Just installed software - Could "leaks" = mouth br

Somnambulist · Post by **Somnambulist** » Fri Oct 13, 2006 8:38 pm

Hi all!

I just received and installed my software and uploaded the info from my card. (Anyone who's interested can view the details by clicking HERE.)

According to the data, I seem to have a problem with leaks. Is it possible that mouth breathing would register as a leak? (Time to tape maybe?)

Also, my machine is set to IPAP = 20 EPAP = 14. I noticed that the IPAP maxed at 20 a couple of times. I'm considering upping the IPAP to 21, but thinking that maybe I should resolve the "leak" issue first.

Problem is that I'm just not sure what to do with these numbers. Looks like there's a LOT of reading ahead of me.

The two things that jumped out at me are that 1) I need to get more sleep on a more consistent basis, and 2) I seem to have a serious(?) leak and/or mouth breathing issue.

One last thing...

I successfully installed the "MyEncore" software but was unable to run it. Here is the error I got:

Unable to access the EncorePro database.
MyEncore will close...
Index #0
Message: SQL Server does not exist or access denied.
LineNumber: 0
Source: .Net SqlClient Data Provider
Procedure: ConnectionOpen (Connect()).

I'm running .Net v2, and the SQL server was up and running and given access through the software firewall, (ZoneAlarm Pro). I ran the EncorePro software, created a "Patient" and uploaded, (and accessed) the data from the card before installing the MyEncore software. The data is still available to me through EncorePro so it would seem that a database exists. Any thoughts on how I may have messed this up would be greatly appreciated.

Mike

Snoredog · Post by **Snoredog** » Fri Oct 13, 2006 9:14 pm

I think your data looks excellent. I wouldn't mess with Max. pressure, there are some events you are just not going to clear no matter what the pressure is increased to. I see your pressure decreasing which is a good thing. Increasing will only make it harder to fall asleep. Your AHI data all looks good.

Incredible, you are having Flow Limitations still seen at 14cm.

Leak: your leak is not really bad considering the high pressure you are under, my pressure is half of yours and leak greater. Don't worry about it unless your AHI numbers start to increase.

How does the Auto's found pressure compare to your last titration? or did the lab just use the machine to titrate you with.

Depends on the OS version you are using, but EncorePro cannot access the database, this may be due to not establishing a log-in and password for the database. It is required with XP depending on how your security is set up. You might try reinstalling EncorePro and when prompted use something like:

Log in=sa
Password=Encore06

OR check to see if the \\yourcomputer\ENCOREPRO1 -MSSQL Server Windows Service is started. Right click on SQL Service Manager and select Start, green arrow should appear. If it still fails check the log in parameters on the service.

Don't forget to check the EncorePro help screens. A lot is covered in those help screens.

Somnambulist · Post by **Somnambulist** » Fri Oct 13, 2006 10:20 pm

Hi Snoredog!

Snoredog wrote:Incredible, you are having Flow Limitations still seen at 14cm.

It's also incredible that I could have this ailment for as long as I have and still be so ignorant. I don't understand the difference between a flow limitation and a hypopnea. I did a search for "flow limitation" and got 1069 matches. I'll have to sift through them tomorrow after work.

Snoredog wrote:How does the Auto's found pressure compare to your last titration? or did the lab just use the machine to titrate you with.

If I read the data right my 90% IP and EP are at 18/14. That would be dead on to the titration. The machine they used for the titration was sitting on the nightstand next to me and looked an awful lot like what I just purchased last week!

Snoredog wrote:Depends on the OS version you are using, but EncorePro cannot access the database, this may be due to not establishing a log-in and password for the database. It is required with XP depending on how your security is set up.

Using XP Pro, and I am administrator and the only user. I definitely did not establish a log-in and password. I don't remember being prompted for one during the install. Do I need to establish a password for the database in EncorePro in order for the "MyEncore" application to access it? If so I will uninstall both apps tomorrow and re-install.

Snoredog wrote:OR check to see if the \\yourcomputer\ENCOREPRO1 -MSSQL Server Windows Service is started. Right click on SQL Service Manager and select Start, green arrow should appear. If it still fails check the log in parameters on the service.

The "Distributed Transaction Coordinator", the "SQL Server" and the "SQL Server Agent" all show running. The "SQL Server Service Manager" is in my tray with the green arrow on.

