How to interpret my data?

[Mark NJ]

I've had my Respironics REMaster Auto A-Flex for several months, but just learned out to access its data. Now I want to know how to use the data I can see to assess my condition and adjust my machine's settings.

I suspect all the info I need is scattered in thousands of replys in this forum; but that's hard to access. Has anyone done a pretty good recap on what each of the numbers mean and how to use the numbers to make adjustments?

For 3 months I was on auto 4 to 20 cm. Actual pressures were concentrated between 7 and 10. Just one occasion as high as 17, several in the 12 - 14 range. My average AHI was 4.3.

My doctor just prescribed a change to a fixed pressure of 8 (he didn't see this data; he used only a titration.) Now, my AHIs have been: 6; 14; 25; 10; 7. I bumped my pressure to 10 cm for one night and got an ANI of 10.2.

My guess is that the data from the Auto period suggests I should have a pressure of at least 10 and maybe higher; perhaps 12 - 14. I'd much rather have a better idea of how to read all this data and apply it to making adjustments in pressure or other settings.
Thanks
Mark

[Pugsy]

Could you please go the User Control Panel in top left under the banner, then go to your profile and then the equipment page and list you equipment in text please. The images are too small to see which kind of equipment and we are lazy and like to read it instead of clicking on the link...

Your reported numbers are all over the place and a bit difficult for me to follow.
In general you would like to see an AHI of less than 5. Your AHI is bouncing around a lot. You seem to have tried several pressures.
I don't see any leak report. If there is a lot of leak it can impact therapy and the numbers.
Are these numbers that you are getting off the machine? Or do you have the software? If you have the software it would really help to see a couple of the detailed data reports (not the summary)

[Mark NJ]

Thanks for your reply.
I've added my equipment, but I'm not sure the selections are exactly correct.
Machine: Resperonics REMstar Auto A-Flex
Selection: M Series Auto CPAP with A-Flex
Mask: Quattro FX Full Face Mask
Selection: Quattro FX Full Face CPAP Mask with Headgear

My machine says nothing about "M Series" nor does it say "CPAP". My mask's manual says nothing about "headgear". It's a new model and it differs from others I've seen in that it has no mechanism that rests on the forehead.
If you think I've made the wrong selections please tell me which I should use instead.

I don't think I have a leak problem. My latest leak reports look stable; since I learned that this data was available I surmized that the spikes on earlier days were due to my disconnecting the hose - for bathroom trips - before turning off the machine. Now I turn off the machine first.

I'm using the software, not just looking at the machine's display. I'd me happy to supply my reports; but I can't figure out out to do that. Taking a <Ctrl> <PrntScr> seems to hang Internet Explorer. I'd like to just attach my .pdf report file so you could see whatever it is that might illuminate the problem (rather than my just taking a few selections). However, I don't see how to attach a file to a post. I'll try to send it to you in a PM.

A little more background on the history of my case. My 1'st doc put me on APAP 4 - 20 cm. I didn't think it helped. He referred me to a 2'nd doc. The 2'nd doc suspected that APAP wasn't appropriate for me. He ordered a 2'nd sleep study and then a titration and prescribed 8 cm a couple weeks ago. Got my machine re-set and used it at 8 cm for about a week. I didn't think my sleep was any better.

When I first got my machine I selected a nose-only mask; bad choice. I'm a mouth breather about half the time. The nose-only mask made compliance difficult. I asked the 2'nd doc if I should continue on APAP until he prescribed a CPAP setting. He said he didn't care. So, I stopped using my APAP machine until it was converted to CPAP. Coincidently, I became elegible for another mask and I got a full-face mask. That helped my recient compliance.

After about a week on 8 cm I found this forum. I learned about the software available so the end-user could see his data; bought this and installed it. I obtained the provider's manual so I could increase the pressure on my machine. Went to 10 for a couple of days and then to 12 last night.

I look forward to your remarks (assuming I can PM you my PDF file or you can explain to me how to attach it to my posting.)

Mark

[Pugsy]

I will respond to your PM shortly. Yes, you can send the pdf files to me and I will sort it out and post here if you wish me to.

I think you may have selected the wrong machine. I am thinking you probably have the PR System One Remstar Auto AFlex. Look at my equipment and click on the link to my machine and I expect yours will be different.

I am going to post my how to post screen images again here just in case another new person might wander by and wonder how. There is no way to attach files here so the posting of images is via photo hosting site is all we can do.

