Updated with titration report, any help analyzing?

Encore Pro 2 won't install on the wife's machine, it says it isn' compatable, I guess because she has a windows 7 machine. I still can't get it to load on mine either, as far as it will ever get is telling me my computer has to restart to continue the install, and then after the restart it comes up and says it again. Humph. So no encore for me for now it seems.

So I thought i'd check the Average AHI, leak, and periodic breathing on the machine display since it is the best I've got to look at. And guess what those little stinkers at the DME did.

They locked showing that info out. They sent me a SD card that changed the pressure to 16/9, and I guess they also put instructions in there to lock the view of the averages.

I have a copy of the provider manual thanks to the kindness of strangers, and I unlocked the machine and put that info right back on the display. Jerks! I'll wait 7 days for the averages to normalize out but it is still looking high, especially the periodic breathing of 6% Humph.

I've got a copy of the sleep report. Could anyone add some insight? I have an appointment with the sleep doc next Thursday. Given this data, what should I be asking the guy, should I be asking for a different type of treatment? Oxygen? It seems I have a lot of centrals. There's a itty bitty paper copy of the oximetry evolution too, and as far as I can tell, I desat to somewhere between 89 - 93ish 23 times over 432 minutes, roughly a quarter occured at 16/9.

History
This patient is a 34 yr. old male whose height is 66 inches and weights 145 lbs. This patient was previously diagnosed with OSA 7/24/10. The RDI for that study was 17.1 / hr with an oxygen desaturation nadir of 90%.

Interpretation
The total recording time for this BiPAP titration polysomnogram was 506 minutes and the total sleep time was 432 minutes. Mean oxygen saturation was 97% during REM and 96% during NREM with a 89% nadir. At a pressure of 16/9 cm H2O this patient’s AHI was 3.5/hr.

Respiratory Data
Total # of Respiratory Events: 29
Obstructive Apneas: 0
Mixed Apneas: 0
Central Apneas: 12
Onstructive Hypopneas: 17
Apnea Index: 1.7
RERAs: 38
Max Duration (sec): 50
RDI: 9.3
REM RDI: 4.2
NREM RDI: 13.7
RDI Supine: 14.4
RDI Left: 2.8
RDI Right: 4.5
Mean Duration (sec): 27

Oximetery Data
Mean Basal Saturation: 97
Desaturation Nadir: 89
Average SaO2 REM: 97
Average SaO2 NREM: 96

Arousal Data
(weird squiggly symbol) Arousal total: 216
Total number of WK or MVT episodes: 18
Arousal Index: 36.8 /h (sleep)

Just a bump to see if anyone can translate that report, thanks.

The AHI of 3.5 appears to be a big improvement. However, the centrals are something to ask your sleep doctor about.

You might want to chew out the jerks at the DME for hiding your efficacy data. If they did that to me, I would either call or visit and tell them "NEVER DO THAT AGAIN BECAUSE I INTEND TO TAKE CHARGE AND BE VERY PROACTIVE ABOUT MY MEDICAL CONDITION."

You said that you had trouble with installing Encore Pro 2. Maybe you should try Encore Viewer 2. Unfortunately, you have to buy it. It is $99 from cpap.com.

Encore Viewer 2 does not show the wave forms but it does give all the detailed data other than that. I used Encore Viewer 1 (had an M Series machine then) with Windows Vista 32 bit - no problem. I now use Encore Viewer 2 with Windows 7 Home Premium 32 bit, since I got my System One machine and it works fine.

I did not have Encore Viewer 2 with my Windows Vista 32 bit but I expect it would work.

Maybe someone can confirm that before you spend the money since I am not very computer literate.

I tried to install Encore Pro 2.4 but my machine would not install the SQL server thing. Encore Viewer 2 does not use the SQL Server. Just like with Encore Pro 2, any memory card reader will work with Encore Viewer 2.

Just a thought.

Mask2sleep wrote:Encore Pro 2 won't install on the wife's machine, it says it isn' compatable, I guess because she has a windows 7 machine. I still can't get it to load on mine either, as far as it will ever get is telling me my computer has to restart to continue the install, and then after the restart it comes up and says it again. Humph. So no encore for me for now it seems.

Odd I have windows 7 and it installed and worked fine for me.. I haven't been able to watch the video that teaches you how to run the softwear to get the readouts though as the site works for about 5 minutes then the sound dies, and wont come back but windows 7 handled my encore pro 2 just fine.. wonder if its something else???

What link did you use to get Encore Pro 2? Is your Windows 7 32 bit or 64 bit?

Thanks

Mask2sleep wrote:... Just a bump to see if anyone can translate that report, thanks. ...

