Encore Analyzer Variable Breathing Poll

[nightjar]

Does anybody here besides Browser and dllfo happen to regularly experience VB spikes above 40%? Thanks!

I've been on my classic BiPAP Auto for over a month now and have 32 days of data. Two weeks ago, I'd have said, yes, I've got VB spikes over 40% on over half my nights.

But since then, I've topped that 40th percentile just once. My VB average for all 32 days is 32.4%; I'm guessing that for the last two weeks it's more like 27.5%.

Maybe I'm getting more used to the BiPAP. Maybe it's the switch from 14 / 11 (straight bilevel) to 14.5 / 11. Maybe it's that I'm taking extra pains to make sure I have as good a seal as possible with my mask. Maybe it's that I'm feeling better, more rested during the day, and that helps me sleep better, too.

Sometimes I wonder what my first 10.5 years on CPAP would have looked like, data-wise. . . .

Anyway, even though I chose the 31-40% range, it seems my numbers are heading down toward the 21-30% range. Maybe the next month's worth of data will confirm that.

Nath

[-SWS]

Does anybody here besides Browser and dllfo happen to regularly experience VB spikes above 40%? Thanks!

I've been on my classic BiPAP Auto for over a month now and have 32 days of data. Two weeks ago, I'd have said, yes, I've got VB spikes over 40% on over half my nights.

But since then, I've topped that 40th percentile just once. My VB average for all 32 days is 32.4%; I'm guessing that for the last two weeks it's more like 27.5%.

Maybe I'm getting more used to the BiPAP.

That sounds like a possibility to me as well. In another thread SAG summarized a recent white paper discussing a somewhat common and gradual biologic adaptation phase: viewtopic.php?f=1&t=35298&p=309175&#p309165

I suppose another possibility might be that your VB spikes over 40% will turn out to be occasional or episodic over the long haul.

[dsm]

I have long been convinced that we adapt to the machine we are given (in most cases) even if the machine is not optimally set up. Also I think familiarity also contributes to increased comfort with a particualr rig & settings.

The things that are hard to adapt to are a badly chosen mask & leaks.

DSM

[jnk]

It's good to know that the VB percentage isn't just junk DNA left over from an abandoned SV algorithm for attempting to recognize CS patterns using chaos theory to analyze the flow data.

No, I don't know what any of that means either, but I was feeling left out and felt like posting in this thread anyway.

[-SWS]

Thanks for making the manual available Den and Doug!

Den SWS Ozij

I am now satisfied that the VB info from a Pro II is because it is the same machine as the Auto (but hobbled) so as not to run in Auto mode.

Well, that doesn't really veer away from what ozij and I were speculating about. But your above statement better describes how VB made its way into the Pro2 rather than why VB is still being privately collected in the Pro2 when FL is not.

I see no hidden reason by Respironics to secretly gather stats via VB info.

Well, they're "privately" gathering PB in both the auto and CPAP. Right? And all along I have been agreeing with that reason you just came up with in the next statement:

But, because VB is effectively an indicator of destabilizing respiration that may impact the effectiveness of CPAP therapy, maybe they decided it was worth gathering it.

Well, since they're gathering VB in the CPAP machine but not FL, I'd say that they think there's a reason to gather VB---probably for in-house epidemiological purposes as you seem to agree.

I do hope we are getting a better understanding of the significance of VB and that unlike PB, VB is an individual person's problem that CPAP today doesn't have an answer for and may never have an answer for but maybe doctors & the drug industry do.

Well, some subset of VB etiologies are presumably addressed by certain PAP modalities. For instance, any patient who happens to present excessive VB because they have machine-induced CSDB would be a candidate for auto/adapt SV.

Thanks for the thoughts!

It's good to know that the VB percentage isn't just junk DNA left over from an abandoned SV algorithm for attempting to recognize CS patterns using chaos theory to analyze the flow data.

I have long been convinced that we adapt to the machine we are given (in most cases) even if the machine is not optimally set up. Also I think familiarity also contributes to increased comfort with a particualr rig & settings.

Agreed that adaptation is a hallmark of our species' survival. I think when we see an anecdote like nightjar's, that we might be seeing the most common case: that of gradual adaptation.

However, when we see a case like James Skinner's, we might be witnessing the opposite case: gradual maladaptation. Conceivably both cases can present as CSDB. But those two cases will longitudinally express differently. In the case of initial homeostatic disruption being properly addressed by gradual adaptation, we should see initial CSDB symptoms that gradually diminish as described in the B&W white paper SAG summarized above. However, in the case of long-term PAP maladaption I'm thinking we will see two very broad longitudinal expressions across the SDB population: 1) sudden CSDB onset that never completely or significantly diminishes over time, and 2) a gradual and maladaptive CSDB onset that progresses a bit over time---as seems to be the case with James' CSDB diagnosis.

I'm also thinking these private VB statistics may help Respironics determine the longitudinal expressions or phenotypes of PAP machine maladaptation versus PAP machine adaptation. Somewhat common adaptive VB cases like nightjar's might have even prompted the Respironics-funded B&W research that SAG summarized in the link above (see reference below).



Reference: Complex Sleep Apnea: It Isn’t Really a Disease, Journal of Clinical Sleep Medicine, Vol. 4 (5), p. 406-408, Atul Malhotra, M.D.; Suzie Bertisch, M.D., M.P.H.; Andrew Wellman, M.D.

[dsm]

It's good to know that the VB percentage isn't just junk DNA left over from an abandoned SV algorithm for attempting to recognize CS patterns using chaos theory to analyze the flow data.

No, I don't know what any of that means either, but I was feeling left out and felt like posting in this thread anyway.

