How to interpret results from Encore Viewer data (Ex. AHI)

[fblauer]

I was wondering if someone could help me interpret the results from the data on my card. I have been feeling tired for a few weeks off and on, and the data collection on my machine wasn't working. (a problem with the clock)
I just had it fixed so there is 3 days data - 25/02/2009 - 27/02/2009 (3 days)
My machine and mask type should show up in my signature
My main question is - why my AHI still at close to 7? Shouldn't I be getting a lower number with the auto CPAP?
Is there any adjustment on an auto CPAP which is set for 4-14?

Auto CPAP Summary
Auto CPAP Mean Pressure 5.3 cm H2O
Auto CPAP Peak Average Pressure 5.4 cm H2O
Average Device Pressure <= 90% of Time 7.4 cm H2O
Average Time in Apnea Per Day 50 secs.
Average Time in Large Leak Per Day 0 secs.
Average AHI 6.7

[Georgio]

Yes, you want a lower AHI.
What is your titrated pressure?
4 is very low.
4 - 14 is a very wide range.
If you post your charts, you might get better advice.

Georgio

[Hawthorne]

Georgio is so right! That pressure range is too wide and 4 is too low a minimum pressure.

If you could post the "daily data" pages (page 4) from those 3 days, it would help us to help you.

I see you are Canadian and from Quebec. I am sending you a PM so that I can see where you are at as far as the situation with your insurance is (if you have any). Maybe you bought the machine out of your own pocket.

At any rate these things are a bit different in Canada so want check that out with you.

If you could post those "Daily data" pages with a program like Photobucket (free) people on this forum could help.

There are lots of people on this forum able and willing to help!

[rested gal]

14 sounds fine to me as the max pressure for the upper part of the range. 20 would be fine for the max, too, imho.

What does need adjusting, imho (I'm not a doctor, though!) is that minimum pressure of 4.

If it were me, I'd raise the minimum pressure to 6 or 7 and leave the maximum pressure where it's at...at 14.

Is there any adjustment on an auto CPAP which is set for 4-14?

There's not supposed to be any way for the user to adjust the pressure. However, users who are determined to adjust their pressure themselves can do that IF they are willing to go into the therapy setup menu (that's what the DME did when setting up the machine in the first place) and IF the user finds out how to access the setup menu on the machine.

Since your autopap is using "90%" as a report number, you were probably given a Respironics machine. ResMed machines use "95%."

If you have a Respironics REMstar Auto (with or without "A-flex") M series machine:

viewtopic.php?p=305612#p305612

[fblauer]

Here is my data:
http://fblauer.com/encore_feb.pdf

I don't really know what the photobucket site is for. Seems to me I would have to take a screenshot of every page crop it, and upload them separately, unless I am missing something. Shouldn't we be using a file sharing site? There seem to be a lot of them out there.

Anyways, please let me know if you can view my information, and if you have any insights. I called the doctor, but he can't see me until March 17th. I have been really tired, and I am looking for some kind of solution, or just some kind of idea about what the problem is. Thanks for your help.

[GumbyCT]

1st - what was your titrated pressure? I am willing to bet it was higher than 4cm.

If you look on your daily page and chart at the bottom - look for OA and follow it across you will see you are having apneas even at 7cm. So if you can tolerate the 7cm that's where you need to be right now. That will help to reduce the H's too. If you can't tolerate it, you need to increase it as close you can and work on get used to the pressure that will treat you more effectively.

Wait at least an hour (60min -NO less) each morning for the machine to finalize your nightly data file on the card.

[Hawthorne]

If it were me, I would raise my minimum pressure from 4 cm to 7 or 8 cm. Set at 4, it is way too low! Your maximum pressure is fine. No need to change it. The mask leak looks quite good so, I think it is the minimum pressure that should be raised.

Your AHI is not too bad but could be a lot better. In my opinion, raising the minimum pressure to 7 or 8 would really help you.

