Inspiration expiration ratio

Pugsy wrote:.............

If your machine flagged a flow reduction...either OA, Hyponea or ClearAirway...it lasted at least 10 seconds.. Plain and simple. The fact that SH is reporting the markers (we never figured out what they really meant) as 6 and it appears that visually it might be 6 seconds...doesn't mean it was 6 seconds.
It has to last 10 seconds to get a flag. There is no away around that little fact.

Thanks Pugsy. I understand. The thing that gets me is, since P Resperonics must have built in the means to measure event time very accurately, if for no other reason than to honor the 10 second rule - no surprise considering it's recording data points 125 times/second - why it can't report duration accurately. (Could Mark be wrong about the "markers?") At any rate looks like I gotta demote SH from the pinnacle of Mt. Olympus to a lower level. But it's still up there - certainly not down here at the bottom with me and Sisyphus. It should remain a great tool for helping me - all of us - sleep better.

Did you verify with Encore that it also had a flag at the exact same time of the one you zoomed in on?

Yes! And the flow neighborhood was contoured the same as well. I see PR would like to see a zoomout. Lemme see if I can post that along with the corresponding Encore region.

-Ron

rkl122 wrote:The thing that gets me is, since P Resperonics must have built in the means to measure event time very accurately, if for no other reason than to honor the 10 second rule - no surprise considering it's recording data points 125 times/second - why it can't report duration accurately. (Could Mark be wrong about the "markers?")

the machine may sample the flow waveform 125 times a second, but that doesn't mean it *records* data points that often.

resmed records data points 25 times a second, as to how often they sample the sensors? I don't know off hand.

respironics data recording has always been less precise than resmeds, just look at the pressure traces that are displayed, resmed steps pressure in minute amounts, respironics seems to step it in halfcm amounts, and then there's the mask pressure trace, which is *measured* pressure on the resmed, the only respironics to have that data is the ASV machine (iirc).

as to marks guesses (because he has no official documentation)... who knows. they're not an unreasonable guess, but guess or not, he can't display data that's simply not recorded.

all you have to do is look at the travesty that is encore and compare it to the data available from resscan, which is SO much better and easier to use... though not nearly as easy to use as sleepyhead.

Well, I think that's settled. Duration as posted from PR machines is not actual, but a representation of some sort. Oh, and Buy ResMed!

I am still curious about this I:E thing. Ron, how about running down the expiration time line until you get to a place where it is short and see what is being measured. You shouldn't have to look too far if your average expiration time is shorter than your average inspiration time. (I think the line lags the flow wave a few seconds)

Kind of like the chart below (which is yours) I know the I:E in the top one is as stated because I could measure it. The one on the bottom would be similar, it is the same scale, the time between inspirations and the length of inspirations is close. The RR is very close about 14 breaths per minute. So, with the same RR and the same the IT, ET would have to be the same (or very close) and I:E would be very close, unless there was an error in calculation, like it used one of those first "bumps" under the arrows to compute ET instead of the obvious start in inspiration.

The point is we can measure the times in the graphic. IT is about 1.5 seconds, ET is about 2.25 seconds. See what SH says they are.

Jay Aitchsee wrote:Well, I think that's settled. Duration as posted from PR machines is not actual, but a representation of some sort. Oh, and Buy ResMed!

wellll, while I am an unabashed resmed fanboy for reasons posted in other threads, and while I maintain that the data recorded by resmed IS better, I wouldn't say it's so much better as to make a difference except to someone who likes to dig deep into it, (like Rich may be) and that respironics does make the second best machine I'm aware of

rkl122 wrote:The thing that gets me is since P Resperonics must have built in the means to measure event time very accurately, if for no other reason than to honor the 10 second rule - no surprise considering it's recording data points 125 times/second - why it can't report duration accurately.

Beats the hell out of me. They could report it if they wanted to...but they (Respironics) don't want to.
Encore used to have a statistic called "time in apnea" but I haven't seen it on any recent Encore versions so I don't know when it was omitted. I suspect that the markers were used for the "time in apnea" calculations...and it was total time over the entire night. It was a line on the last page of the Encore reports which was an overall summary page. I know it used to be there a long time ago but I don't know when it was removed.

You have to remember that the data on these machines was designed primarily for DMEs and doctors...and the software accordingly. Most of the time hours of use is all that is really looked at...some docs will look at average AHI over a period of time or they look for trends and patterns. They don't put the data under the microscope to see how long each individual event lasted.
This stuff was never designed with the patient in mind...we aren't the customer.. The DME/Doctor is the customer and that's who the machine manufacturers want to please. It isn't us.

