Encore Viewer 2 numbers? Assistance for clueless?

I'll get to work on those leaks. I have a Resmed Mirage Liberty mask that I have not tried yet. I don't know much about these masks and I wanted to make sure my DEM was not dumping it on me. (trust issues?)

I've been trying to fix these leaks. Here's a snapshot of my the results with a taped mouth (sleeping on my back). Do these leaks seem good enough? The centrals are still up there pretty high. I think that the incidents of periodic breathing, central apneas and hypopneas that show up at around the end of the night are when I'm waking up. Could that be? Is that to be expected. I took the data with me to my neurologist and he said he "knows nothing about all this apnea stuff, that's why he sent me to the sleep doctor." So I can use all the help I can get.
Tonight I will try to sleep on my side.

Hi underdog, the leak line looks great! At 8cm with your mirage micro, the vent rate is 28 lpm so you're right there (well just under if the graph scale is correct ?!). The mouth leaking may have been the problem!

For the CAs, if you ignore the first and last hours (let's assume they're sleep/wake onset centrals for now), your CA index is about 3. It's difficult to know whether those are true CAs, or whether they are artifacts of poor sleep (pain, meeds, etc). What was the HI? It still looks a bit high too, but only in the last two hours.

To be conservative, I would say stick this setup out another few days. If you have indeed been leaking air out of your mouth the whole time, it may take a few days for your sleep to stabilize (sort of like if you were just first starting out with cpap). On the other hand, if this continues, and your CA index remains high while at the same time your HI is high, and there is still no improvement in your symptoms, it may be time to pursue a new sleep consult. A pulse ox in the meantime could also provide some insight.

Do you have a good hose management system in place, one that ensures that you don't get tangled up in your hose at night?


By the way, does anyone know, is this one of the machines that overscores the HI?

I don't think leaks are the issue. The acceptable leak rate for that mask at 9 cm is about 30 LPM, and you're right there. It doesn't look like leaks are the problem.

Centrals and hypopneas sometimes do cluster during "transitional sleep", but last night you had a fair number of hypopneas in what is probably REM sleep. In response to Echo, no I think it's the Resmed that overscores hypopneas. PR S1's tend to overscore Vibratory snores, but they dont' go into the AHI number.

You might try turning your CPAP up or down just ONE notch. See if that increases or decreases the AHI(some people have increased centrals when there is increased pressure, but your hypopneas suggest increasing). Watch your AHI for a few nights (unless it goes up dramatically from this small change) and see what happens. Remember that "one night does not a trend make".

Thanks for providing some feedback. I plan on trying the tennis ball in my back tonight and leaving everything else the same. Something written in my sleep study (I finally got a copy) suggests this might be a factor. The two nights before this one didn't provide any good data because the 2- year old kept waking up and spent half the night in my bed kicking me in the head but at least those night did give me practice sleeping with the tape over my mouth. Masking tape right?

This stuff is AMAZING! All I see on the screen of my S9 Elite with respect to leaks is a happy face vs a frowny one.

Chunky, you need to check out this post: ht[url]tp://www.cpaptalk.com/viewtopic/t54185/S9-Us ... creen.html[/url]

And then you need to find out how to get Rescan software so you can print out your own details. You have machine that can give you all this!

Last night did not work out as well as I had hoped. (I have my mouth taped and my leaks under control and the pressure holding steady at "8". I tryed to sleep on my side but my wife kept swiping the cover so I may have rolled onto my back at some point and then rolled back to my side. The early morning is the worst. I turned the machine off when I woke up at 4:30 this a.m. Then I got dress and went for a long walk. I cannot get the data off the machine until after noon when it writes to the card. I've included that data here.
It was a strange night. I'm getting used to the sound of my respiration with the mask on. I hear the rush of air in and get used to the rhythm. But several times last night I was in that zone where you are almost asleep but not quite and I notice that I was not breathing at all. No sound of air being sucked into the mask. I know I'm not breathing. I sure wish I could get a handle on this. Very frustrating.

Underdog, the graphs do bear out what you are saying about not breathing, but I do want to say that while I can hear the breathing very loud and Darth Vaderish when I am trying to go to sleep, I can wake and hear absolutely nothing, yet I am breathing just fine. I don't know why it's so loud at first.

It does seem like you are not breathing, yet you are awake? Interesting! You need to show this to your sleep doctor. This looks more like a complex apnea and it might need some other approaches.

