Enccore Pro vs. Silverlining software

WNJ · Post by **WNJ** » Fri Jan 06, 2006 9:39 pm

A new CPAP user here!

I've been on a rental CPAP for almost two weeks with good results and I'm trying to decide which machine I'll order from cpap.com. In the research I've done to date, I've narrowed my choices to the PB 420E with GoodKnight H2O heated humidifier and the REMstar Auto C-flex with REMstar heated humidifier. An important factor in my decision is the software I can purchase for each, as I want to be pro-active in my treatment.

Does either the Silverlining software or the Encore Pro software have a significant advantage over the other? What are the advantages and disadvantages of each of these software packages?

I'm thinking mainly in terms of useful information each software will track and output in a usable format, but also in terms of ease of use.

Thanks for sharing your experience!

Wayne

Guest · Post by **Guest** » Fri Jan 06, 2006 10:04 pm

Your question is about the software, but I was wondering if you know your titrated pressure. If you think you might benefit from exhalation relief then I'd opt for the Remstar because the PB420e doesn't have that feature. Do you travel? The PB420e is significantly smaller so if you travel then I'd opt for that.

I've used both machines and I like the EncorePro software better because I use Derek's MyEncore which makes it extraordinarily user-friendly. Scroll down through this link to see the graphs and the type of information you can get with MyEncore and EncorePro.

myencore.php

Guest · Post by **Guest** » Fri Jan 06, 2006 10:34 pm

rested gal gave us a link some time ago to her website for screen shots of both EncorePro and Silverlining software but I can't find it.

WNJ · Post by **WNJ** » Fri Jan 06, 2006 11:05 pm

In response to your question, Guest, I've been titrated at 13 cm (fairly high, I guess). But I can't say that I need the C-flex feature, necessarily. So far, my only real problem with the rental CPAP (Resmed S8 Escape, with Resmed H3I heated humidifier) is waking with a dry mouth. I probably need a chinstrap.

Thanks for the link.

Wayne

Guest · Post by **Guest** » Fri Jan 06, 2006 11:46 pm

Maybe send a PM to rested gal to get the Silverlining graphs she put on her website.

ozij · Post by **ozij** » Sat Jan 07, 2006 12:18 am

Wayne,
My Encore, written by Derek of this forum, teases out info from Encore Pro that is very helpful in self titration.

Silverlining (SL3 for short), lacks some of that info, and the missing info can't be teased from it. On the other hand, SL3 has a very detailed details screen that some find very helpful.

I have a PB420E, use SL3, and discovered the Excel export has as bug - see Silverlining export bug explained.
I used the export option a lot when I was trying to find out the trends in my therapy - but once I settled on my preferred settings, I use it much less.

O.

John M · Post by **John M** » Sat Jan 07, 2006 6:37 am

I just read the postings on SL3's missing "mixed apneas" in the export files. This is interesting to me, because when I look look at the details screen in SL3, I find that I have about an equal number of obstructive and central events, and about 25% of those have a double tick-mark, so must be mixed apneas.

Just wondering if anyone knows what would cause mixed apneas, and what the "fix" would be? My average AHI is less than 2, so I'm not overly concerned. . .

Incidently, I found a fairly strong correlation between flow restricted Runs/hr and Average Pressure--Runs/hr increases linearly with Average Pressure. This must be why I have to turn off IFL1, but I still have the problem because the machine goes up on snore and I think this paradoxically causes more flow restricted Runs. There seems to be no drop in AHI with increased pressures (no correlation), so I'm wondering if I wouldn't be better off with straight CPAP at a relatively low setting. . .

My pressure limits have been between 5 and 9 cmH2O.

Any ideas/thoughts?

Thanks,
-John

ozij · Post by **ozij** » Sat Jan 07, 2006 11:59 am

Incidently, I found a fairly strong correlation between flow restricted Runs/hr and Average Pressure--Runs/hr increases linearly with Average Pressure.

Correlation is a two way street - without causality. In elementary school you'll find a high correlation between children's shoe size and their knowledge of mathematics...
In the PB420 I the causality works the other way around:
With IFL1 on, the machine is programmed to raise pressure when there are more flow limitation runs. Hence the linear increase that you noticed.

