Recommendations

NightMonkey wrote:... You also need to post the graph of your leak line.

What was your diagnosis? AHI? Central apneas? Oxygen desaturations? Any comorbidities?

Did you have a titration study? What was the single pressure that best treated your breathing?

With settings of 4 to 16, I suspect you did not have an in-lab titration study and the doc is going to use the data being collected now to set a final narrow range of pressure. Is this the intention? You need to know this. Otherwise a setting of 4 to 16 would only make sense for someone whose apnea was controlled by a pressure of around 4 to 7 cm.

NightMonkey:

SleepyJohn wrote:DreamDiver - you are correct in thinking I never had any titration. The tech brought the machine and just set it up, presumably to the script that the sleep doc had written. Nothing more was said except see you in 3 months!

10 might be too high, considering his AHI tends to be higher at that pressure than at other lower pressures.
I agree, a full-night condensed graph leak line would be nice for the night shown in the original post.

"See you in three months..." I feel like chewing out your doctor, SleepyJohn.

DreamDiver wrote:
10 might be too high, considering his AHI tends to be higher at that pressure than at other lower pressures.
ee montI agree, a full-night condensed graph leak line would be nice for the night shown in the original post.

The problem with that analysis is it is unknown when John was sleeping and when he was awake. The pressure points where the lowest AHIs are shown could have occurred when he was awake. With the number of events John is having and the big pressure swings it is very likely he was awake much of the night.

Unless they saw a tendency to central apneas in a lab study, I would take that min pressure to 10 cm tonight. We can see in John's Summary of Daily Events and the detailed line graph that his pressure is hitting 10, 12, and 13. I don't think a minimum below 10 is going to control his events well.

I titrated myself by setting the minimum high enough to get rid of almost all events. That immediately gave me more energy and more resolve. Then I dropped the pressure one cm per night until events started showing up again. Then the next night I bumped it back up one cm. This got me titrated to optimal pressure in less than a week and I was very happy about it.

You and John can suit yourself, but I see no reason to dilly-dally around with lower pressures that are not effective. When I found out there was a treatment for my fatigue and brain fog, I said, "Let's do it now!" and then I did.

SleepyJohn wrote: Have you tried JediMark's Sleepyhead application? It is excellent running in Ubuntu and allows you to zoom in the waveform to small timeperiods, i havent yet tried the windows version.

Can you provide a link? And does it run under anything *other* than Ubuntu linux?

EncorePro waveform output seems to be only .pdf. Is the raw waveform available in any other format in Encore?

Near as I can tell from reading the EncoreViewer and EncorePro documentation, all saved *reports* are in PDF. And you can't "save" anything except as a *report*. But somehow EncoreViewer and EncorePro do save the database stuff *somewhere* in *some format* because once you download the data, it stays put even if you don't click "save" anywhere before quitting the program.

RobySue - SleepyHead app details viewtopic.php?f=1&t=61805&p=578840&hili ... ad#p578840. I haven't tried the windows version yet but the ubuntu version does nice graphs. Here's the pressure and leak ones as NightMonkey suggested:



NightMonkey - I managed to talk to the technician at the hospital that diagnosed me, and I have uploaded my SD card data to her just now, so should get her take on the situation tomorrow, but your suggestions are very helpful and i will do a self titration if things don't improve. My diagnosis was "mild/moderate sleep apnea". I heard the tech say i had o2 desaturations. AHI was i think 9. I have had episodes of Afib on waking (middle of night or early morning). They seem to occur after apneas. Otherwise health is not too bad. I also have pectus excavatum, if that has any bearing on things.

DreamDiver - yes, chewing would be good but they keep changing faces. I am lucky here to get the machine through the public health system (no private health insurance, self-employed, only paid stringent taxes for 40 years ), so have to box clever as they say.

Trying to decipher Respironics summary graph numbers will cause a person to become cross eyed and crazy.

My thoughts... Minimum pressure is too low to deal with events. Takes too long to get to where it needs to fight.
I see centrals. Gotta be watching them.

If this were my report I would raise the minimum to 7 and leave max alone for the time being. See what happens. If the pressure increases are disruptive to sleep, then maybe tighten the range. It may not be as disruptive going from 7 to 10 than 4 to 10.
Machine won't go up without a reason. Now sometimes the reason is good (battle events) sometimes reason is not good (fighting leaks). Gotta watch which battle it is fighting. Leaks are important.

It is good to keep your options open. But that minimum of 4 is just too far away from where the events are that it can't get there fast enough to do battle.

