two part question

Bonnie · Post by **Bonnie** » Sat Apr 01, 2006 11:37 am

Since I download daily, the EncorePro records are piling up and updating the database is taking longer and longer. How do I archive this information or move it? I'd like to save it but have no clue how to do this.

My second question relates to apneas and hypopneas. My readings are always low numbers on apneas but higher on hypopneas. These are the last three nights from MyEncore, 3/31 being higher than I have had since starting recording in November..

3/31
Total Obstructive Apneas: 11
Total Hypopneas: 25
Total NR Apneas: 0
Total Snores: 100
Total Flow Limitations: 4
Total Time in Apnea: 144 sec.
Average Apnea Duration: 13.1 sec.
Fraction of Night in Variable Breathing: 22.3%
Obstructive Apnea Index (OAI): 1.52
Hypopnea Index (HI): 3.45

3/30
Total Obstructive Apneas: 4
Total Hypopneas: 6
Total NR Apneas: 0
Total Snores: 139
Total Flow Limitations: 8
Total Time in Apnea: 42
Average Apnea Duration: 10.5 sec.
Fraction of Night in Variable Breathing: 22.5%
Obstructive Apnea Index (OAI): 0.57
Hypopnea Index (HI): 0.86

3/39
Total Obstructive Apneas: 2
Total Hypopneas: 12
Total NR Apneas: 0
Total Snores: 74
Total Flow Limitations: 18
Total Time in Apnea: 24 sec.
Average Apnea Duration: 12.0 sec.
Flow Limitation Index (FLI) 2.35
Obstructive Apnea Index (OAI): 0.26
Hypopnea Index (HI): 1.57

After reading the Cpap dictionary I am still confused as to what an apnea is compared to a hypopnea or central apneas or nonresponsive apneas. And would like help in understanding why my hypopneas are always so high. I'm not concerned with snores, I believe it is picking up on a lot more. I don't understand flow limitations, but think they might be related to leaks?

Thanks so much for the help and it's good to be back after a month away! Looks like I have a lot of catching up to do.

Brent Hutto · Post by **Brent Hutto** » Sat Apr 01, 2006 12:01 pm

Bonnie,

Keep in mind that the machine is reporting its estimate of what sort of events you are experiencing. Since it doesn't have all the sensors used in a sleep study, some of the finer points of defintions that apply in a PSG study are not applicable in reading APAP logs.

In general, an apnea is a "complete" cessation of breathing where "complete" is usually definited as something like "less than 25% of normal flow". A hypopnea is a "partial" cessation of breathing which is usually defined as a "between 25% and 50% of normal flow".

In a PSG study, you know whether the person was trying to breathe so they distinguish between a "central apnea" where there was no flow and no effort versus an "obstructive apnea" where there was no flow and the person was trying to breathe. The APAP machine doesn't actually know if you were trying to breathe so it has ways of guessing whether an apnea was central or obstructive. The machine will score a "non-responsive" apnea as one that doesn't resolve after being hit with an increase in pressure. The assumption is that the "non-responsive apneas" might be centrals so after a while it will stop trying to overcome it with pressure just to be on the safe side.

As for "flow limitation" that's not related to leakage. Rathre it's a name for events where the increase in airflow as you start breathing in flattens out rather than increasing to a normal peak. Recognizing and responding to flow limitation is the primary method for accomplishing treatment with APAP. Those flattened inhale patterns can be responded to without waiting for a frank apnea to occur, thereby allowing preventative PAP rather than just reacting and trying to stop apneas once they occur.

Moogy · Post by **Moogy** » Sat Apr 01, 2006 2:14 pm

Bonnie wrote:Since I download daily, the EncorePro records are piling up and updating the database is taking longer and longer. How do I archive this information or move it? I'd like to save it but have no clue how to do this.

Bonnie,

The database resides in C:\Program Files\Microsoft SQL Server\MSSQL$ENCOREPRO. The EncorePro program updates this database each time you download.

If you delete the data on the SmartCard, the old data in this master file is not deleted. You can still retrieve it from the list of prior downloads on EncorePro, or you can retrieve it with MyEncore. Just don't erase the prior downloads on EncorePro and you will be ok.

I delete from my SmartCard every few days, just to speed things up.

