Encore Analyzer Variable Breathing Poll

OutaSync wrote:Hey, I'm not dead. I can see you talking about me
...
Maybe that is because I've increased my melatonin to 6mg and started taking a coated aspirin before bed (Thanks, Snoredog, for those suggestions)

Yay, glad to see you

What's the aspirin for again? Pain?

Yes, the aspirin is for the constant back and shoulder pain. My prescription was apparently messing up my sleep architecture and the Lyrica made me feel terrible. I wanted to get off any medication that might affect my next sleep test.

Bev

Wild conjecture no. 2:

They put the VB field in the database in the hope of eventually using breathing patterns to identify REM. Unlike flow limitation, REM is highly relevant for both fixed pressure and automatic machines - so it would make sense to have the parameter on both kinds of machines.

They would not have been the only ones to enterntain such hopes.

Rapoport (he of cardiac oscillation fame) applied for a patent for a SYSTEM AND METHOD FOR DIAGNOSIS AND TREATMENT OF A BREATHING PATTERN OF A PATIENT

Described is a system including a sensor and a processing arrangement. The sensor measures data corresponding to a patient's breathing patterns. The processing arrangement analyzes the breathing patterns to determine whether the breathing patterns are indicative of a REM sleep state.

And recieved one on March 2007 USPTO 7,186,221 for a "Positive airway pressure system and method for treatment of sleeping disorder in patients" in which:

The processing arrangement analyzes the breathing patterns to determine whether the breathing patterns are indicative of at least one of the following patient's states: (i) a regular breathing state, (ii) a sleep disorder breathing state, (iii) a REM sleep state and (iv) a troubled wakefulness state. The processing arrangement adjusts the applied pressure as a function of the patient's state.

<snip>
FIG. 7 shows a waveform of airflow from a patient which is indicative of a period of troubled wakefulness; and

FIG. 8 shows a waveform of airflow from a patient which is indicative of a period of REM sleep with irregular breathing due to phasic REM in a patient.

"[A]t least on of which" doesn't indicate he is surecan identify REM sleep by breathing pattern, but he sure is trying - so why not assume others others are or were trying as well?

Remeber the Respironics Series' name?
REMstar.
O.

OutaSync wrote:Hey, I'm not dead. I can see you talking about me

Actually I'm not sorry I got the SV. I kinda like knowing that if I stop breathing for more than 15 seconds it will kick in for me. Sure beats the Auto just sitting there in a holding pattern waiting to see if I wake up after 15 minutes.

My personal experience has been that when I set BPM to Auto, I see PB markers. I haven't seen any with BPM set to 4. I haven't gotten used to the plunger effect on my face, yet, but the sound of the machine no longer bothers me. Once I do get to sleep, I don't wake up as often as I did before. Maybe that is because I've increased my melatonin to 6mg and started taking a coated aspirin before bed (Thanks, Snoredog, for those suggestions)

Bev

Glad you are feeling better, that BPM=4 will certainly slow your breathing down but it is only for backup mode when centrals are seen, so very strange indeed. Only way I see that working to eliminate PB is by slowing your breathing down after a central, then when you go back to spontaneous breathing you are breathing much slower. I would leave it there for a while maybe it will retrain your breathing to a slower rate (I suspect your Avg. BPM reported by the machine is much higher). Would be interesting to learn if use of a BPM=8 or 10 would not be just as effective. Have you tried higher BPM=xx values?

James may have to do the same thing if BPM=Auto doesn't eliminate his PB. Didn't I say that before? Oh that't right no one wanted to listen (Not you Bev) , all that matters is you are feeling better.

It looks like there's going to be a good sample collection. In order to interpret this stuff, the next step would be to go back and get the NPSG data on all of the sleep architecture parameters to account for as many of the variables as possible (I know, some of this data will be dated). The participants should report all VB values, paying particular attention to suspected reasons for large variations in night-to-night data.

I believe a matrix could be assembled composed of two variables. The first would be a measure of breathing stability (presence or absence) plotted against sleep stability (presence or absence). This would give 4 possibilities. Using this matrix, I believe an interpretive strategy could be defined that would include a predictive factor for CompSAS.