Snoredog wrote:Don't forget to check the EncorePro help screens. A lot is covered in those help screens.

I should have done this before I posted! This will be the first order of business after work tomorrow. Sorry I missed that... I'm tired and not thinking right.

Thanks for the info and suggestions. I have to be up for work in 7 hours so I'll give it another go tomorrow and let you know how it went.

Again, thank you very much for your help.

Mike

Snoredog · Post by **Snoredog** » Fri Oct 13, 2006 11:56 pm

Somnambulist wrote:Hi Snoredog!

Snoredog wrote:Incredible, you are having Flow Limitations still seen at 14cm.
It's also incredible that I could have this ailment for as long as I have and still be so ignorant. I don't understand the difference between a flow limitation and a hypopnea. I did a search for "flow limitation" and got 1069 matches. I'll have to sift through them tomorrow after work.

Snoredog wrote:How does the Auto's found pressure compare to your last titration? or did the lab just use the machine to titrate you with.
If I read the data right my 90% IP and EP are at 18/14. That would be dead on to the titration. The machine they used for the titration was sitting on the nightstand next to me and looked an awful lot like what I just purchased last week!

Snoredog wrote:Depends on the OS version you are using, but EncorePro cannot access the database, this may be due to not establishing a log-in and password for the database. It is required with XP depending on how your security is set up.
Using XP Pro, and I am administrator and the only user. I definitely did not establish a log-in and password. I don't remember being prompted for one during the install. Do I need to establish a password for the database in EncorePro in order for the "MyEncore" application to access it? If so I will uninstall both apps tomorrow and re-install.

Snoredog wrote:OR check to see if the \\yourcomputer\ENCOREPRO1 -MSSQL Server Windows Service is started. Right click on SQL Service Manager and select Start, green arrow should appear. If it still fails check the log in parameters on the service.
The "Distributed Transaction Coordinator", the "SQL Server" and the "SQL Server Agent" all show running. The "SQL Server Service Manager" is in my tray with the green arrow on.

Snoredog wrote:Don't forget to check the EncorePro help screens. A lot is covered in those help screens.
I should have done this before I posted! This will be the first order of business after work tomorrow. Sorry I missed that... I'm tired and not thinking right.

Thanks for the info and suggestions. I have to be up for work in 7 hours so I'll give it another go tomorrow and let you know how it went.

Again, thank you very much for your help.

Mike

CollegeGirl · Post by **CollegeGirl** » Sat Oct 14, 2006 12:09 am

Hi Somnambulist,

Actually, I'm going to have to disagree with Snoredog a little here. There's a pretty big difference in the leaks you're having - 30lpm in the earliest nights, 50lpm in the most recent. This inconsistency would at least make me want to check a few things out.

What I would do is check your mask's manual. In that manual will be information on "Vent Flow Rate." Find your pressure and compare the vent flow rate at that pressure to what you're getting. If there's a major discrepancy, you have a leak problem. And yes, absolutely, mouthbreathing shows up as leaks on Encore Pro.

Somnambulist · Post by **Somnambulist** » Sat Oct 14, 2006 5:40 pm

Looks like we got the software problem beat!

Apparently, I somehow got hold of an older version of MyEncore. After installing v15b7, the program fired right up. Problem solved!

As to my mask, unfortunately I was not provided with a manual. I went to the Respironics site, but was only able to find the product brochure, which did not supply information for "Vent Flow Rate". So, I googled +"Profile Lite" +"Vent Flow Rate" with no success.

I'm thinking maybe the thing to do now is to try taping and see if that makes a difference with the leaks. I'll let ya know what happens.

Thanks for all your help!

bdp522 · Post by **bdp522** » Sat Oct 14, 2006 6:07 pm

Here is the page with the leak info on it;

PROFILE LITE LEAK INFO

Hope it helps

Brenda

Somnambulist · Post by **Somnambulist** » Sat Oct 14, 2006 6:40 pm

bdp522 wrote:Here is the page with the leak info on it;

Hope it helps

Brenda

Thank you Brenda!

According to the info, it would seem that at a pressure of 18, my leak rate should be about 30. My software shows that over the last week, my average, (90%), leak rate has been 65.8. I don't know if that would be considered a significant difference.

I also notice from that link that they suggest "reforming" the mask to minimize leaks. If anyone has done this, can you tell me how it worked for you? I'm a little hesitant to do this because if I mess it up I can't buy another mask for 2 months.