I will take a stab at it.

Mask2sleep wrote:... I've got a copy of the sleep report. Could anyone add some insight? I have an appointment with the sleep doc next Thursday. Given this data, what should I be asking the guy, should I be asking for a different type of treatment? Oxygen? It seems I have a lot of centrals. There's a itty bitty paper copy of the oximetry evolution too, and as far as I can tell, I desat to somewhere between 89 - 93ish 23 times over 432 minutes, roughly a quarter occured at 16/9. ...

Mask2sleep wrote:... History
This patient is a 34 yr. old male whose height is 66 inches and weights 145 lbs. This patient was previously diagnosed with OSA 7/24/10. The RDI for that study was 17.1 / hr with an oxygen desaturation nadir of 90%. ...

This provides the background. I was diagnosed a year or so before your current age, though I was already severe at the time. You appear to be ideal height, so don't panic about trying to loose weight.

By the way, you DO want to keep up the therapy. I know it's a nuisance. But ongoing, uncontrolled sleep apnea will lead to weight gain, type 2 diabetes, uncontrolled high blood pressure, heart attacks and strokes. None of which is good for your family.

Mask2sleep wrote:... Interpretation
The total recording time for this BiPAP titration polysomnogram was 506 minutes and the total sleep time was 432 minutes. Mean oxygen saturation was 97% during REM and 96% during NREM with a 89% nadir. At a pressure of 16/9 cm H2O this patient’s AHI was 3.5/hr. ...

They note the amount of time you slept. That's important to tell if the results are valid. They want to see one to two cycles through REM sleep, since that is a time when most people have more apneas. Why? When we reach REM sleep, our muscles normally go lax. This lack of muscle tone is normal, but tends to make the obstructive apneas worse.

You had one point when your blood oxygen level reached 89%, but the average was 97% during REM sleep and 96% during the remainder of your sleep. Both are good values and indicate th therapy makes a huge difference.

They note that at a BiLevel pressure of 16 (inhalation) and 9 (exhalation) you had only 3.5 apneas & hypopneas per hour. Your sleep doctor may prescribe a lower pressure or a pressure range (if he moves you to an auto-titrating BiLevel machine). It depends on your and how your have been doing (as well as your doctors' experience with auto-titrating machines).

Mask2sleep wrote:... Respiratory Data
Total # of Respiratory Events: 29
Obstructive Apneas: 0
Mixed Apneas: 0
Central Apneas: 12
Onstructive Hypopneas: 17
Apnea Index: 1.7
RERAs: 38
Max Duration (sec): 50
RDI: 9.3
REM RDI: 4.2
NREM RDI: 13.7
RDI Supine: 14.4
RDI Left: 2.8
RDI Right: 4.5
Mean Duration (sec): 27 ...

During the recording time, you had 27 respiratory events. These are items such as apneas and hypopneas .

Of those, 12 were Central Apneas. Essentially for some reason you did not even try to breathe during those events. There was no obstructions. You did have 17 obstructive hypopneas. That is 17 times during the sudy your airway restricted enough to decrease the flow of air. Not a full obstruction, but you had to put some extra effort into breathing.

Now it's my turn to ask a question. Did you have a sleep study without a mask? If so, did you have central apneas then? The reason I ask is that if you did not have central apneas then, but have them now, it could indicate that the increased pressure of xPAP (Positive Airway Pressure) therapy is triggering the central apneas. You will want to discuss that with your sleep doctor.

You might also want to ask if oxygen might help eliminate the central apneas. This can often help reduce the central apneas. However, please note that for some people, use of xPAP therapy helps eliminate the central apneas. However, sometimes it takes a much more advanced machine (an auto servo-ventilator or ASV) to help eliminate the central apneas.

A little bit of background here. Clearly if you stop breathing because the airway is blocked, the added pressure helps break that cycle. However, with a central apnea the basic issue is that for whatever reason as you are breathing your body fails to sense the correct amount of CO2 building up in your body. This is the undershoot stage of the cycle. When your body does finally recognize the problem it tends to overshoot. That is you breathe deeper and faster than is normally needed. You blow off too much CO2 and the cycle starts over again. Over the long term this can lead to periodic breathing. It can lead to severe central apneas. And of course this places a horrible strain on your cardiovascular system. Trust me, on this one I *know* from hard experience.

You might also want to ask your doctor when the AHI was 3.5, how much of that 3.5 was due to central apneas.