Moogy

Bonnie · Post by **Bonnie** » Sat Apr 01, 2006 7:12 pm

Moogy, thanks, I too erase the smart card every few days.

And thanks, Brent, I'm only a little less confused now

Wulfman · Post by **Wulfman** » Sat Apr 01, 2006 8:44 pm

Hi Bonnie.

I'm probably not going to be able to help you much on your sleep statistic numbers.....mine have been all over the place since the first of the year, too. For example, the night before last my AHI was 0.4 and last night it was 2.0. I bumped up my pressure two weeks ago to 12 cm and that has probably helped a little, I think, but don't know how much. From reading other posts lately, it seems that we're not alone.

What I'm here to suggest is (hopefully) something that may speed up your downloads and updating. One is to go into your browser (Internet Explorer I presume) and clean out (delete) your Cookies and Temporary Internet files. And the next is to run Disk Defragmenter (out of your "System Tools"). I believe this should speed things up a bit.

Let me know if you have any more questions and/or whether this seems to help.

Glad to see you again and hope your sleep stats improve.

Best wishes,

Den

Moogy · Post by **Moogy** » Sat Apr 01, 2006 9:20 pm

Bonnie wrote:Moogy, thanks, I too erase the smart card every few days.
_________________

Ok, I guess I misunderstood your question, then. If you want the database to process more quickly, have you tried entering yourself as a new patient name? I don't know if that will help, but that is the first idea that comes to mind.

It will take someone more computer literate than I am to figure out how to actually back up the SQL file and create a new one.

I spent hours today reinstalling MyEncore, EncorePro, and the driver. Computer died and I replaced it yesterday. When I went to install, I did something wrong, apparently with the options on the SA account. After much effort I got it to work. It would NOT work with a designated SA password, or with leaving the password blank. I finally took the option to disable the SA account. I can tell you from that experience that if you want to COMPLETELY start over, you can erase everything and reinstall. However, there are files in misc. places that have to be removed, in addition to removing the software.

Moogy

CheezWiz · Post by **CheezWiz** » Sat Apr 01, 2006 11:22 pm

Bonnie,

I am curious about some things.

How many days of data do you have in your patient now?
Is it actually taking longer to pull the data off the card?
What is the processor speed and memory in your computer?

It is possible to have multiple databases. I just spent the last two hours learning Microsoft Desktop SQL Server management to figure it out. It requires copying a fresh encore database into a folder *next* to the current database. Then you have to use a command line tool to detach the server from the current encore database, then connect to the new one in the other folder.

This is not an easy thing to do, but it is possible and might be easy to automate.

In encore pros help file, they mention using multiple databases trivially, but I have not found an easy way to do it.
SQL is quite fast and should take a lot of data to cause issues.

Try Moogies suggestion and create a new patient and download to it and see if that is faster.

Guest · Post by **Guest** » Mon Apr 03, 2006 9:55 am

Cheez, I have data from November to current. And yes it does take longer to pull it off the card, which I do erase every few days. Can't tell you what my processor or memory is but I have a computer guru friend who is always tweaking my computer to perform at its max. Your suggestion about multiple databases is a good one but out of my league to impliment.

In the mean time I am going to try Moggie's idea and create a new me AND print the daily chart summary from MyEncore and just keep a hard copy file to take to the doctor.

Hey, Den...I regularly clean out the temps and cookies, can't go anywhere on the net without those buggers being added. And as for clean up when I do a disk cleanup and defrag XP will tell me if I need it or not. It's another thing I do on a regular basis. Now as to my numbers, I have to admit they are MUCH better than my sleep study numbers of 100+ events per hour. But I am concerned about the high apopneas. Guess I'll make my appointment with the sleep doc. in my spare time

Thanks for everyone's help and suggestions, it is appreciated!

Bonnie · Post by **Bonnie** » Mon Apr 03, 2006 10:17 am

I thought I was signed on.........Bonnie

Wulfman · Post by **Wulfman** » Mon Apr 03, 2006 10:18 am

Bonnie,

Even if you set yourself up as another patient, it'll still probably be adding the data into the same database.....just designating it as another person/patient. I don't think that's going to gain you anything. It'll also disconnect you from your data that's been accumulating from the beginning. I've got all of my data going back to 05/14/05 and the file is about 3/4 of a Gigabite in size. It doesn't take that long to download and update (10 to 15 seconds maybe).