So yeah...Respironics could easily add that event duration if they wanted to...they just haven't wanted to. What we want doesn't really matter.
They still persist in keeping the clinical setup menu as some sort of national secret and we aren't supposed to even know how to get there...much less what the machine is gathering or not gathering.

So...next time you get a machine...or if you want a back up machine...get a ResMed machine.

rkl122 wrote:

Pugsy wrote:.............

.............
Did you verify with Encore that it also had a flag at the exact same time of the one you zoomed in on?

Yes! And the flow neighborhood was contoured the same as well. I see PR would like to see a zoomout. Lemme see if I can post that along with the corresponding Encore region.

-Ron

Ok, I gotta retract that "exact" same time, because it doesn't look to me like the OA in the Encore and SH traces align to the second, or even within a few seconds. Then again, I'm not sure how to read the time axis in Encore, never futzed with it before. Anyway, FWIW, here's the comparison:

http://imgur.com/a/qoCAT

I marked the event in the Encore trace we're talking about. Sorry it's near the beginning - no way to scroll horizontally in the Encore report. But I think you'll agree from the neighborhood contours, these are the same events. Now: why my flow graph is so crazy stupid around these events - around most of my events, truth be told - is a whole nuther question. I'm hoping it's all just SWJ, and I don't need to worry about it. Anyone agree? Disagree (gently now)?

Sorry Pugsy, I did create an account in Imgur, but still don't see refs to thumbnails. Maybe it's because the account wasn't verified yet. Will check later. PR, not sure what you're looking for, but I did zoom out on the SH trace this time. BTW, somewhere in this gigantic thread I gave a link that reports the sampling rate for all the major manufacturers. (IIRC, Resmed's is slower than PResperonics.) But recording rate is not reported. My impulse was to believe them to be equal, but good point - not necessarily.

Jay, I saw your last post, but I gotta say I'm plumb tuckered out. I can't believe I started this monster of a thread. Gotta take a break from this stuff. I shall return. -Ron

You have to be logged in to the imgur account...
then you will see these addresses below. If you don't see them and you are logged in...I don't know what to tell you.

and yes...figuring out the exact same time for an event in Encore to compare it to SH..sucks due to the way Encore always starts at 0. And then DST also will mess with the graphs if you are looking on the wave form which does have the real times shown. I once spent an hour thinking SH was flagging stuff that Encore wasn't until I realized I was an hour off in where I was looking because of DST on the wave form.

rkl122 wrote:Ok, I gotta retract that "exact" same time, because it doesn't look to me like the OA in the Encore and SH traces align to the second, or even within a few seconds. Then again, I'm not sure how to read the time axis in Encore, never futzed with it before. Anyway, FWIW, here's the comparison:

http://imgur.com/a/qoCAT

the time axis on the encore, iirc, is starting at the time on the left, and one minute per tick mark on the bottom, 10 minutes per strip. (though it's been months since I looked at one).

if I were marking up your SH pic, I'd count the event starting at the end of the breath to the left of the relatively flat space, and going until the large breath that ends it. so from about 2:41:04 to 2:41:16. (one problem for seconds counters with sleepyhead is that watkins uses automatic numbers on the x axis, and so each tick mark means different things at different zoom levels. in this one, unless I miscounted, it's two seconds per tick.)

rkl122 wrote:I marked the event in the Encore trace we're talking about. Sorry it's near the beginning - no way to scroll horizontally in the Encore report. But I think you'll agree from the neighborhood contours, these are the same events.

looking at the two events on the encore strip you posted, it looks like encore sticks a marker in after 10 seconds, (when it's an official event) if you look at the first OA, which I'm calling 12 seconds, the marker is right near the end, on the second one, which is longer, the marker is *holds fingertip up to screen* about the same width past the last good breath.. or 10 seconds ish.)

rkl122 wrote:Now: why my flow graph is so crazy stupid around these events - around most of my events, truth be told - is a whole nuther question. I'm hoping it's all just SWJ, and I don't need to worry about it. Anyone agree? Disagree (gently now)?

SWJ is typically referring to CAs around the sleep wake times.

rkl122 wrote:Sorry Pugsy, I did create an account in Imgur, but still don't see refs to thumbnails. Maybe it's because the account wasn't verified yet. Will check later.

follow these guidelines exactly: https://sleep.tnet.com/reference/tips/imgur

Without seeing the rest of the wave form it's kinda hard to come with what the irregularities are but I am thinking the the irregularity between the first and second OA is arousal irregularity...which you may or may not have been officially totally awake and I doubt you would remember it if you were because it looks like things are starting to calm down a bit near the hyponea flag and looks sort of like normal sleep breathing was starting right before the image was cut off on the right side.
Talking about the wave form graph.

