Encore Pro Report ... What is Happening???

I'm still trying (as a new user) to understand what the EP report is telling me!

I really would appreciate input from those of you that have used the software enough to describe to me what is being shown in the attached report.

Everything looks good until about the 3rd hour ... then the Leak goes up and goes nuts ... at the same time the Obstructive Apnea kicks in at a rapid rate ... then of course the pressure has gone up to the max 10 cm.

Very simply ... what is the EP report telling me? What's happening?

The only difference from the info in my profile is that I wore a Full Face Mask for this report (had trouble breathing through my nose). I was on Auto with A-Flex and at 6 to 10 cm.

I was awake for the last half to one hour before getting up (back pain).

Thanks ...

Jan

The report:

Is it just possible that around the 3 hr mark, you moved, dislodged the seal a bit, created a leak and it allowed some events (apneas) to occur? There isn't always a good, let alone rational, explanation for everything that goes on in a given night, and unless it becomes routine (the timing, etc.), I wouldn't worry a lot about it.

Jan,

Now you know what makes some of us "daily downloaders".....it's like a box of chocolates.....you never know what you're going to get (see).
And, in Auto mode (range of pressures), it can REALLY get interesting.


Den

My opinion? You need to tighten up the range on your machine. Using APAP works best when the low number is no more than 2cm less than your 90% number. Your machine appears to be set wide open, 4-20. Since your 90% is at 10, I would set the bottom number to 8 and see how you do. If this is a "weird" chart for you, check the 90% on a more normal chart and use that to set the bottom number. Starting out at a higher pressure might also help you to get the mask adjusted for the pressures you will experience during the night so you won't get major leaks. It should also help to reduce your AHI.

janp wrote:Very simply ... what is the EP report telling me? What's happening?

I think you should consider switching to CPAP mode. Your initial pressure of 6 cm. seemed to be doing pretty good for you. I'd turn off the Ramp and just set it to 6 cm. in CPAP mode for a few nights and see what the reports look like. That will prevent the runaway pressure changes if your nasal pillows become dislodged again.

Den

BeanMeScot wrote:My opinion? You need to tighten up the range on your machine. Using APAP works best when the low number is no more than 2cm less than your 90% number. Your machine appears to be set wide open, 4-20. Since your 90% is at 10, I would set the bottom number to 8 and see how you do. If this is a "weird" chart for you, check the 90% on a more normal chart and use that to set the bottom number. Starting out at a higher pressure might also help you to get the mask adjusted for the pressures you will experience during the night so you won't get major leaks. It should also help to reduce your AHI.

BeamMeScot ...

Thanks for your response.

Actually, the Auto is set to 6cm, with 10cm max.

Except for the spikes in pressure ... I assume responding to apneas ... the pressure did stay at the 6 minimum and all was well ... until it went wild for some reason.

I'm trying to understand what that reason was.

I tend to agree with you on the tighter range, but my doctor just changed the setting to 6/10, so I'm going to try it for a week for evaluation.

Jan

Wulfman wrote:

janp wrote:Very simply ... what is the EP report telling me? What's happening?

I think you should consider switching to CPAP mode. Your initial pressure of 6 cm. seemed to be doing pretty good for you. I'd turn off the Ramp and just set it to 6 cm. in CPAP mode for a few nights and see what the reports look like. That will prevent the runaway pressure changes if your nasal pillows become dislodged again.

Den

Den,

It was in CPAP mode at 6cm and wasn't helping (confirmed by the EP reports).

The doctor just changed it to the Auto 6 to 10 cm.

Doesn't the first part of the pressure graph show that it's working when it spikes higher than 6? Am I not reading the information correctly?

Thanks,

Jan

janp wrote:Den,

It was in CPAP mode at 6cm and wasn't helping (confirmed by the EP reports).

The doctor just changed it to the Auto 6 to 10 cm.

Doesn't the first part of the pressure graph show that it's working when it spikes higher than 6? Am I not reading the information correctly?

Thanks,

Jan

Those little pressure "bumps" or "probes" are a characteristic of the REMstar Autos. If you'll notice, there are no "events" below or above them in that 2-hour period to warrant it changing pressures......no FL, no hypopneas, apneas, snores.....just a few little dips in your leak line. If you look at the Events per Hour chart, you spent 118 min. at 6 and had an AHI of 1.5. Everything above that pressure reported higher numbers of events (although that could be a cause-and-effect situation).....probably due to the leakage. The Auto (range of pressures) didn't actually do any thing FOR you in those first 2 3/4 hours. For all intents and purposes, you were at a constant pressure and there was only one flow limitation and one apnea (which, if you'll notice, happened during a flat spot in your leak line and there was no corresponding bump in pressure on the pressure line). That apnea came and went without a response from the machine.


Den

Another thought or two.....would be to set your pressure range from 6 - 7 of use a straight pressure of 7 and see how that looks.

Den

I went back through your previous posts to refresh my memory....

Was that the Comfortfull 2 (FFM) you were wearing last night?

Den

Wulfman wrote:I went back through your previous posts to refresh my memory....

Was that the Comfortfull 2 (FFM) you were wearing last night?

Den

Den,

It was the Comfortgel FFM.

Jan

Oooooooo.....K.

Den

You were going along well until the leak rate went over 40 LPM, after that you were no longer being treated, not enough air pressure being held in your airway to hold it open. You need to correct the leaks and as Den says a higher starting pressure without a ramp and more control for the high pressure. APAP 7cm to 8 cm, or CPAP at 7 CM with the leaks stopped. Jim

Goofproof wrote:You were going along well until the leak rate went over 40 LPM, after that you were no longer being treated, not enough air pressure being held in your airway to hold it open. You need to correct the leaks and as Den says a higher starting pressure without a ramp and more control for the high pressure. APAP 7cm to 8 cm, or CPAP at 7 CM with the leaks stopped. Jim

Jim,

Thanks ...

Two questions.

I was doing great on the leak rate until the last 1-1/2 hours. Any guesses as to what changed? In fact the leak rate seems to drop everytime the pressure went up ... I assume the pressure went up responding to an apnea event. Am I wrong?

How does the ramp come into this ... since that was at the start of the night and the leak/pressure/apnea were all under control for almost 3 hours afterwards?

Bear with me, I'm still very new to all of this and trying to understand it all.

Jan

Several factors can enter into this......

If the mask (headgear tension) is adjusted for the lower pressures, when the pressure goes up too far, it can lose the seal.

Bed pillow.....if the pillow dislodges the mask (especially when one is sound asleep), the leaking will continue until the person moves to a different position or wakes up enough to rearrange it so it will stop.

Sleeping position.....if the person's airway becomes restricted, it will cause/allow the apneas to take place.


Den