Gee, and I was about to correct the etiology from SV to 1st Auto - certainly sounded good

DSM

[dsm]

<snip>

I see no hidden reason by Respironics to secretly gather stats via VB info.

Well, they're "privately" gathering PB in both the auto and CPAP. Right? And all along I have been agreeing with that reason you just came up with in the next statement:

But, because VB is effectively an indicator of destabilizing respiration that may impact the effectiveness of CPAP therapy, maybe they decided it was worth gathering it.

Well, since they're gathering VB in the CPAP machine but not FL, I'd say that they think there's a reason to gather VB---probably for in-house epidemiological purposes as you seem to agree.

But how does this data get to these backroom Respironics gremlins ?

I do hope we are getting a better understanding of the significance of VB and that unlike PB, VB is an individual person's problem that CPAP today doesn't have an answer for and may never have an answer for but maybe doctors & the drug industry do.

Well, some subset of VB etiologies are presumably addressed by certain PAP modalities. For instance, any patient who happens to present excessive VB because they have machine-induced CSDB would be a candidate for auto/adapt SV.

But, we saw what happened with Bev when a genuine case of VB got put on an SV - Bev probably regrets buying it.

<snip>

[Wulfman]

A question (or two) came to my mind while reading -SWS's last post.......
The Respironics machines are "gathering" VB data.....but since the data is not being displayed/reported in any version of Encore software that we've seen (the "Pro" version being for the "Pros")......WHAT other possible software do they have that would display/report it and under what circumstances would it be scrutinized? (and by whom?)

Den

[jnk]

Could it be the world's first SDB-interactive-Easter-egg?

OK. OK. I'll shut up now.

[-SWS]

Well, since they're gathering VB in the CPAP machine but not FL, I'd say that they think there's a reason to gather VB---probably for in-house epidemiological purposes as you seem to agree.

But how does this data get to these backroom Respironics gremlins ?

Just like any other medical research. They select a subset population. Then they collect the data. Voila! In this case they collect the VB data on the smart cards of the study populations. Very straight forward and gremlin-free I would think.

Well, some subset of VB etiologies are presumably addressed by certain PAP modalities. For instance, any patient who happens to present excessive VB because they have machine-induced CSDB would be a candidate for auto/adapt SV.

But, we saw what happened with Bev when a genuine case of VB got put on an SV - Bev probably regrets buying it.

Bev is only one anecdote or data point. Why would we expect any one data point to reveal population-based epedemiological trends of any kind? All the more reason for Respironics to employ a statistical method rather than a single-person case study method. Alas poor Bev... We knew her autoSV well.

[dsm]

A question (or two) came to my mind while reading -SWS's last post.......
The Respironics machines are "gathering" VB data.....but since the data is not being displayed/reported in any version of Encore software that we've seen (the "Pro" version being for the "Pros")......WHAT other possible software do they have that would display/report it and under what circumstances would it be scrutinized? (and by whom?)

Den

Den

Agreed, hence my question as to how does the data get to the REspironics backroom gremlins ?

One answer (letting SWS off the hook )
The only way would be if Respironics conducts field studies and in 2005 I and 100 other people in Australia did participate in a Respironics study conducted here through Mayo Healthcare (Respironics agent).

They said the study was to look at how 50 people who were given familiarization with cpap therapy fared comapred to 50 who weren't. We had to send in our data card every week. We were all offered Respironics Remstar machines (CPAP) but I had bought my own Remstar Auto (they hadn't reached Australia at that time - mine came from cpap.com).

It was an interesting result (obvious to us here) and somewhere I have a copy of the final report.

So that is one way I can see the data being sent back to Respironics.

DSM

[-SWS]

A question (or two) came to my mind while reading -SWS's last post.......
The Respironics machines are "gathering" VB data.....but since the data is not being displayed/reported in any version of Encore software that we've seen (the "Pro" version being for the "Pros")......WHAT other possible software do they have that would display/report it and under what circumstances would it be scrutinized? (and by whom?)

Den

It's also very conveniently sitting in the SQL data structures on the cards of in-house study populations----and just as easily accessed by Respironics researchers as it is by us. Very straight forward and methodologically convenient IMHO.

I don't understand why it intuitively seems implausible that Respironics would take advantage of smart cards for certain longitudinal studies. What if they selected 1,000 patients to study that way? What's sitting on our smart cards and the fact that Respironics hasn't collected our smart cards in no way invalidates their taking advantage of smart cards during in-house studies... I would think.

Could it be the world's first SDB-interactive-Easter-egg?

OK. OK. I'll shut up now.

Sure hope not!

[dsm]

SWS

As you so often like to remind us - 'it is all conjecture anyway'

Maybe they do & maybe they don't - we are unlikely to ever know

But, then again ...

DSM

[-SWS]

Doug, let's get something very straight. My reasoning above is not at all mere conjecture. Rather, what I have moderately considered and shared above is....

...WILD conjecture.




Very seriously, thanks!

[OutaSync]

Hey, I'm not dead. I can see you talking about me

Actually I'm not sorry I got the SV. I kinda like knowing that if I stop breathing for more than 15 seconds it will kick in for me. Sure beats the Auto just sitting there in a holding pattern waiting to see if I wake up after 15 minutes.

My personal experience has been that when I set BPM to Auto, I see PB markers. I haven't seen any with BPM set to 4. I haven't gotten used to the plunger effect on my face, yet, but the sound of the machine no longer bothers me. Once I do get to sleep, I don't wake up as often as I did before. Maybe that is because I've increased my melatonin to 6mg and started taking a coated aspirin before bed (Thanks, Snoredog, for those suggestions)

Bev