I never save my files as pdf but for those that do

Open the PDF file to view it at 100%, then take a snapshot of the pdf file (if you have Vista, use the snipping tool). Crop it if you need to get it trimmed down.
Save that snapshot as a jpg file.
Then go to the photo hosting site, upload, get the IMG address and post it here.
Use the preview button to see if you see the image, if not, try again.

Normally I will just take a screen shot of the report and put it in a folder full of such screen shots. I have Vista and the Snipping Tool in Vista makes it so easy to take the snapshot and crop at the same time that I find it effortless.
Don't have Windows 7 so don't know if they changed that. Windows XP snapshots have more steps with print screen to get a cropped image.

There are some excellent free snapshot software out there that members use. I am sure someone will offer what they use so that you don't have to try to mess with alt/prt/scr.

More comments later. Short on time and I need to respond to your PM.

[Pugsy]

Sent you a PM. I don't need reports that don't pertain to current changes. Let's see what is going on with last few nights at CPAP with the new mask. Old stuff doesn't really matter at this time.

I don't have your type of machine that offers the mask selection thing. Not sure exactly what it does. Can other PR System One users please explain what this feature does? Does it make any difference in how the pressure feels that might impact therapy?

[Hawthorne]

With the PR System One machines, the mask selection only really applies to Respironics masks, as far as I can tell. I use a couple of Respironics masks that the machine can adjust for and, yes for me, choosing the right mask setting does make the air delivery feel different (better) with Respironics masks. I have a Swift FX too, which is a Resmed mask, as you probably know. I don't use this mask much anymore but when I do, I set it at 0 or off in the "System Resistance" which is the mask setting in the PR System One.

[Mark NJ]

Hi Pugsy,
My machine and software don't seem to have a feature to designate the make and model of mask I'm using.

My software simply shows a leakage graph which seems to squiggle pretty consistantly near about 25. I don't know what the scale is.

My guess is that some other manufacturer and software publisher invites the user to specify his/her make & model of mask. Then, they probably look-up on an internal table and subtract X, Y or Z units from the actual reading of leakage to adjust for what they think various makes & models leak on average. If that's so, it seems to be a gimmic of no real value. The graph itself reveals my actual leakage for my make & model. Anything above the lowest value regularly observed is extra leakage. Anything that looks like a spike in the graph is excessive.

I can't imagine that the mask selection does anything sophisticated.

Thanks,
Mark

[mayondair]

The mask resistance settings for your machine are found in the set up menu, to access this get the clinicians manual from someone here, ask around , or go to Apneaboard.com for a free download. Not sure it makes a lot of difference. Check the wiki or search subject for mask leak data chart to know the expected leak at your pressure. If Encore Viewer is showing large leak for any amount of time, your leaks are way out of control, lots of room for unacceptable leak without triggering encore viewer large leak kathy

[Pugsy]

I have a few reports and will be posting them shortly.

Mostly from what I see the leak is not bad but I see Centrals and Apneas driving the AHI up.

So my question to Mark is "Has anyone ever mentioned to you that you had any central apnea events during either the original sleep study or the titration study"? Do you have copies of the sleep study reports?

Don't go playing around with increasing pressure right now till we sort things out more. Increasing pressure is not advised when centrals are present. It actually can make the centrals worse...

[Pugsy]

Mark reports that no one ever mentioned centrals during first sleep study. I suggest he get a copy of that report.
Apparently he opted for an in home titration with APAP instead of formal titration.

I have reports from 4 nights here. These are all straight CPAP reports. Some pressure changes. Before this he did try APAP without much luck either.

I don't have the PR system one machine, so my machine doesn't give me PB or RE. Could someone explain those items to Mark. I have already explained the common, CA, OA, H, VS . I don't know what periodic breathing entails nor RE other than theory.

I think that Mark needs to alert the doctor to the presence of centrals on these reports. If he didn't have any during the first sleep study maybe these are pressure induced centrals. Might be time for a formal sleep titration.. Just my thoughts. While I am happy to dissect these reports, it is easy to see something is not working and with the presence of centrals it goes beyond my usual ideas.

I posted these with Mark's consent and he request input from the members as to what options he might have.

[Pugsy]

Link to Rested Gals explanation on PB, periodic breathing.

This also explains your question to me about why doctors don't tell us about this software. It never was really designed for our use. Most of the "establishment" think or treat us like we don't have enough sense to understand the data. When I had my sleep titration study the tech actually told me that it was against a Federal law for me to have the software.

viewtopic.php?p=566612#p566612

[ozij]

I've had my Respironics REMaster Auto A-Flex for several months, but just learned out to access its data. Now I want to know how to use the data I can see to assess my condition and adjust my machine's settings.

