Data - What and how to share

[jimplasticguy]

Friends,

I have had the S8 Autoset II set up for 4 nights now and am downloading to ResScan Software. I started typing an introductory message that I think is way too much info to start. If interested, I can add my history.

The bottom line is that I have had apnea for quite some time, and have been religious about my CPAP therapy for around 1.5 years. I had some real serious issues with drowsiness creep up on me. I had a huge increase in pressure needed (from 6 cm to 12 cm straight CPAP, titrated at sleep study).

I have been able to get a Resmed autoset II from the DME to rent for now (it is used, I want them to give me a new one if it is working for me and insurance rents to own). The doctor ordered up an auto when I was pushing for help, but he warns not to "pay too much attention to the data." DME asked me to not tweak to much. I am a mechanical engineer, highly technical. As we used to say in the coast guard, they can "go pound sand" if they don't want me to figure this out. The last year was a disaster. With this new machine - The first night on the DME settings where they locked out EPR, even though I have been using C-Flex for years, was a disaster.

So, here is the question. What can I share that can help you help me? Now that I fixed the EPR thing, the mouth leak went away, but I am still having significant hypoapneas, and some apneas nightly.

My AHI was 10.3 on the best night with one actual apnea happening. The rest were hypoapneas. I believe there is some tainting of the data due to things that happen when I am awake with the mask on. There were basically no leaks that night, except for when I pulled the mask off once during the night and in the morning.

Last night, not as good as the previous, the apnea index was 1.0, hypoapnea index 16.5, and AHI 17.5.

The DME set the min and max pressure to 6 and 14 respectively, and after reading some of what you all are saying, I think that may be too wide of a gap. It looks to me like there are less hypoapneas when pressure is up around 9 or 10, but it just isn't that consistent.

I think the graphs of each night tell the story (there is some inconsistency to me). So I can share if you guys tell me what the customary things are which enable others to help and comment.

There is some real urgency to get this right. Professionally, this illness just about took me out. I am a top technical salesperson of polymers. I need to keep it that way. So, I appreciate any help. Want to see some techy stuff?

Jim

[BleepingBeauty]

Friends,

I have had the S8 Autoset II set up for 4 nights now and am downloading to ResScan Software. I started typing an introductory message that I think is way too much info to start. If interested, I can add my history.

<snip>

So, here is the question. What can I share that can help you help me? Now that I fixed the EPR thing, the mouth leak went away, but I am still having significant hypoapneas, and some apneas nightly.

Hi, Jim, and welcome to the forum.

First, the equipment shown in your profile must be your "old" equipment; you say you have the ResMed Autoset II now, but your profile shows a Respironics machine.

Second, it's helpful if you can post some of your data. Many here will be able to help you learn how to interpret it and/or make suggestions to better your therapy. To post your data here on the forum, you'll have to save it as a .jpg file on your pc and then upload it to a photo hosting site (like Photobucket). When you have your data graph on-screen:

1. Be sure your viewing window on the pc is at full-size, so all the data is visible.
2. Hit the Print Screen key on the keyboard.
3. Open your photo editing program. (I use MS Photo Editor.)
4. Open a new file in your photo program and paste (Ctrl+V) the image in.
5. Crop the image to remove extraneous info (like your name, for instance).
6. Save the cropped image to your pc as a .jpg file (perhaps on the Desktop, so it's easy to find).
7. Upload the .jpg to the free image-sharing site.
8. Name and save the image.
9. Copy the Image code on the newly-uploaded file (hover the mouse over the image, and then copy the [IMG] code from the drop-down that appears).
10. Open a new post here, and paste the Image code into the post. Make sure the [ Img ] [/Img ] codes surround the link.

Then click on the Preview button to see if the image shows up correctly in your post. If it does, hit Submit.

The process sounds more convoluted than it is. (And my apologies if you know how to do most of this already, being a technical guy.) Hope that helps.

[jimplasticguy]

That is a perfect answer. Thank you so much for responding. Here is the last two nights data, at least what I believe will be useful.

[ozij]

Hi Jim,
The software lets you change the order in which the charts appear.
It would be a great help if you could order the charts so that the Evnets chart appears directly above (or below) the Pressure chart.

A few things you should know about the ResMed algorithm's logic:

• It responds to snores (the software doen't show them)
  It responds to flow limitations -- when it figures your airway is showing imminent signs of closing down but hasn't started yet
  It does not respond to hyoponeas, ever
  It responds to apneas, but only till your pressure gets up to 10 -- it won't respond to apneas above 10.

