test message: does my Encore basic screenshot show up?

[ellen1159]

http://s1348.photobucket.com/user/ellen ... ncorebasic

[RandyJ]

It shows up as a link. You need to put that link between the 2 Img codes.

Like this:

[img]your%20link%20here[/img]

Then do "Preview" first instead of "Submit" to see if you can see the image in your post. If you can't, you didn't do it right.

[Pugsy]

Let me help you out a little. I used your link to get to your album...then I clicked on the image you put there and have it up close so it is easily seen in full size and on the right side of the now larger full size image there is a box with 4 address codes....so I copied and pasted the last line in that address box and now we have this image.

[Pugsy]

Ellen,
Did you ever get copies of your sleep studies? Were centrals mentioned either in the diagnostic sleep study (no cpap machine) or the titration sleep study with mask and machine that came up with the hurricane force winds RX needs?

Last night...how long did it take you to get to sleep during the first 2 hour segment? The first 2 hours right before the first large leak flag?
From about the 3rd hour on the leaks were so bad we can't really evaluate the therapy portion of things.

[JDS74]

Ellen,

Your 90% numbers look like mine. Are your sure that you need the top IPAP value of 25cm?

A second question. Could you post a link to the Encore Basic page corresponding to the first big cluster of CA's shown on your graph? It might be helpful in determining if they are transitional ones or real centrals.

When I get a night like yours, I see average CA duration of almost 20 seconds and some of more than 60 seconds.

[ellen1159]

Ellen,
Did you ever get copies of your sleep studies? Were centrals mentioned either in the diagnostic sleep study (no cpap machine) or the titration sleep study with mask and machine that came up with the hurricane force winds RX needs?

Last night...how long did it take you to get to sleep during the first 2 hour segment? The first 2 hours right before the first large leak flag?
From about the 3rd hour on the leaks were so bad we can't really evaluate the therapy portion of things.

Yes, sleep study done in April gave me overall apnea-hypopnea index of 104.8 events/hr. and 1 central apnea during dx phase. DUring treatment phase, the overall hypopnea-apnea index was 33.4 events/hr and 14 central apneas. I spent most of my time during the dx phase on my left side (78%) but during the treatment phase I spent most of my time (62%) on my back and 37% on my left side. During the titration phase I had 3 OA's and 5 centrals during 1 hr. 15 mins of sleep and on my left side I had 3 OA's and 9 centrals during 51 mins of sleep.

At home I usually sleep on my right side but I didn't during the sleep study, I think because the wires and stuff were so uncomfortable. Last night I started out on my right side, switched to my left, then went back to my right side.

[Pugsy]

Your clear airway events may simply be awake/semi awake breathing irregularities getting flagged. This report looks uglier than your report from last night in terms of clear airway events. Some clear airway event flags are normal...until you get your leaks under better control so that the first thing you don't tell me is "fiddled with mask most of the night" I wouldn't worry so much about the clear airway events at this point. If you know you fiddled with the mask a good bit during the night due to leaks...and we see so much evidence of large leaks..then we also know that you were awake a good bit of the night (or else you wouldn't remember fiddling with the mask) and there's a good chance that a good number of those CAs are awake/semi awake breathing getting flagged.

For right now just concern yourself with getting the hours of sleep and getting the mask leaks under better control...and then we worry about CAs if they still are present in large clusters once you have the other issues resolved.

If you could keep all your reports in one thread...it would help us have a better idea what is going on. I saw this report before I saw last night's report in another thread. Bouncing around with multiple threads and multiple reports makes it a bit difficult to see what has been said or not said.

[ellen1159]

Thanks, Pugsy.

[DoriC]

Pugsy, since Ellen is having so much trouble with leaks and her epap pressure line is staying steady, couldn't she lower her pressures and see what happens? I haven't read her whole story so I may be all wrong but I've heard you suggest this solution before to others.

[Pugsy]

Pugsy, since Ellen is having so much trouble with leaks and her epap pressure line is staying steady, couldn't she lower her pressures and see what happens? I haven't read her whole story so I may be all wrong but I've heard you suggest this solution before to others.

I have said all along to try lower pressures and maybe work up to higher pressures if needed but Ellen has been hesitant to change the pressures herself and wanted to do what the doctor said to do. So finally the pressures were lowered a little by her doctor but IMHO not enough but my opinion isn't the most important opinion in this situation.

In regards to the EPAP line seeming somewhat non active....I don't know how much of that is large leak and how much of that is the machine not wanting to fight anything. When large leaks are present the auto adjusting feature goes flying out the window and can make it look like there is a straight line when in fact the machine just doesn't know what to do. So it may appear flat because of the large leaks and not because of apnea events not needing the pressure.
Also if she was awake we would expect the EPAP/IPAP lines to not be very active...and we know that there is considerable time being spent awake fiddling with the mask.

I have seen other people's reports where it looks like the auto adjusting machine is in fixed mode because it just doesn't vary the pressure and the reason it doesn't vary the pressure is that the leaks are so bad the machine doesn't know what to do.
I suspect that part of Ellen's inactive EPAP/IPAP lines are related to large leaks....I don't know how much though.
For sure the last couple of hours (and that flat EPAP/IPAP line) in the above reported dated 8/18 where it's obvious the leaks are massive.
Not sure about the first couple of hours when leaks aren't as massive because she said she was awake for a good bit of that time frame.

Bottom line is that until leaks are better controlled and she gets some uninterrupted sleep we can't do much except speculate.
The AHI (excluding the CAs which I think are most likely sleep/wake/junk) isn't that bad at these pressures but the leaks are so bad we don't know if the machine is able to even sense the events in the first place.
I know that once leaks exceed 100 L/min we can't trust the data shown at all..not pressure needs and not flagged events..the machine can easily misinterpret or simply miss events when leaks are that large for that long.

[DoriC]

Yes, I do remember when Mike his having LL his pressure stays low because the machine doesn't seem to take any action when leaks are so high. I'm glad you answered that question!