Good luck,

Den

Bonnie · Post by **Bonnie** » Mon Apr 03, 2006 11:14 am

Thanks Den, I think I'll just leave it as is for now seeing as it really doesn't take up a lot of space. I just finished printing out 3 months of MyEncore summary pages and it took a very short amount of time. I'll keep those handy for quick references and eventually chart them for my own personal use. I have been working on a spreadsheet this winter to chart a year's worth of data comparisons. But it is quite a ways away from being finished. If I didn't have to do foolish things like work or house work I'd have it completed by now....
Have a good day!

Guest · Post by **Guest** » Mon Apr 03, 2006 11:31 am

Flow limitations are the same thing as a Hypoapnea, only difference is the Hypoapnea causes a 3% drop in oxygen levels where the flow limitation does not. The FL is usually less than 50% drop in volume.

So techncially no machine on the market can truly detect a hypoapnea other than the Resmed machines with the optional Reslink SAO2 interface. And if you read their documentation on the A10 algorythm they only respond to FL, apnea and snore.

So the rest of the machines can only estimate they are hypoapneas from their tidal volume drop changes and duration. A Hypoapnea is typically described:

-50% drop in air volume.
-lasting >10 seconds
-with >3% drop in SAO2 levels.

So if there is only a 40% drop in volume or it lasts only 5 seconds or doesn't cause a drop to SAO2 levels, that hypoapnea is considered Flow Limitation. Basically it is a less severe Hypoapnea. It is thought left untreated Flow Limitations can turn into Hypoapneas and Hypoapneas can turn into snores and snores into apneas. But you can have one without the other at any time.

If your on an autopap and want to reduce the number of hypoapneas seen, normally you would increase the bottom pressure and then monitor the reports for the change results.

On your Encore reports, you can save those reports off by printing them to a PDF file (it also does it in HTML format), they are located in the C:\Program Files\Remstar sub folders. These files don't have a good naming schema (overwrites the previous) so you have to rename the file after it is generated or:

It is easier to download Cute PDF writer (google it, it is freeware) and install it as another virtual Printer on your PC. Then when you want to save/print those reports you print to that PDF virtual printer and it prompts you for the filename.pdf to use. I use it for on-line bank statements etc. very useful.

Brent Hutto · Post by **Brent Hutto** » Mon Apr 03, 2006 11:38 am

In the literature, there is a additional slight distinction between flow limitation and hypopnea. The more detailed definition of flow limitation sometimes used is a flattening of the flow-vs-time pattern during inspiration. So if you were looking at a trace of the flow rate, you might see decreases in volume and flattened inspiratory flow curves as different events.

That distinctive flattening would be considered a more definite marker of inspiratory flow limitation (IFL) than a simple 30%-40% tidal volume reduction would be. For instance, a slight transient hypoventilation can happen in repsonse to non-obstructive events. If it doesn't exhibit any flattening of the flow-vs-time curve it should probably be ignored rather than intervened on by an APAP. Or at least that's what I come up with from my limited reading.

Guest · Post by **Guest** » Mon Apr 03, 2006 2:33 pm

Bonnie wrote:Thanks Den, I think I'll just leave it as is for now seeing as it really doesn't take up a lot of space. I just finished printing out 3 months of MyEncore summary pages and it took a very short amount of time. I'll keep those handy for quick references and eventually chart them for my own personal use. I have been working on a spreadsheet this winter to chart a year's worth of data comparisons. But it is quite a ways away from being finished. If I didn't have to do foolish things like work or house work I'd have it completed by now....
Have a good day!

Bonnie,

It would not hurt to try the additional patient as an experiment. Just do not erase the card and you can download the data into your original patient, if there is no change. I also think it will still be slow. But it never hurts to try. I am guessing that it may be an issue of processing power & Memory. Do you know what version of Windows you have?

Wulfman- · Post by **Wulfman-** » Mon Apr 03, 2006 2:44 pm

She said she's using XP.

I'm guessing it might be a combination of processor speed and memory, too, but, since I can't be there, I can't judge how "slow" it is.

Den

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