26 days in; first 'encore' rpt via clinic: I have questions

Went to the sleep clinic. they downloaded the data for the first 26 days and printed me a 2 page report. they made no changes to the settings. Here is some of the info, I started with a AHI of 70 26 days ago.

Days with usage: 26
Average usage: 6 hours
Maximum titrated IPAP pressure: 15
Average device IPAP <= 90% of time: 14.4
Maximum titrated EPAP pressure: 13
Average device EPAP <= 90% of time: 11.9
Average time in apnea per day: 13.2 mins
Average time in large leak per day: 1.3 mins
Average AHI: 9.7
Another table indicates that I spend (on average) 21% of the night at a pressure of 15 and at this pressure of 15: no flow limit., vibratory snores of 7.9, hypopneas: 1.2. these numbers are repeated for IPAP, EPAP at the various pressure settings of 6 to 15.

1) if my max IAPP is 15 and I spend most of the time at 14.4 and on average 21% of the night at 15. Wouldn't it have made sense to bump up the max pressure a bit to give me some leeway?
2) I guess we never totally get rid of apneas and 13 mins is not much. Is it? And how does it tie into the AHI=9.7? At different pressures in the table, the Hypopnea index varies from 0.6 to 15.3 and the Obstructive apnea index from 4.7 to 30. How do we get a AHI=9.7?
3) what is a large leak?
4) how is a vibratory snore detected?
5) what is a non-responsive apnea/hypopnea? I have none.

6) why is it that I sleep well for 2, 3, 4 hours then wake up for some reason. Take mask off, put it back on and have incessant leaks till morning. Am I, a) too sleepy and put it back on wrong b) insensitive to leaks in the first few hours of sleep, c) or?

7) Why does one doctor say night shift is bad enough for 'normal' people, people with sleep disorders should not work night shifts because they are dealing with a sleep disorder in less than ideal circumstances with varying schedules and short nights. (I am a a nurse on rotating shifts) while another doctor has told me that working nights should make no difference? Why do doctors have such different understandings/opinions of how OSA affects us and how we should deal with it? sigh..... And what do you think of rotating schedules which include nights shifts for those of you who have in the past or currently do such schedules.

I would like to thank all that have responded to my previous posts. This board has made the initiation so much easier. I don't feel alone and more importantly I know others are faced with the same difficulties as me and this Board is always very supportive to all.

If it is true that Encore viewer and Encore pro provide the same data (except in different format printed report vs sql database). Some day when I am rich and famous I will splurge for the software and reader. I would like to see data around the times of night I wake up to see exactly what is going on and see if it can be fixed. I know many of you do not sleep straight through the night but I sure would love to get 6 hours straight without waking up.

OK enough for now. Thanks for your help.

Bernard

Hi Bernard
Two numbers stick out like a sore thumb:
Your average AHI of 9.7 and the average time in apnea per day: 13.2 mins

Both are too high. 13 minutes in apnea per night, on average is a lot. Both could be a result of the minimum pressure being too low.

Your minimum pressure seems to set at 6 - too low, and may explain the long time in apnea. You should be aware that contrary to what many DME's and doctor's think, you machine will not stop an apnea once it starts, it will only raise pressure after an apnea (or hypopnea) has stopped. The machines are often not as good at preempting events as the manufacturers would have us think.

So, if this were my therapy, and I had those results, I would start by nudging the minimum pressure upwards.

You could try to track your data daily via the LCD screen - see instructions on this thread: viewtopic.php?f=1&t=40931&p=359532&hili ... ta#p358714

1) if my max IAPP is 15 and I spend most of the time at 14.4 and on average 21% of the night at 15. Wouldn't it have made sense to bump up the max pressure a bit to give me some leeway?

You must be looking at two types of data, since the 14.4 =<90% means you spend only 10% of the time above 14.4. The other table (detailed data?) probably refers to the last 5 nights, and not to the whole 26 day period.

A DME is not allowed to change your pressure settings - but those data should have made them contact your doctor about a change.

BML wrote:6) why is it that I sleep well for 2, 3, 4 hours then wake up for some reason. Take mask off, put it back on and have incessant leaks till morning. Am I, a) too sleepy and put it back on wrong b) insensitive to leaks in the first few hours of sleep, c) or?

I wonder if you wake up when apneas as you enter REM sleep. in addition to option a, you mask may become more slippery if you face is oily -- or if you haven't take care to clean you face and mask thoroughly daily, my face is not oily, but I've discovered daily cleaning makes a big difference.

O.

Until you have your leaks under control, and they are not, the data may be useless. It seem like they consider your treatment to be OK! I do not, you need the software and reader, and also need to find the answer to controling your leaks, then you can find your pressure. Jim

ozij wrote:Two numbers stick out like a sore thumb:
Your average AHI of 9.7 and the average time in apnea per day: 13.2 mins

Both are too high. 13 minutes in apnea per night, on average is a lot. Both could be a result of the minimum pressure being too low.

