


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Wulfman
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Post by Wulfman » Sun Jul 27, 2008 10:05 am

Gregg,

Has it occurred to you that your "bad days" may be from all the pressure changing that's going on during the night with your Auto settings?

Your overall numbers don't look that "bad".
According to the mask chart (in the following link), your leak rate is about right for a pressure of 17 - 18 with the UMFF (a little high, but not really excessive):

http://www.internetage.com/cpapinfo/leak-rates-1.html

If it was me, I'd be experimenting with straight Bi-PAP settings of EPAP - 12 or 13 and IPAP of 15 or 16......for starting points. Then, select whichever BiFlex setting is comfortable to you....if you use it.

What were your prescribed pressures?


Den

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Gregg
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Post by Gregg » Sun Jul 27, 2008 10:19 am

Thanks. The bumping up of pressure is interesting. I also took a look at the Max pressure difference setting. And increased it. That could also keep pressure from being able to rise.

I've been at these settings a few weeks. It's all new stuff. And the leak graph for the mask is about right. 50 L/min for 18 cm h20. So there is leakage, but not bad. And I do have it tight, otherwise the leaks were greater. Especially side sleeping.

I'm really discouraged. I can't take many more bad days. I know it's working to some extent though, since I no longer have to get up in the night several times. Whoopie. Maybe January 2009 will bring me up. Anyways, thanks folks.

By the way, after the changes, here's last night's data. It's probably meaningless considering it's just one night. But raising Ipap may have contributed to it. And I do feel fairly human this morning.


The off period is me just lying there unable to breath because of stuffed sinuses. I'm grading on a tractor and it has wreaked havoc with my nose. Which I'm sure is also contributing to bad nights.

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Gregg
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Post by Gregg » Sun Jul 27, 2008 10:27 am

Oh, good thinking. I think it was you who mentioned it in a previous thread, Wulfman.

I'll note that idea. In fact, I may just set it up like that now. The only problem I see with it is that with Ipap pressure set at even 16, that's where it was when I was feeling lousy. I'm not sure what settings would be proper. Epap even ramps way up.

This could be much smarter than expecting some generic algorithm in firmware to ramp things up.

Thanks. Duly noted.


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Wulfman
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Post by Wulfman » Sun Jul 27, 2008 10:41 am

Gregg wrote:Oh, good thinking. I think it was you who mentioned it in a previous thread, Wulfman.

I'll note that idea. In fact, I may just set it up like that now. The only problem I see with it is that with Ipap pressure set at even 16, that's where it was when I was feeling lousy. I'm not sure what settings would be proper. Epap even ramps way up.

This could be much smarter than expecting some generic algorithm in firmware to ramp things up.

Thanks. Duly noted.
Last night looked pretty good. Take notice in the "grid" (at the bottom) where your best AHI numbers were, at which pressures.....you had some 0.0 numbers there.

Also notice that where you started to do a little snoring just before the end of the first hour your pressure started increasing.....and then when you were leaking right after the end of the first hour and for another hour and a half, your leaking and apneas kept the pressure up. There are any number of things that can cause leaking, but if you aren't having significant apneas or hypopneas, there's no good reason for the pressure to increase.


Den

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Snoredog
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Post by Snoredog » Sun Jul 27, 2008 12:59 pm

I would:

Increase your IPAP max to 20 or higher. When IPAP max is limited it will peg at the prior set limit then it can move no higher, when that happens EPAP will begin to move up to eliminate the event that IPAP couldn't address. The closest these two will ever get is 2 cm on the narrow side as that is hard coded into the machine.

I'm seeing 3 cm PS??

I would increase that to 4 or 5. You don't want the IPAP pressure bumping into the Maximum set limit. There is really no reason to limit that to 16.

Sometimes a low AHI is not everything, you have a lower AHI but feel worse. You feel worse because you are manipulating the therapy with EPAP like a CPAP machine. I would adjust EPAP back down get some comfort out of it and allow the machine to move thru the range freely.

For the most part EPAP pressure is remaining at the EPAP Minimum set. This is because the events driving a pressure increase are from those events addressed by IPAP (upper IPAP chart at the bottom of the reports).

so I would set mine at:

IPAP Max=20 (or higher)
EPAP Min=8 (8 to 10 is fine)
PS=4 (or 5)
Flex=2

The "PS=" (default=3) you set is the differential pressure between IPAP and EPAP, it is like a tether or string between the two pressures, when it reaches the end of that string it pulls the other pressure higher (or lower), how long you make that string can either pull a pressure up or down sooner (not faster but sooner). Longer the string the longer it takes to pull up EPAP or the longer it can take EPAP to pull down IPAP. The bumper between the two will always be 2 cm and never narrower (in auto modes).

someday science will catch up to what I'm saying...

Gregg
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Post by Gregg » Sun Jul 27, 2008 1:29 pm

Thanks Snoredog.

I had been decreasing PS for some reason. But I forgot that it could have a limiting effect on the ability to titrate proper pressures.

However, I also thought that by opening up the settings to that "default starting place", I might end up with potentially slower machine response time.

So it seems to me that I should stay on auto until I find the best therapy numbers. And then perhaps go the straight bipap route.

At any rate, I feel quite relieved to have all of your help.

The funny thing is, I have spent three years learning all about espresso. I recently got very serious about it, and discovered that it too is simple yet complex. Thanks to the forums, we all get to help each other out.


In other news, here's what I've been doing for the last three days. This redwood stump was huge. I estimate about ten thousand pounds. It took every bit of my effort to get it out, and then split it so I could even lift it with the crane, or move it with the tractor. Even the "shoots" are small trees, as you can see.

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GumbyCT
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Post by GumbyCT » Sun Jul 27, 2008 5:11 pm

Gregg wrote:So it seems to me that I should stay on auto until I find the best therapy numbers. And then perhaps go the straight bipap route.
I agree with that too but - Gregg STOP the presses check your PM's.

SD check your PM's


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Post by Snoredog » Wed Jul 30, 2008 12:15 am

GumbyCT wrote:
Gregg wrote:So it seems to me that I should stay on auto until I find the best therapy numbers. And then perhaps go the straight bipap route.
I agree with that too but - Gregg STOP the presses check your PM's.

SD check your PM's
someday science will catch up to what I'm saying...

Gregg
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Post by Gregg » Wed Jul 30, 2008 10:09 am

Here's more data from the last two nights.

The first night resulted in a horrific day, following.
The second night appears to be a bright healthy day here, despite large mask leaks. And even what the machine sees as snoring.
I'm posting here so it's on the record. I'm not sure it amounts to much or if it can be useful. And I realize I've been doing the forbidden rapid succession machine adjustments. Hell, I'd grind the machine up and eat it if it helped avoid days like yesterday.

I did increase the max pressure support on the second night. As well as going from 3 to bipap setting 2. This is all on auto mode.

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Wulfman
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Post by Wulfman » Wed Jul 30, 2008 10:50 am

I still stand by my previous thoughts and suggestions.


Den
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