Which means that you are dependent on snore, apneas and flow limitations to keep you from having obstructive hypopneas. Works great for most people, doesn't work at all for some.

You can select the time window for charts in ResScan -- you drill down to 10 seconds -- I usually find the 10 or 5 minute focus informative enough.

[jimplasticguy]

Thanks so much for your replies. Let me try it this way and see if it looks better than the other way. This is last night, which was clearly yuckier.
When I start putting it together, I think that I may need to raise the lower limit pressure to 8 or 9. On the second one, I drilled down to the first set of events. Doesn't it look like the pressure drops too low bringing on bad things?
Note on the one-hour view that the series of events ended when I ripped the mask off, because I had one of what my wife and I call my "choking nightmares." I wake thinking that some object is in my throat and will be swallowed. It aint pretty. When my apnea is really under control with cpap, these mostly go away.





I have a question for you ResScan experts. What does the amplitude of the apnea event tell me? I was thinking it was the number of seconds, i.e., 10 meant 10 seconds. When I drill down and look at times, it looks like a "10" may run into an "11" within 5 seconds, so I am confused on that.

I am OK with eventually going back to straight pressure with exhale relief if that is what works. I just want to make sure that I have an auto with data so that I have the capability to check when things don't feel right.

Thanks -- Jim

[dtsm]

Hi Jim,
A few things you should know about the ResMed algorithm's logic:
It responds to apneas, but only till your pressure gets up to 10 -- it won't respond to apneas above 10.
Which means that you are dependent on snore, apneas and flow limitations to keep you from having obstructive hypopneas. Works great for most people, doesn't work at all for some.

Can you elaborate? I'm still tweaking my pressure range on apap and maybe should go to cpap given my first 6-7 weeks of data are pretty consistent but improving. My range started at 4-20 but now tweaked to 8-11.4 (don't ask re the deciment point, it's just me!).

I'm ave 9.6 pressure, leakage pretty much under 0.15 range, AHI started at 15 range but recently gone done to below 10, Ai under 3 but Hi still 8-9 range. So if pressure doesn't get up over 10, what happens during 'events'?

I can only read the data from the LCD, my card reader was back-ordered and won't arrive till next week.

[DreamDiver]

... It responds to apneas, but only till your pressure gets up to 10 -- it won't respond to apneas above 10...

I thought pertained only to central apneas...

[ozij]

The algorithm on the S8 can't tell the difference between an obstructive apnea and a central apnea. Epidemiological data show that pressure induced central apneas happen more frequently above 10 cms.
In order to avoid pressure induced central apneas above 10, ResMed's older A10 algorithm works as I described it above: It ignores (does not raise pressure in response to )any apnea above 10.

When people need more than 10 cms of pressure to keep them from having obstructive apneas and obstruction related hypopneas, and do not have snores or flow limitations to drive the pressure on the Autoset above 10, then their pressure will hover in the vicinity of 10, and their obstructive events will not be responded to, their obstructions will continue.

These people exist -- on the ResMed they will have to set their minimal pressure low enough to avoid the majority of obstructive events

Other people will have the pressure sailing way above 10 cms because of flow limitations - even though their snore and apneas and hypopneas are cleared at a much lower level.

Many on the ResMed, may benefit from its pre-emptive abilities and enjoy lower pressure when in Auto mode.

Every algorithm, on every automatic machine will fail to treat a certain segment of the population. Auto algorithms do their best to analyse breathing patterns based on various statistic heuristics. Which is why most machines are good for most people, but none are good for all.

[Julie]

A very common problem that comes up once people are on Cpap is that the pressure of air being pumped in when they're asleep converts them to overnight mouth breathers - sounds unnappealing, but it's a fact of life that you won't control when sleeping. The point is that you lose all the 'good' air that way, and therefore should try out a full face mask that will allow you to breathe that way (also helpful if you have a cold) and still get the benefits of your Cpap. If you do a search on 'taping' it will give you some ideas about how to experiment with overnight taping to guage if you do have that problem prior to just buying a FF mask right away. It also shows up as large leaks on your data, but if you don't consider the source, you may think you need to raise your pressure even higher, or tighten straps, which can cause new leaks.

[dtsm]

When people need more than 10 cms of pressure to keep them from having obstructive apneas and obstruction related hypopneas, and do not have snores or flow limitations to drive the pressure on the Autoset above 10, then their pressure will hover in the vicinity of 10, and their obstructive events will not be responded to, their obstructions will continue.