I tried lowering the pressure on the Phillips Respironics CPAP from 8 to 5.5. (thanks to the person that send me the manual for the Phillips Respironics CPaP)
Boy that lower pressure is really easy to deal with. No problems getting a good seal, my ears did not bother me the next day and it was a very comfortable sleep. But the results were not what I had hoped for once again. And I did not feel rested in the morning (although I did have a dream at night). I ended up with some snoring and some a few obstructed apneas. I'm glad I tried it. Tonight I'm going to raise the pressure up to 9 and see if I notice any change in those H and CA numbers. You gotta admit I really have those leaks under control. My nose feels like its going to fall off, but heh, anything in the name of science.

I wish mine looked like yours since then I would at least have an excuse for not feeling any better. I wonder if you should have an APAP rather than a CPAP - I think everyone who doesn't need a BiPAP or more sophisticated machine should have an APAP rather than a CPAP . It looks to me like you are having a lot of different events each night and at least with and APAP the machine would be actively making adjustments to try and compensate for those events.

I'm a firm believer that no two nights of sleep are ever the same and certainly not over weeks and months so having a machine that can't adapt is asking for problems in my opinion.

But at least you have the software and can see that your therapy is not effective that is the good step in making it effective. I would be taking that report back to the doctor and see what the doctor has to say. Hopefully you have a doctor that is as willing to listen and work with you. If not I would change doctors. Life is too short and your health is to important to put up with closed minded medical people.

Good Luck
John

Underdog,

With leaks under control, and still so many CAs, you should probably going back to your sleep doctor (bring all your graphs). You probably have complex apnea and this machine just isn't working for you. Probably most of those CAs are during REM sleep.?

slaaplekker wrote:I wish mine looked like yours since then I would at least have an excuse for not feeling any better. I wonder if you should have an APAP rather than a CPAP - I think everyone who doesn't need a BiPAP or more sophisticated machine should have an APAP rather than a CPAP . It looks to me like you are having a lot of different events each night and at least with and APAP the machine would be actively making adjustments to try and compensate for those events.

John, while you're probably right for that for a lot of people APAP is the way to go, some people just cannot tolerate the changing pressure of the APAP and thus do better on CPAP.

In underdog's case, if he really does have complex apnea, then even APAP won't work. The pressure needed to stop the apnea's will be much higher than the pressure which induces Centrals (as appears to be the case here: a CPAP pressure of 8cm gives a good OA and HI but even at 5cm the CAs are probably still a problem.)

John, you bring up a good point regarding "no two nights being alike." And I worry that I'm not getting a true read on the impact of the changes I try because I don't go for a week before trying something new. I should try a few nights before making changes. But I'm impatient.
The one night in the sleep lab had me down to 2.7 AHI and those results were my expectation for home therapy.

Of course hope blooms eternal. I keep reading posts on this forum and trying new things.

Boy, your numbers look terrific. Have they always been so good? I'm sorry to hear your sleep is not getting you to feeling healthy. So much of sleep is such a mystery. I don't think I'm alone in this perception.
I was at a family member's house over the weekend and there was a photo of me on the frig taken a year ago. Narrow empty eyes, drawn hollow cheeks. I was smiling with child in my arms, but it was obvious from the photo that I was physically and emotionally tortured. Looking at that photo was like staring at a dead man.

So I took the pressure up to 9 last night and here are the results. The leaks got out of hand when I loosened the headgear straps to a more comfortable level. Guess that is not a good idea just yet. Tonight I'm going to raise the pressure to 10. Stay tuned.

Underdog wrote:John, you bring up a good point regarding "no two nights being alike." And I worry that I'm not getting a true read on the impact of the changes I try because I don't go for a week before trying something new.

My numbers have been pretty good since starting therapy, I've been watching them since day one.. My big problem is I wake up because the mask is bothering me, or my legs (Restless Leg Syndrome) or joint pain. So I'm awake probably as much as I was before, just traded AHI events waking me for mask bothering me events. Which is hard on the sleep but better for the heart. The good news is since I got a Oximeter and followed up on my desaturation events that really don't show on stats I'm now staying at 90% or above on 02 saturation with takes a lot of pressure off the heart.

If I can get the right mask I'm hoping to get more sleep it is just hit and miss on finding the right combination of mask.

It looks to me like you have a Complex Apena with all of those centrals so it is going to take some work on your end to get things right. I have a friend that has that situation and he had to go on BiPAP with supplemental 02 at night to fix it. I would guess they may need to get a more sophisticated machine to resolve your numbers.

I would be proactive about getting back to you doctor and showing him your reports. I would also request an overnight Oximeter to take home and monitor your O2 levels for a night.

Good Luck
John