Help with MyEncore data/charts

[cby1]

Hi Den, Pugsy:

I have some new subjective information that might be useful (and I need to post those reports). I dropped the pressure from 17-20 o 16-18. That seemed to help somewhat on a couple nights last week.

But here's what still happens - I'll sleep OK (subjectively) for the first 4-6 hours. I'm not conscious of dreaming during this time. Then, after the 6-hour mark, I'll start to have crazy, fragmented dream images. Not whole dreams, and not related - just random. When that happens, I can't sleep for more than a few minutes (it seems) and I wake up sometimes needing to take a breath. One of you asked if it feels like I have to "initiate" a breath - sometimes it does, I would say.

The obvious solution would be to get up at the 6-hour mark, whether you feel rested or not (I do not). So last night (Fri-Sat) I "slept" for 11 hours, trying to catch up and also see what would happen. Well, the last 4 hours were on this dream merry-go-round and were bad, and there were bunch of OAs clustered in the last 2 hours, which were the worst - pressure was mostly topped out at 18 cm during those 2 hours (not many Hypopneas during the 2 hours). I was also conscious of waking up burping, swallowing past something, passing some gas - only in the last hour I'd say. Most of that has gone at these lower pressures.

In all the sleep studies I've had (4 since 2005), they have never been able to catch this fragmented dream state - it always ends too soon, or they have to fiddle with the mask too much, etc. I get the sense many of the techs aren't that good. Some periods since 2005 I've slept fine, others like this - you wake up feeling like you were sucking on an exhaust pipe all night.

Final question: I've been downloading the myEncore data every night this week - there doesn't seem to be a way of combining all those nights together for a Detailed Report. It's useful to correlate each night with the subjective experience, but then you can't see what the Detailed report looked like over time (hours) for the whole week - any way around that?

Thanks,
Chris

[Pugsy]

Sounds like may during those wee hours of the morning that you are having more REM sleep (which is really normal) and probably need more pressure at those times than other times (also is normal but can obviously cause problems)...also sounds like the higher pressures also cause aerophagia problems (also normal unfortunately because you probably need the more pressure and if we increase the pressure to ward off the REM stuff then we create another problem with the aerophagia stuff).

When it comes to the detailed reports...there no easy way to get around it...we need the detailed reports really more than we need trends.

Can you pick 2 detailed reports...one that shows a night that you consider maybe a better night for any reason and another that is a horrible night for any reason...and let's start with those.
Just the Encore detailed page for those 2 nights. In this situation I actually like the Encore reports because the basics are all there in one easy to view image.

[Wulfman...]

Hi Den, Pugsy:

I have some new subjective information that might be useful (and I need to post those reports). I dropped the pressure from 17-20 o 16-18. That seemed to help somewhat on a couple nights last week.

But here's what still happens - I'll sleep OK (subjectively) for the first 4-6 hours. I'm not conscious of dreaming during this time. Then, after the 6-hour mark, I'll start to have crazy, fragmented dream images. Not whole dreams, and not related - just random. When that happens, I can't sleep for more than a few minutes (it seems) and I wake up sometimes needing to take a breath. One of you asked if it feels like I have to "initiate" a breath - sometimes it does, I would say.

The obvious solution would be to get up at the 6-hour mark, whether you feel rested or not (I do not). So last night (Fri-Sat) I "slept" for 11 hours, trying to catch up and also see what would happen. Well, the last 4 hours were on this dream merry-go-round and were bad, and there were bunch of OAs clustered in the last 2 hours, which were the worst - pressure was mostly topped out at 18 cm during those 2 hours (not many Hypopneas during the 2 hours). I was also conscious of waking up burping, swallowing past something, passing some gas - only in the last hour I'd say. Most of that has gone at these lower pressures.

In all the sleep studies I've had (4 since 2005), they have never been able to catch this fragmented dream state - it always ends too soon, or they have to fiddle with the mask too much, etc. I get the sense many of the techs aren't that good. Some periods since 2005 I've slept fine, others like this - you wake up feeling like you were sucking on an exhaust pipe all night.

Final question: I've been downloading the myEncore data every night this week - there doesn't seem to be a way of combining all those nights together for a Detailed Report. It's useful to correlate each night with the subjective experience, but then you can't see what the Detailed report looked like over time (hours) for the whole week - any way around that?

Thanks,
Chris

"Clusters" could indicate "positional sleeping"........on one's back or chin tucked down to the chest (for examples). Which could also possibly account for the feeling of needing to take a breath.
Swallowing air, burping, gas, etc. is an indication of "aerophagia" and is more common at higher pressures than the user can keep from ingesting. Also possibly attributable to GERD and acid reflux conditions.
Could be any number of things leading to your "dreams" being fragmented and "crazy".

Other than the report that is produced by Encore showing each of 7 nights (or sessions, if there's more than an hour gap in the night from having the machine shut off longer than 60 minutes) of detailed data, I can't think of any way to show the detailed data in another way. Both "MyEncore" and "Encore Pro Analyzer" are just ways to put the detail from the database in graphics forms.