These people exist -- on the ResMed they will have to set their minimal pressure low enough to avoid the majority of obstructive events

Other people will have the pressure sailing way above 10 cms because of flow limitations - even though their snore and apneas and hypopneas are cleared at a much lower level.

Many on the ResMed, may benefit from its pre-emptive abilities and enjoy lower pressure when in Auto mode.

I'm still a little confused. Understand the concept introduced but if one sets ResMed to auto, say 8-11 range, does that mean with an event above 10, the pressure won't hit 11? Or another way of asking is: does this imply that many of the Hi and Ai registered occur when the machine won't increase pressure beyond 10 in auto mode?

Btw, I got up at 6 am this morning and as I do everytime I turn off the cpap, check the pressure at that moment: 10.4?

Thanks

[jimplasticguy]

Julie and OziJ - Thanks for the very helpful information.
I am still baffled on the hypoapneas. Before I bury my earlier question again, can anyone explain to me what the number and amplitude indicates on an apnea on the graph? I assumed time in seconds, but if you drill down on data, one will hit another well before that many seconds pass.

Last night, I bumped my min pressure up to 8 to see if I could clear some of this. I had NO leaks.
I had two apneas for an index of 0.5
I had a lot of hpyoapneas with the hypoapnea index being 22.3, which is still worse than my best nights.

I can post graphs, but am not sure that they are helping, because they have not yet caused much speculation. Please let me know if you need more info.

Jim

[ozij]

Julie and OziJ - Thanks for the very helpful information.
I am still baffled on the hypoapneas. Before I bury my earlier question again, can anyone explain to me what the number and amplitude indicates on an apnea on the graph? I assumed time in seconds, but if you drill down on data, one will hit another well before that many seconds pass.

Last night, I bumped my min pressure up to 8 to see if I could clear some of this. I had NO leaks.
I had two apneas for an index of 0.5
I had a lot of hpyoapneas with the hypoapnea index being 22.3, which is still worse than my best nights.

I can post graphs, but am not sure that they are helping, because they have not yet caused much speculation. Please let me know if you need more info.

Jim

It is time in seconds, that's a correct assumption. The graphs don't show you when one apnea starts and when it stops -- so this "overlap" shouldn't bother you.

[ozij]

I'm still a little confused. Understand the concept introduced but if one sets ResMed to auto, say 8-11 range, does that mean with an event above 10, the pressure won't hit 11?

Snores will drive the pressure up.
Flow limitations will driver the pressure.
Above 10 apneas won't.
Hypopneas never drive the pressure on the ResMed.

Or another way of asking is: does this imply that many of the Hi and Ai registered occur when the machine won't increase pressure beyond 10 in auto mode?

I have no idea -- you have to check that on the charts, you can't guess reliably based on the LCD.

Btw, I got up at 6 am this morning and as I do everytime I turn off the cpap, check the pressure at that moment: 10.4?

Looks like the machine had a reason to raise the pressure above 10. doesn't it?

[ozij]

I had a huge increase in pressure needed (from 6 cm to 12 cm straight CPAP, titrated at sleep study).

My AHI was 10.3 on the best night with one actual apnea happening. The rest were hypoapneas.

Last night, not as good as the previous, the apnea index was 1.0, hypoapnea index 16.5, and AHI 17.5.

The DME set the min and max pressure to 6 and 14 respectively, and after reading some of what you all are saying, I think that may be too wide of a gap. It looks to me like there are less hypoapneas when pressure is up around 9 or 10, but it just isn't that consistent.

Last night, I bumped my min pressure up to 8 to see if I could clear some of this. I had NO leaks.
I had two apneas for an index of 0.5
I had a lot of hpyoapneas with the hypoapnea index being 22.3, which is still worse than my best nights.

When they raised your pressure, in the psg -- was it to control apneas or to control hypopneas?
Do you see the pressure going to 12 and more -- ever? I don't see that happening on the graphs you posted.

[dtsm]

I have no idea -- you have to check that on the charts, you can't guess reliably based on the LCD.

My card reader is on the way and hopefully will have better feeling for actual events next week.

Looks like the machine had a reason to raise the pressure above 10. doesn't it?

Good news is I'm dreaming like crazy since cpap therapy started, must be getting some REM sleep.

Many thanks for the quick turn-around - this is very educational and helpful to not just me but others.