Please understand that SOME central apneas are perfectly normal. I don't want to scare you. When we toss and turn at night, we often hold our breath for a short while. When we transition to sleep, we often have central apneas. Those events should not have been counted in these central apneas. And 12 over 432 minutes is not all that high. 432 minutes is 7.2 hours. 12 central apneas over 7 hours is 1.7 per hour. That is WAY below the number that would require a major intervention, such as an ASV machine. Essentially, if your AHI remains above 5 and most of that is central apneas, then doctors will address it. 5 or lower is considered normal.

However, if you remain tired after you start this therapy, you might want to look into the arousals (more after that section).

Please remember, my thoughts here are only based on my experience, which is quite unusual, since I suffer from severe central apneas and it is not heart related.

Mask2sleep wrote:... Oximetery Data
Mean Basal Saturation: 97
Desaturation Nadir: 89
Average SaO2 REM: 97
Average SaO2 NREM: 96 ...

This means that most of the time your blood oxygen levels were high (and by inference the CO2 levels were low). A low of 89 every now and then is not a problem, as long as the average is well above 90 percent.

Mask2sleep wrote:... Arousal Data
(weird squiggly symbol) Arousal total: 216
Total number of WK or MVT episodes: 18
Arousal Index: 36.8 /h (sleep) ...

Arousal is when we have an alpha intrusion for several seconds during normal sleep. Essentially part of your brain is trying to awaken - at least enough to handle some event. You might have heard a sound. You might find sleep in a position painful. You often move from a deeper level of sleep to a lighter level of sleep. It disrupts your normal sleep.

The weird squiggly line (~) means "approximately". These arousals can sometimes be inexact.

By the way 216 arousals during 432 minutes means that (on average) you had an arousal every two minutes. These might be clustered.

I am not sure what "WK or MVT episodes" indicates. I suspect it means "wake or movement episodes". You might want to ask your doctor about that.

If it does mean that, they might be noting that of the 216 events, only 18 (less than 1 tenth) could be attributed to normal issues. Since you did not have obstructions they probably did not include arousals due to respiratory distrubances (apneas or hypopneas).

I assume the rest of these arousals were spontaneous - that is there was no clear reason why you had the arousal. You might want to ask if these arousals disturbed your normal sleep. Did they tend to make you move from a deeper level of sleep to a lighter level?

You might want to see if there is any medications, such as the generic of Remeron that can help increase your sleep.

It's not too bad. It seems to indicate the BiPAP helps. Again, I do not know if you had obstructive apneas without the xPAP therapy. I do know (from my own experience) that those spontaneous arousals can make you REALLY tired the following morning.

And as I note, I am not, and do not pretend to be a medical professional. I just offer information I've gathered as I went through a similar journey. I've used xPAP for almost the past 20 years. Due to my central apneas, I had to learn a LOT more than normal. My hope is that by arming you with more information you will be better able to get effective therapy faster than I did.

Hope all this helps and makes sense.

Hawthorne wrote:What link did you use to get Encore Pro 2? Is your Windows 7 32 bit or 64 bit?

Thanks

Find Uncle Bob Hawthorne... check his signature

Thanks for the great replies.

Maybe I got an older copy of the software and that is what is causing the issue? My wife’s computer is windows 7 32 bit. Mine is windows vista 32 bit. It may be easier just to get a resmed machine and get their software instead of trying to get this to work. 

John,
Great job at translating that, thank you.

In response –

No worries, I’ll keep at the therapy, I just want it to start working! My father has it as well, straight CPAP though, and he is overweight.
The sent and SD card to me which changed the settings to the 16 / 9, which I have had it at since Tuesday night. I failed to mention that I knew how to change the pressure myself… they look down on that sort of thing so what they don’t know won’t kill them. I haven’t messed with it anyways, but I am the sort of fellow who wants the option.

The study without the mask had little to no centrals, so it is the PAP which is causing them, my luck. It’s the centrals that worry me most too.

Good idea, I’ll ask him about the 3.5 evaluation and what it was composed of.

I’ll ask about the arousals too, thank you for the suggestion.

The 7 day average data on my machine is worrying. I’ve used it 4 nights… Tuesday, Wednesday, Thursday, and Friday, so I realize it will be a bit skewed since there are 3 other nights in there, but here’s what it says today:

Large Leak: 0.0%
AHI: 46.5
Periodic Breathing: 20%

The AHI number is way too high, but the periodic breathing number is super high and worrisome. Maybe my machine is busted? If that is close to right, I have “period breathing” 20% of the time I’m asleep? As I recall, periodic breathing are basically centrals. I live basically at sea level, so it isn’t an altitude thing. Should I push for adding oxygen or the like or a different machine? I know their response is going to be that in the lab I was fine, but those numbers, averages though they are and assuming they remain consistent after 7 days, seems indicate things aren’t going quite well at home.