I don't know how your doctor would feel about you doing that. Some are not happy about it but titrated pressures are often not very accurate, since they are based on one in a strange situation.

I sent you a PM (Private Message) with my email address, if you would like the Clinician's manual to change that minimum pressure. If you email me, I can send it as an email attachment if you would like it. You can also PM me by clicking on "PM" below my name and information at the left of the post, and give me your email address in a PM and I'll send that Clinician's setup guide to you so you can change that minimum. Maybe you already know how to do that!

Photobucket is a file sharing site but, it is a little confusing. You seem to have a found a better way!! That's great!

[fblauer]

Thanks to everyone for your help and suggestions. I have set the minimum to 7, and will let you know how it goes.

[fblauer]

Here is the data from last night, after increasing the minimum to 7:
http://fblauer.com/ARNet280209.pdf

I still have an average AHI of 6. I kept waking up because my mouth was dry, so I hooked up the humidifier again for tonight.

[DoriC]

I don't usually feel qualified to give setting recommendations, but I know RG or Hawthorne will jump in and correct me if I'm wrong so I'll test what they've taught me. It would seem to me that a min of 9 or 10 would be the right pressure to get your AHI down, the max is probably OK at 14. My husband does better with a narrow range but everyone's different. Of course it is suggested that you give each setting change 3-4 nights to get an accurate picture unless something is really uncomfortable. I didn't always take that advice and it only caused more confusion and lengthened the adjustment period. How did I do, girls? BTW, how did you get your reports on here without using Photobucket,etc? Thanks, Dori

[Hawthorne]

DoriC- Good advice! I think jumping up to 9 or 10 this soon (when he was at minimum 4 until last night) MIGHT be difficult. You ARE right that his minimum pressure will probably end up in that area but I think he should move up more slowly - as you said to give him time to adjust. You asked RG and myself how you did -- You did very well!!

[GumbyCT]

You never did say what your titrated pressure is??

If you look a the chart below your graph you can see you didn't have any apneas at all. So 7cm suppressed ALL of your OA's. How do YOU feel? Now just follow the 'H' row over and it looks like that needs a pressure of 10.

But the increase in pressure also increased your leaks, likely mouth breathing which will really mess up your data.

Do some searching here on controlling mouth leaks. If you decide to increase don't go more than 1 cm at a time. Keep a log on how you are feeling at each pressure but note the leak rate also.

You may want to eventually try your pressure at straight CPAP of 10cm. Use the ramp at 7 or 8 if needed. Keep in mind if 10 or 12 or 14 seems too much right now that in time your body will get used to it. Take it slow.

What was your titrated pressure??

[Quinda]

fblauer ... I experienced a similar situation to what you are experiencing currently, obviously your hypopnea's are affecting your overall AHI. At the time I was at a relatively high pressure, 16 cm H20 and was still having a high hypopnea rate and I too, felt tired in the mornings ... I consulted with my specialist and they added oxygen therapy to my CPAP therapy using a concentrator since then I've dropped down to around 1 on my hypopnea index, my AHI is < 2.0 ... I'm currently at 20 cm H20 and getting a great night's rest ... you might want to consult your specialist and see what they think about considering some oxygen supplement ...


--Quinda

[DoriC]

Gumby, that's what I meant to say!(LOL) Hawthorne, thanks.

[fblauer]

The titrated pressure that I was originally prescribed with was 7, if that was what you meant (Gumby). I had a fixed CPAP a few years ago. Then I went to another doctor last year, and he was the one who prescribed the APAP with 4-14. Then the clock on my machine was broken, so I wasn't able to get any data until I got it fixed recently. I have an apt. with my doctor on March 17th. I was feeling tired, so I was trying to find out what to do in the mean time.

I uploaded the data to my web site. I found it easier than using photobucket. I don't know what other people are doing, but I have to print to a .pdf file from the encore viewer program. If it is helpful, I will look into file sharing programs for other people here, if you don't have your own web site.