This analysis may require lowering the number of categories to 3, but we'll have to see the data before we can define where the breakpoints should be.

SAG

Doug, wonder if Respironics scrutinized your VB data when they collected your card.

OutaSync, only kidding about the "Alas, poor Yorick..." insinuation regarding your autoSV machine.

Snoredog, I don't think a BPM=4 setting on any S/T (backup mode) machine can literally drive slow breathing, as can be the case on a purely timed-mode machine (the T mode only, with no S driving the rate). An S/T or backup mode @4 BPM provides only an EPAP-to-IPAP transition (that "backup") if a spontaneous human transition rate doesn't occur as fast as 4 every 60 seconds. So while a faster than spontaneous S/T backup rate (BPM setting) will speed up spontaneous inspiration, a significantly slower than spontaneous BPM on S/T modality has no timing means to force slow breathing. The standard procedure of setting backup rate two or three points below spontaneous rate relies on that same non-intrusive principle regarding spontaneous breath timing. Bev's breathing is literally too variable and easily-disrupted on the time axis for her to sleep with BPM=spontaneous rate minus 2. A tight backup range frequently kicks in for Bev, inducing PB. But running in spontaneous mode or BPM=off would at least allow SV modality to very actively correct her flow amplitudes on the Y axis throughout the entire night. So allowing that autoSV BiPAP to actively maintain Bev's Y axis (peak flows), while not so "tightly" maintaining her X axis (timing), seems to be Bev's autoSV preference from what she has mentioned. And setting BPM=4 is very close to simply running in spontaneous mode... but that BPM=4 setting at least allows long-duration apneas to receive a machine-generated EPAP-to-IPAP pressure transition (the "backup") in under 15 seconds.

SAG, I like your idea of trying to correlate the above VB data to PSG. The biggest caveat IMHO is the fact that the collection and characterization of the above data can never entail adequate controls. Just the wording "what seems to be your most commonly occuring" lends itself to not much more than a rough curiousity peek. But still, a deeper curiousity peek sure sounds interesting to me!

Ozij, interesting speculation! The original inventer of the REMstar automated CPAP technology was Dr. John Remmers. Maybe he was destined to perform REM related work.

HAPPY THANKSGIVING!

Bump - More poll takers please

-SWS wrote:Doug, wonder if Respironics scrutinized your VB data when they collected your card.

<snip>

SWS,

No they were out of luck in my case.

They couldn't read the cards my machine created (twas a brand new not yet released in Australia C-Flex Auto).

For a while I figured I'd been sent a bad machine until I got the software & a reader & discovered I could read the cards. As far as that
study went they settled for me providing an estimate of compliance.

DSM

Now here is a trip down memory lane - I found the post where I talked about it
viewtopic.php?f=1&t=4113&p=33064&hilit= ... lty#p33064

Bumping this thread since I recently discovered the VB information buried in the EncoreViewer xml file, searched through the forum, and found this discussion.

I haven't been following my VB statistics regularly, so I just did a sampling of a dozen nights.

Time in VB (displayed in the xml file) ranges from just under 2 hours to around 5.25 hours.
Counts of recorded VB events (30-second data samplings) range from just over 200 to just under 550.
Calculated VB index ranges from around 24 to around 65 "events" per hour.
Calculated % time in VB ranges from 22% to 66%.

Average sleep time is between 8:00 and 8:15.
Occurs with both Activa and UMFF masks; the highest numbers, but also the lowest, are with the Activa.
No obvious correlation with any parameters I'm following.

This is all from a standard REMstar M-Series Auto. No fancy machinery.
My several PSG's have never identified any "complex" breathing patterns. Just standard OSA.

A true curiosity. What does it mean? Why is it there? Should I waste any more time looking at it?
Any new thoughts since the thread closed itself down? Velbor

I would also like to bring this thread to BleepingBeauty's attention. She was initially diagnosed with severe complex sleep apnea.