This must be why I have to turn off IFL1, but I still have the problem

I'm not sure which problem you're referring to.

because the machine goes up on snore and I think this paradoxically causes more flow restricted Runs.

I think of flow limitation runs as something between a baby hyponea and baby snore. Sometime however they are simply a result of the structure of you airways - neither caused by pressure nor affected by it.

In my case, I never snore with cpap, (I do without it) have about 25-30% flow limited breaths almost every night, and have IFL1 off.

My results - and feeling - turned better when I narrowed the PB range from 5.5-10 to 5.5-7.5.

There seems to be no drop in AHI with increased pressures (no correlation), so I'm wondering if I wouldn't be better off with straight CPAP at a relatively low setting. . .

One of SL3's problems (at least that's the way I see it) is that it doesn't really give you data of the number of apneas per pressure, or the time spent in apnea in each pressure level. On a machine that automatically raises pressure when apneas are encountered you'ld expect your average pressure to be higher on nights when you have more apneas - not vice versa.
So the fact that you don't find a drop in AHI with increased pressure - without changing the pressure range - isn't very informative.

If, however, you change the pressure range, or working mode of the machine, and those changes correlate with your AHI - then you've got info you can use.

Things get ever more complicated: on a auto, you will hopefully spend less time in higher pressure than you will at lower pressure. But that means that if you have 1 apnea during the 15 minutes you spend at 10, your AHI for those 15 minutes is 4. However, the reason you didn't spend more time at 10 is that the machine figured you no longer need 10 - and dropped the pressure to 9. Which is why auto's use the "pressure efficient for X% of the time" parameter to describe and prescribe optimal pressure. An AHI of 4 based on 15 minutes at that pressure is meaningless. 1 apnea at a pressure of 10 for 15 minutes, and and 90% of the rest of the night spent at a pressure of 7 is very meaningful.

Hope this helps...
O.

John M · Post by **John M** » Sat Jan 07, 2006 5:55 pm

Hi Ozij,

I understand your argument about the correlation I described, but I should have been more clear that this correlation between flow restricted Runs/hr and Average Pressure was with IFL1 OFF. With the exception of a few obstructive apneas here and there, the only reason the pressure is increased is due to "acoustical vibrations". Subsequently, it seems with the higher pressures, I have more flow restricted runs and more acoustical vibrations, so the pressure goes up more, and so-on, until I reach the max pressure.

I've noticed that on the rare occasion that I have two or more nights in a row where the "% normal cycles" is near 90% I feel much better, so I've been trying to figure out how to improve this variable. . .

Thanks,
-John

ozij · Post by **ozij** » Sat Jan 07, 2006 10:47 pm

Hi John
Could you be snoring (that's what acoustical vibrations are...) because of congestion? Have you tried saline nasal flushes? What made you set your machine at the range you set it? Have you tried searching for a range in which you snore less, and feel better?

O.

John M · Post by **John M** » Sun Jan 08, 2006 10:08 am

After giving it some more thought, I'm convinced that if I want to check for correlations with pressure, I'll have to set the machine to CPAP mode and test each individual pressure.

Right now, snoring is the primary reason for increases in pressure. And yes, I have nasal congestion and enlarged turbinates. I don't want to go through nasal surgery again (it would be the third time)--I've had my septum straightened about 12 years ago. When I saw an ENT a couple of years ago, he said my septum is still "straight as an arrow" (good news), but that my turbinates were somewhat enlarged. His recommendation was RF ablation, but I'm not too keen on having needles in my nostrils, again, especially with the mixed results I've been reading about.

I'm now realizing that maybe I'll have to bite the bullet and try it, but first I'm going to try to optimize my xPAP treatment one more time.

I chose 5 to 9 as my APAP range for a couple of reasons:

1. My prescribed CPAP pressure was 7 cmH2O, and +/- 2 seemed to make sense.
2. Using a larger range didn't work very well--above 9 cmH20 I have severe leaks and I think more "events".

Yes, I've been using saline and Afrin (my doctor doesn't have a problem with this because I don't suffer from rebound congestion during the day and one or two squirts keeps me fairly clear till morning).

Bottom line--I guess I'll start experimenting with constant pressures to see if I can learn more. I've already dropped the range to 5 to 7 cmH20, and it seems like I am having fewer runs, hypopneas, and apneas. . .

Thanks,
-John