Thanks again!

bdp522 · Post by **bdp522** » Sat Oct 14, 2006 6:49 pm

I can tell you that this is a significant difference. Is the mouth taping working? I can't tell you about fitting the mask, I've never used this mask. I'm sure someone with more knowledge about this mask will pop in with recommendations for you soon.

Brenda

Somnambulist · Post by **Somnambulist** » Sat Oct 14, 2006 6:59 pm

bdp522 wrote:Is the mouth taping working?

Haven't tried it yet, but planning on it tonight. The scary thing is that the only tape in the house right now is duct tape, and I have a moustache.

Things could get very interesting in the morning...

Somnambulist · Post by **Somnambulist** » Sun Oct 15, 2006 11:20 am

Tried "taping" last night using a couple of Band-Aids. Seemed pretty secure when I went to bed, but when I woke up the seal was broken. I'll pick up some medical/cloth tape today and try that tonight.

One thing I noticed from the reports, (last weeks and last night's), that seems kind of odd to me. Unless i'm misreading them, it appears that the leak rate does not increase with the pressure. I would have thought that increased pressure would cause more leaks.

Maybe i'm just reading this wrong?

Snoredog · Post by **Snoredog** » Sun Oct 15, 2006 12:06 pm

You can "reboil" that mask as many times as you want. If you haven't done that I would.

You hold it in boiling water to get the main cushion hot/warm then dip it in ice water so it doesn't burn your skin and form it to your face. Once the cushion cools it should stay there.

Leak Rate:

All masks should have a flow rate at a given pressure. You are using a Respironics mask with a Respironics machine, it should fall under the Remstar's expected leak rate. The machine can determine that automatically up to the flow delivery limits of the machine.

If the EncorePro report says you have an avg. leak of 47L/m then:

30L/m of that leak is your mask's intentional leak at the given pressure.

So 17L/m of that 47L/m is external LEAK, meaning it is either leaking from the hose, humidifier coupler, or between your skin OR you are mouth breathing. Keep in mind these machines can only deliver approx. 30-38L/m of maximum flow. Your Bipap may be a bit higher than that, but your leak including intentional leak cannot exceed the flow characteristics of the machine.

Mouth breathing usually takes you to a LL (LargeLeak) which will trip any Patient alert on the machine, impact therapy (if an autopap), it will show BLACK bars at the top of the Leak chart in EncorePro.

If you suspect you are continually getting LL, I would suggest enabling the Patient Alert until you can determine which is happening. But at 18cm pressure it is much more difficult to control leaks than at 10cm.

Somnambulist · Post by **Somnambulist** » Mon Oct 16, 2006 11:14 am

I taped last night using 1" 3M Micropore Surgical Tape. Held together beautifully.

The results for last night: Avg. Leak = 46.0 / Avg. 90% Leak = 67.0.

It would seem that mouth breathing is not the problem. I'll reform the mask today, that should help. If not, I'll try nasal pillows and see if there's any difference.

As a side note, it cannot be said enough what an incredibly valuable tool this software is! My DME supplier is about 40 miles away. I can't imagine that I would have bothered driving there on a daily basis to have my card read, (for a small fee. )

It also cannot be said enough what an incredibly valuable resource this community is! I have learned more here in the last two weeks than in 13 years of xPAP use, and I know I'm still just a "babe in the woods".

Thank you for your wisdom, and your willingness to share.

aka_oldgearhead · Post by **aka_oldgearhead** » Mon Oct 16, 2006 11:32 am

Keep in mind these machines can only deliver approx. 30-38L/m of maximum flow.

Snoredog - Where did you find that? Many masks have a a passive exhaust flow in excess of 40 LMP at 15 cm/H2O. Are you sure its not 350 LPM?

Snoredog · Post by **Snoredog** » Mon Oct 16, 2006 11:55 am

aka_oldgearhead wrote:
Keep in mind these machines can only deliver approx. 30-38L/m of maximum flow.
Snoredog - Where did you find that? Many masks have a a passive exhaust flow in excess of 40 LMP at 15 cm/H2O. Are you sure its not 350 LPM?

Found in the last few pages of your User Manual, under Specifications, Max flow varies by model, on the M series Auto, page 8-2 Max. Flow=35LPM.

Older model Remstar Auto, page 4 Specifications: Max Flow=35LPM.