Then in this thread three more crucial pieces of information were eventually revealed: 1) she was one of the lucky 50% or so CompSAS patients who seemed to largely adapt to fixed pressure CPAP, 2) she continued to experience significant residual fatigue despite that much-improved AHI using CPAP, and 3) a doctor-arranged home APAP trial revealed APAP pressure-variations resulting in increased episodes of dyscontrol (compared to previous fixed-pressure CPAP mode during same-night split-study mode at home). Some additional information was presented in this thread immediately after BleepingBeauty's follow up PSG.

BB, if you ever get around to getting a card reader in the near or distant future, please add comments about your variable breathing numbers to this thread. It would be nice to see what's going on in variable breathing with a "biologically adapted" CompSAS patient. Thanks.


P.S. But please don't buy a reader just to satisfy our VB data curiosity.

-SWS wrote:... three more crucial pieces of information were eventually revealed: 1) she was one of the lucky 50% or so CompSAS patients who seemed to largely adapt to fixed pressure CPAP, 2) she continued to experience significant residual fatigue despite that much-improved AHI using CPAP, and 3) a doctor-arranged home APAP trial revealed APAP pressure-variations resulting in increased episodes of dyscontrol (compared to previous fixed-pressure CPAP mode during same-night split-study mode at home)...
... would be nice to see what's going on in variable breathing with a "biologically adapted" CompSAS patient. Thanks.

When I had seen the VB data in my respironics database a few months ago, looking around, I had missed this thread. I seem to match the 1), and to some extend 2) above before I went very low pressures. I had written in another thread recently:

I have been on cpap for over a year now. I was able to guess (on my own, not confirmed by any sleep study) that I have Centrals or CSA within a few months of my starting on cpap by careful daily data analysis. It turned out I have only mild obstructiveness, but my AHI was ~30 pre-cpap. I could not tolerate any pressures above about 7cm, then the Hs will start to go up significantly (my conclusion: Centrals). Now I use auto 4-5cm (yes! that low!) and have a reasonably stable <4AHI most nights. I am also very very sensitive to CO2 retention (a known cause/effect of Centrals); I had to (on my own) very carefully tune my CO2 retention levels with hose length adjustments, partial port blocking, cflex settings, humidity level controls.

My VB graphs (Encore Pro Analyzer) for the last ~4 moths show those numbers between 24-40, with big daily variations. Not clear what that % value of VB means. In looking thru the data base, I see VB is stored as events just like H, A and my VB/hr is typically in the high 30s (while my AHI <3 or 4). There is no obvious (so far) correlation of VB to anything else we follow, but they do come in bunches, and swarms all other events.

When I discussed my data with my doc, s/he was amenable to try another sleep study to determine the Central, and go with one of the newer VB machines. It was the relatively low AHI I was able to achieve soon after, coupled with the large out of pocket expenses of a study, and machine that made my decision, instead to stay with my M-series machine. With my current low AHI, insurance will not pay for any of these...

BTW, I have been working on an add on software program to better graph the daily details of respironics data. I am looking for a few beta testers for this. I would be adding another thread about this soon. I will come back and add a sample detailed daily report graph. I am adding the VB items to the display now.

feeling_better wrote:BTW, I have been working on an add on software program to better graph the daily details of respironics data. I am looking for a few beta testers for this. I would be adding another thread about this soon. I will come back and add a sample detailed daily report graph. I am adding the VB items to the display now.

Here are the daily detail display from new program, with and without the VB events. One set was selected for a relative high VBI day, but the AHI was not that different that day.

Watch out, my newbie is about to show.....but you don't have VB data on straight cpap machines, right? I don't recall ever seeing this data.

klockemy wrote:Watch out, my newbie is about to show.....but you don't have VB data on straight cpap machines, right? I don't recall ever seeing this data.

klockemy, I do not know if your straight cpap machine provides the data. Well, as for your recall, no, you have not forgotten anything. This is the first time, AFAIK, anybody has displayed the VB detailed data from these machines (at least in this form).

I think Wulfman had mentioned somewhere in this thread that the RemStar Pro 2 records VB data. Klochemy, that VB data is hiding in the SQL data structures on the card. It takes a third party utility to bring it out.

Feeling_better, interesting and wonderful are two words that come to mind regarding your data project. Have you been able to correlate any kind of following-day subjective assessment(s) with certain temporal VB characteristics or even overall VB index?