I find Encore wave form easier to make a sort of half assed guess as to awake vs semi awake or arousal breathing than Sleepyhead.
Let me dig around and see if I can find a nice wave form that clearly shows sleeping breathing with some ugly mixed in where I was most likely asleep and the ugly was real and not SWJ.

Pugsy wrote:Without seeing the rest of the wave form it's kinda hard to come with what the irregularities are but I am thinking the the irregularity between the first and second OA is arousal irregularity

Yes, I agree those aren't normal sleeping waveforms. The amplitudes are large. Ron's normal sleeping waves he's posted are around +/- 25-30. These are hitting +/- 60, and they do precede the events. I'd say an arousal or wake, definitely a disturbance. Quick, irregular breathing, the OA's a result of pauses and the H from the decreasing amplitude.

Take some time off, Ron. Get some rest.


Here's one of mine as I'm falling asleep which shares similar characteristics



Here's one of mine from this thread showing sleep, then disturbance, then sleep

Will have to wait until tomorrow to get some waveform...I totally screwed up my Encore reports from the 560 I am trialing...so I lost all wave form in Pro.
I don't have time to go looking for old stuff and I won't remember about sleeping well or not.

OK Ron, here's the I:E for the two samples you put up. The measurements are by eyeball, but close enough for government work, I think.
As you can see, they are no where close to "Inverse."
Now, all you have to do is check these against what was reported by SleepyHead for IT and ET for this night (Aug 25) and times.

Pugsy wrote:Will have to wait until tomorrow to get some waveform...I totally screwed up my Encore reports from the 560 I am trialing...so I lost all wave form in Pro.
I don't have time to go looking for old stuff and I won't remember about sleeping well or not.

You give me a thought (no, probably not an orignal one). Why don't we all keep little diaries in which we record our opinions about quality of sleep, headaches etc every morning upon waking? The resulting data could then be analysed for association with AHI, pressures, CAs etc etc. If we somehow standardised the reporting we could pool our data and conduct a proper study!

Well I can dream can't I ....

Pneumophile wrote:

Pugsy wrote:Will have to wait until tomorrow to get some waveform...I totally screwed up my Encore reports from the 560 I am trialing...so I lost all wave form in Pro.
I don't have time to go looking for old stuff and I won't remember about sleeping well or not.

You give me a thought (no, probably not an orignal one). Why don't we all keep little diaries in which we record our opinions about quality of sleep, headaches etc every morning upon waking? NThe resulting data could then be correlated with AHI, pressures, CAs etc etc. If we somehow standardised the reporting we could pool our data and conduct a proper study!

Well I can dream can't I ....

well, I for one can't be bothered, but there are many people who DO use the notes page on sleepyhead to do that very thing.

Pneumophile wrote:. Why don't we all keep little diaries in which we record our opinions about quality of sleep, headaches etc every morning upon waking?

Some people do. I don't. Too much work and everyone knows I am a lazy sot.
I am more or less an immediate gratification person and I don't really feel the need to put past details under the microscope. I can't fix the past.
But then I have been on cpap for over 7 years now and I know that sometimes my sleep quality sucks but it isn't because of cpap therapy or sleep apnea. I can go 6 months or more and not even pull the SD card for a data download. Only reason I am doing it daily now is that I am testing a machine that has a history of acting whacko and I am trying to get it to act whacko for me.

I just don't dwell on sleep anymore. If I were having some issues that I knew that maybe something needed fixing that I could fix (can't always fix all issues) then maybe I might be a little more likely to do some extra work trying to sort out things.

But I got no problem if someone else wants to do all that extra work...

Pugsy wrote:Will have to wait until tomorrow to get some waveform.

Okay...I got some wave form from last night and I will go through it in a bit and see if I can spot some interesting stuff. Might be a good example of SWJ in there because we had a thunderstorm go through last night and it woke me up. Don't know what time it happened though...no clock in the bedroom and I didn't have the presence of mind to turn the machine off and back on to give me a marker to go by.
I know I had at least 2 prolonged awake times for sure...one was the storm and another was just a wake up and thought it was time to get up but it was dark outside and I said "no, try to go back to sleep" and I guess I did. I think the storm came after that wake up.