Hi Mark,
The data Pugsy has so kindly posted for you is not the type seen with usual, "garden variety" osbtructive sleep apnes.
Both "preriodic breathing" and "central apnea" inidcate that when you're on CPAP, something in the regulation of your breathing is off kilter. You need to discuss that with an accredited professional who has experience treating sleep disordered breathing.

I suspect all the info I need is scattered in thousands of replys in this forum; but that's hard to access. Has anyone done a pretty good recap on what each of the numbers mean and how to use the numbers to make adjustments?

You could try the CPAP wiki, (yellow light bulb ) in the banner line.

A little more background on the history of my case. My 1'st doc put me on APAP 4 - 20 cm. I didn't think it helped. He referred me to a 2'nd doc. The 2'nd doc suspected that APAP wasn't appropriate for me. He ordered a 2'nd sleep study and then a titration and prescribed 8 cm a couple weeks ago. Got my machine re-set and used it at 8 cm for about a week. I didn't think my sleep was any better.

Can you please share the report for this titration? If you don't have it, your first step in understanding your condition it to make sure you have it, and the to make sure you unerstand everthing it says.

My guess is that the data from the Auto period suggests I should have a pressure of at least 10 and maybe higher; perhaps 12 - 14. I'd much rather have a better idea of how to read all this data and apply it to making adjustments in pressure or other settings.

Before you start "self titration", which is what you're planning to do, you need better understanding of what your problem is, what the in lab titration showed, and what problem you're trying to solve. Guessing has very little role in all those things. Careful gathering of the data may show you what's going on.

To summarize:
Get a copy of you titraton study
Post it here so we can help you understand what it says
Look for an accredited sleep doctor, and tell him (or her) how little the therapy help you. Discuss the titration sesults with them, and try to show them the data from you machine use at home. It may help if you have an oxygenation report to accompany that.

Most important: give your body and brain a chance to get used to whatever setting it is you're using.

[snnnark]

What I find interesting is the complete lack of Flow Limitations. That and the fact that the centrals did not increase with pressure.

I agree with Ozij. Oximetry data during those PB periods will be very interesting.

Mark, do you have any heart problems?

[Mark NJ]

What I find interesting is . . . that the centrals did not increase with pressure.

Mark, do you have any heart problems?

Hi Snnark,
I don't have any heart problems - yet. However, I have several risk factors. Those that are manageable are now well managed (apart from apnea).

Interesting point about the corrilation of CA with pressure. Although a small amount of data, here is the series I've acccumulated so far:
Cm CA
---- -----
12 4.0
12 3.0
10 5.4
10 5.1
8 4.3
8 5.0
8 12.1
8 7.6
8 2.6

The CA = 12.1 was coincident with an average leakage of 46.8; 18.8 points over the base of 28 (i.e., the lowest leakage rates I've observed are 28.2 and 28.5. So, I surmise that when my mask is not leaking that the vent is read as a leakage rate of about 28.) So, tentatively, I discount that observation. The only evidence of an increase in CA is a comparison of the 1'st CA=2.6 vs 5.1 and 5.4 at 10 Cm and 3 and 4 at 12 Cm. Not yet a convincing case that increases in pressure from 8 --> 10 -> 12 is causing me an increase in CA.


Mark

[Mark NJ]

The mask resistance settings for your machine are found in the set up menu, . . . . Not sure it makes a lot of difference. Check the wiki or search subject for mask leak data chart to know the expected leak at your pressure. If Encore Viewer is showing large leak for any amount of time, your leaks are way out of control, lots of room for unacceptable leak without triggering encore viewer large leak kathy

Hi Kathy,
Thanks for your response.

I looked in both my APAP machine's user manual and provider manual and couldn't find a place that mentions selecting the mask make & model. The only reference I saw is a setting for an alarm on mask leakage.

I looked in my mask manual and found a chart titled Pressure-flow curve. It says that at 8 Cm I should expect a flow of 32; at 12 Cm it should be 41. These seem reasonable compared to my observed data. I've got a couple of lower observations of 28.2 and 28.5 at 8 Cm; and another at 31.8 Cm. For 2 days at 12 Cm I have obserrvations of 36.6 and 43.7.

After adjusting for 32 @ 8; 37 @ 10 and 41 @ 12 cm, my adjusted leakage rates (i.e., reported values less the mask's reported leakage rates) I seem to have only an occasional problem with excess leakage.

While excess leakage is certainly a problem I need to watch out for, I think I'm close to manageing this variable.

Mark