Den

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[cby1]

OK, Thanks. I am going to attempt to post 2 screenshots from last night below (just went to the Imgur site):





Don't know if that'll work. If yes, I should post Wed night, because I actually felt almost good Thursday.

Ugh - I see they aren't that big. These are captured from an XP machine with video card issues, so 1024 x 768 is all I can get. I haven't even tried to get Encore Pro to work on my Win 7 machine. I know I'm in need of a CPAP/BiPAP upgrade (and companion software). I'm not sure about just going for it without a sleep study - OTOH, the first study was the only one that seemed to be useful ("yes you have OSA").

Chris

[Wulfman...]

Yeah, you were doing pretty good up till the last couple of hours.
Maybe you shouldn't have gone back to sleep and just stayed up ........ (I'm kidding!)

I would tend to wonder if it's "positional" (your leaks are higher then, too). That's quite the clusters in such a short time.
Either that or VERY relaxed.
In those breaks that are shown, are you getting up to go to the bathroom or anything else? Otherwise that would be a long time to not empty the bladder.


Den

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[cby1]

To answer Den - I get up once or twice on a weeknight to use the bathroom - usually around the 4-hour mark - but last night (Friday) after 4-6 hours, I was up about every 2 hours for the bathroom. I find the anxiety makes me have to go more frequently.

OK, here's Wed night - I wold call it a good night - which was followed by a better Thursday. The absolute times aren't right - I sleep (or try anyway) from about 12:30-7:30 am on weeknights. Don't know where you set the absolute time (on the CPAP?).

Thank you very much for your help.

[Wulfman...]

To answer Den - I get up once or twice on a weeknight to use the bathroom - usually around the 4-hour mark - but last night (Friday) after 4-6 hours, I was up about every 2 hours for the bathroom. I find the anxiety makes me have to go more frequently.

OK, here's Wed night - I wold call it a good night - which was followed by a better Thursday. The absolute times aren't right - I sleep (or try anyway) from about 12:30-7:30 am on weeknights. Don't know where you set the absolute time (on the CPAP?).

Thank you very much for your help.

Without the special cable (kind of pricey) and software, you can't reset your internal clock on the CPAP.
I purchased some of them back in early 2010 but I don't think they're available anymore.


Den

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[Pugsy]

Could be supine sleeping like Den says. REM maybe but it would be unusual to go from awake to REM so quickly....I think...so that makes me also think supine may be a factor.
Do you know if you happen to be on your back more during those wee hours of the morning or not? If you know you do then if there is some way to stay off your back you could see what the pressure does during those time frames.
If you are absolutely sure you aren't ever on your back...then that leaves REM as the culprit. The remembering of the dreams...you know that they say we don't normally remember our dreams unless we wake up during them and the OA clusters could definitely be causing the wake ups.

Since aerophagia has to be a consideration....if this can't be resolved by simply staying off our backs (which sometimes is easier said than done) and we have zero control over REM....if your body could handle a 0.5 cm increase in the minimum only...it might be enough to break up the clusters whatever the cause.

Should you get in a position to get a new machine I would definitely try to get a bilevel pressure machine if it were me.

[cby1]

OK, thanks both of you. Some answers:

Pugsy: I'm pretty sure that I'm on my side that whole time (the "REM" period). I have back issues, and it's painful to sleep on my back for long. Plus, I absolutely know that I wake up slightly during those dreams - and when I do, I'm also conscious of being on my side. Now - interesting fact - I find it easier to relax and fall asleep on my back - but what usually happens is I'll begin to drift off and/or become aware of pain and switch to one or the other side for (pretty sure) the rest of night. I usually end up changing sides a few times due to pain, but sometimes I'm not even aware I do it.

> if your body could handle a 0.5 cm increase in the minimum only...it might be enough to break up the clusters whatever the cause.

So if I interpret this correctly, instead of setting my APAP from 16-18 cm, I should try 16.5-18 cm? Is that what you meant? I used to have it set at 17-20 (but got aerophagia) - so 16.5 is doable.

Also, are my leak levels acceptable? If they're not, I'm not sure what else I can do, as I have the Respironics ComfortGel Blue FFM on pretty tight, and I even use a chin strap (front to back of head, not as an actual chin strap) to seal the nose bridge and prevent leaks from there.

> Should you get in a position to get a new machine I would definitely try to get a bilevel pressure machine if it were me.

I will have to figure out how to best pursue this. I could afford to outright buy one - and I suspect figure out (with help) how to use it - my wife would kill me however - so I suspect I'll have to figure out how to get another study done, and convince them to just start at like, 15, with BiLevel in mind - as opposed to the rigid "start from 6 cm titration" (FYI - my last study was in March 2013).

Can you tell me what the main advantages are - outside of able to do higher pressures, and better exhale relief (I use C-Flex at 3 on current machine) - well, and better data ?