Your minimum pressure seems to set at 6 - too low, and may explain the long time in apnea.

The tech did mention something about increasing a pressure to 8. I don't know if he did it or not. I could check that out on the therapy screen, I think. In EPAP, pressures <8, would account for all double digit apnea events per hour. But these obstructive apnea numbers are derived if they are events per hour. For example, I spent 2 minutes (!) at an EPAP of 4 and the obstructive apnea events per hour reported is 30. I would read that as having had 1 apnea event in a 2 minute span which works out to 30 events per hour, correct? Without knowing when I am actually at these pressures, it is difficult to extrapolate too much. For example, at an EPAP of 6, I have an AI of 14.2 that drops at higher pressures (makes sense) to a low AI=4.7 until at EPAP of 13 it climbs back to an AI= 9.7.

ozij wrote:You could try to track your data daily via the LCD screen - see instructions on this thread: viewtopic.php?f=1&t=40931&p=359532&hilit=lcd+data#p358714

I will, thanks. Awkward but doable

ozij wrote:You must be looking at two types of data, since the 14.4 =<90% means you spend only 10% of the time above 14.4. The other table (detailed data?) probably refers to the last 5 nights, and not to the whole 26 day period.

That's exactly right. Thanks for the clarification.

ozij wrote:A DME is not allowed to change your pressure settings - but those data should have made them contact your doctor about a change.

That is what is so frustrating. If I am going to be wearing this contraption to bed for the rest of my life. I want to get the most bang for my buck out of the treatment. I think I am entitled to answers and action from the people who 'theoretically' are following my therapy. In the meantime, thanks to you for your help.

Goofproof wrote:Until you have your leaks under control, and they are not, the data may be useless.

I thought as long as large leaks (ones the machine considers significant) were minimal, I was doing ok but just annoyed by the re-adjustments required during the night to adjust for the smaller leaks. Does the software report on leaks and when they happen?

Thanks.


On a final note, I am adjusting to this therapy better than I thought and , again,it is mostly thanks to the posts I read on this Board. Glad i found all of you.

Bernard

BML wrote:But these obstructive apnea numbers are derived if they are events per hour. For example, I spent 2 minutes (!) at an EPAP of 4 and the obstructive apnea events per hour reported is 30. I would read that as having had 1 apnea event in a 2 minute span which works out to 30 events per hour, correct? Without knowing when I am actually at these pressures, it is difficult to extrapolate too much. For example, at an EPAP of 6, I have an AI of 14.2 that drops at higher pressures (makes sense) to a low AI=4.7 until at EPAP of 13 it climbs back to an AI= 9.7.

You're correct about the extrapolation. That AHI per pressure chart of Respironics' becomes misleading when the time periods shrink - you get huge AHI's for very small time periods - and I'd say that as long as you spend very little time in those higher pressures, the high AHI can be ignored.

However, the length of time you spend in apnea per night is not a calculation artifact, and is concerning.

O.

BML wrote:Went to the sleep clinic. they downloaded the data for the first 26 days and printed me a 2 page report.

What they printed for you was the "Summary" or perhaps the "Trend" report (instead of the "Full Details" report) from the download of your Smart Card. They're probably so used to using only that short report from a download, it never occurs to them that some people want to see every detail about their treatment. Most cpap users are not the least bit interested in knowing anything at all about their treatment other than how to turn the machine on and off. Most prefer to leave everything to the doctor and DME, figuring that the "professionals" know best.

I personally don't find the Summary or Trend particularly helpful since averages include things caused by mask issues that might be happening at the beginning of one's treatment, that may have improved on later nights as a new person gets mask problems resolved...like the leak rate. Early days of struggling with a mask could produce higher leak rates for a few days that are going to keep being averaged in, skewing the picture in regard to what's been happening leakwise more recently.

I like to look at the "Daily Details" graphs that begin on page 4 of an Encore Pro or Encore Viewer report... the graphs that show what was going on during the 5 or 6 most recent individual nights. Older "details" get overwritten with newer.

The DME could still print out the whole report, which would show the graphs for several individual nights.

If you want to, you could go back to the DME, ask them to open up your downloaded report again (they don't need your Smart Card to do that...the full downloaded report remained in your patient file in Encore Pro on their computer) and print out a "Full Details" report for you.

All they have to do is click "Full Details" instead of leaving the mark in front of "Summary" when a little window pops up for how they want to view the report. That's not too much to ask for -- it will be about a dozen pages. It's part of your medical record which you're entitled to see.

I agree with ozij...

ozij wrote:the length of time you spend in apnea per night is not a calculation artifact, and is concerning.