Thanks.

[Pugsy]

I only worry about large leaks as long as leaks don't wake me up (big or little).
Your first report above had no large leaks and the second one had some leaks and was a bit ugly in general but it looks like maybe only 3 % of the night and maybe 15 minutes if I am seeing it right and to be honest...I don't worry about time in large leak below 10% at all and above 10% on a case by case basis depending on how far into large leak territory I might go.

So if I interpret this correctly, instead of setting my APAP from 16-18 cm, I should try 16.5-18 cm? Is that what you meant? I used to have it set at 17-20 (but got aerophagia) - so 16.5 is doable.

Yes, that is what I meant. If it prevents the clusters or at least makes the clusters a little less ugly and you can do it, then it might be worth it. If the belly can't handle it then maybe a compromise is in order as the bulk of the night you don't seem to really need it.

Can you tell me what the main advantages are - outside of able to do higher pressures, and better exhale relief (I use C-Flex at 3 on current machine) - well, and better data ?

Main advantage is more available exhale relief than you can get with the Flex set to 3...I am not sure just how much reduction is actually available with CFlex at 3 since it is flow based and even at optimal relief probably not getting more than a 2 cm reduction (that's what it says in the manual about AFlex...up to 2 cm at max setting).
With bilevel you have 2 distinct pressures. One for inhale and one for exhale and the difference is what affords the comfort and the drop during exhale helps lessen the chance of aerophagia issues rearing their ugly head...and the difference can be 2 cm up to 8 or more but most people do really well with 4 cm difference. In your situation that might mean 19 inhale and 15 exhale and still give you good therapy results. Plus that difference makes it feel a whole lot more natural. First time I ever tried a bilevel machine it took me about 15 seconds to say "self, you gotta get one of these for yourself". At the time I was testing a used machine for a friend to make sure it worked okay and then it went to her. I told her if she hated it I would gladly take it back but after she used it one night her response was "over my dead body". Her pressure needs were up in the 16 and 17 range on cpap and it was a bit of a chore for her because she had a little bit of COPD.

[Wulfman...]

Chris,

I don't know if this has been asked, but do you have "facial hair" (beard)? I'm trying to figure out that large leakage in the second report.

Also, why are you using a range of pressures? You're having very few events (from what I see) at your base/minimum pressure.


Den

.

[cby1]

I love all this information from people who know - thanks again.

Den: Facial hairs - yes. I keep them closely cropped, and my wife (there she is again never wants me to shave it - but there have to be priorities - obviously - because my anxiety is almost intolerable these days). As for a range of pressures, I am beginning to wonder about that too. I was tempted to reduce the range to 16-17. I could always try straight 17cm and see what happens. I guess tonight I'll try 16.5-18, and then maybe straight 17 the next night.

Pugsy: Good information. That's an incredible difference between exhale/inhale pressures. I remember they tried me on a BiPAP my second sleep study (2006-2007) and I didn't like it - it seemed like it would actually "suck breath away" from me right at the height of inspiration - I felt "air hunger" almost - it was a very panicky feeling - so we went to CPAP with CFlex. I suspect they have improved markedly since then - I can't even count the variety of machines/mechanisms I see discussed on these boards now. The fact that you call it "BiLevel" and not "BiPAP" suggests to me there are a lot variants on the theme.

Chris

[Wulfman...]

I love all this information from people who know - thanks again.

Den: Facial hairs - yes. I keep them closely cropped, and my wife (there she is again never wants me to shave it - but there have to be priorities - obviously - because my anxiety is almost intolerable these days). As for a range of pressures, I am beginning to wonder about that too. I was tempted to reduce the range to 16-17. I could always try straight 17cm and see what happens. I guess tonight I'll try 16.5-18, and then maybe straight 17 the next night.

Pugsy: Good information. That's an incredible difference between exhale/inhale pressures. I remember they tried me on a BiPAP my second sleep study (2006-2007) and I didn't like it - it seemed like it would actually "suck breath away" from me right at the height of inspiration - I felt "air hunger" almost - it was a very panicky feeling - so we went to CPAP with CFlex. I suspect they have improved markedly since then - I can't even count the variety of machines/mechanisms I see discussed on these boards now. The fact that you call it "BiLevel" and not "BiPAP" suggests to me there are a lot variants on the theme.

Chris

Well, "Bi-PAP" is actually a term (maybe copyright name) used by Respironics (Philips/Respironics), just like "VPAP" is used by ResMed.

I suspected there was a beard.

How about just a straight 16?


Den

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[palerider]

The fact that you call it "BiLevel" and not "BiPAP" suggests to me there are a lot variants on the theme

yup, as den says, "bipap" is respironics name for bi-level, like vpap is resmeds name for the same thing... different inhale and exhale pressures.... bi-level.

[cby1]

BTW, I should mention that when I have sleep problems like this, I take Lunesta - it does help me sleep better, but for all I know, it might be muddying things up too.