SleepyJohn wrote:RobySue - SleepyHead app details viewtopic.php?f=1&t=61805&p=578840&hili ... ad#p578840. I haven't tried the windows version yet but the ubuntu version does nice graphs. Here's the pressure and leak ones as NightMonkey suggested:

[image]

NightMonkey - I managed to talk to the technician at the hospital that diagnosed me, and I have uploaded my SD card data to her just now, so should get her take on the situation tomorrow, but your suggestions are very helpful and i will do a self titration if things don't improve. My diagnosis was "mild/moderate sleep apnea". I heard the tech say i had o2 desaturations. AHI was i think 9. I have had episodes of Afib on waking (middle of night or early morning). They seem to occur after apneas. Otherwise health is not too bad. I also have pectus excavatum, if that has any bearing on things.

DreamDiver - yes, chewing would be good but they keep changing faces. I am lucky here to get the machine through the public health system (no private health insurance, self-employed, only paid stringent taxes for 40 years ), so have to box clever as they say.

I'll be interested in hearing what the tech suggests. Thanks for the leak rate. That looks covered. Nightmonkey and I aren't doctors, but I have to agree with him. If this were my machine I'd crank it up to 10 for the minimum pressure, but I was pretty aggressive with changing my machine settings for my latest at first, as was NightMonkey. I'd also lower the max to 12, or maybe even lower. I don't know how extreme Pectus Excavatum would have to be to affect cpap therapy. Hopefully, Afib would benefit from a narrower therapy range with a higher minimum. I'm glad you talked with your tech.

The 90% mark is supposed to be an indicator of where to put the minimum pressure, right? I'm curious how a 90% pressure of 9.9 cm is derived from that mess of numbers. Robysue, can you shed some light?

Encore Pro data are all saved on a MSSQL database that is set up as a service. This means the database is up and running even when Encore Pro is off, unless you use the systray function that can turn it off too.

DreamDiver wrote:The 90% mark is supposed to be an indicator of where to put the minimum pressure, right?

No. It is simply the number where 90 % of the time a person has been at that pressure OR below. The remaining 10 % is of course above that pressure. It's just a number that doesn't always tell us the whole story, even though we might think it does.

Sometimes this 90% number will be close to what someone might need as pressure but it isn't always a "given" that is where the minimum should be or if cpap were used, where it would need to be set at.

Example. Me. I use 10 to 20 range. Most of the time my 90% number will be 11 or 12 BUT on occasions I have seen 90% pressures 15 to 18 and it wasn't because of leaks. It was because I had some super duper events that needed super pressure to deal with. I don't have them all the time though. Even if I were using straight CPAP I would probably use 10 cm because this is where I have the best overall results with breaking up any clusters. At 9 cm minimum I start seeing the clusters. I sure would not want to use straight 15 pressure or set minimum to 15 just to get those super duper events that occasionally show up.

90 % makes a good guide but it doesn't always show the whole story and it isn't an automatic setting point.

DreamDiver wrote:

Nightmonkey and I aren't doctors, but I have to agree with him. If this were my machine I'd crank it up to 10 for the minimum pressure, but I was pretty aggressive with changing my machine settings for my latest at first, as was NightMonkey.

About setting the maximum, at the suggestion of a forum member I leave my max wide open - 20 cm. My min is 9 and the pressure rarely goes above 10.5. If something should go badly wrong, hopefully the pressure would ramp up toward 20 and awaken me. I see no reason to cap the max down close to the min. Just my strategy, YMMV.

DreamDiver wrote: The 90% mark is supposed to be an indicator of where to put the minimum pressure, right? I'm curious how a 90% pressure of 9.9 cm is derived from that mess of numbers. Robysue, can you shed some light?

I think patients would be better off if that statistic had never been devised. Maybe it it for lazy doctors to have something to write on the prescription. 90% pressure means the machine ran at that pressure or lower for 90% of the time the machine was used. The doctor may be satisfied to prescribe that pressure for a patient, but for me it is a summary number that is not useful.

For my buck, the only way to titrate is to look at the daily details report and get the events pushed down to an optimal level.

DreamDiver wrote:Nightmonkey and I aren't doctors

How do you know I am not a doctor?

NightMonkey wrote:I think patients would be better off if that statistic had never been devised.

I was just thinking the same thing. People tend to make more of it than it is really meant to be. It's just a number and not the "perfect" setting because any number or average or percentile figure can easily be skewered from outside forces.

Well, the MOST sleep time was spent at 6 cms so .... w/an AHI of 6.5 at that pressure I'd be inclined to set my lower pressure setting at 6 cms and I'd be inclined to set my upper pressure setting at 13, maybe even 12.

Usually when titrating a bi-level they come up w/a range of 4 cms to 5 cms as the difference between IPAP and EPAP setting. Assuming (and maybe I am wrong to do so) that that 4-5 cms difference is the most comfortable for most people I'm thinking that might well hold true w/for an APAP range plus 1 cm on each side of the range for a range of 6-7 cms between the APAP's upper and lower ranges.

But heck, what do I know? I'm just a patient too. And I tend to be conservative. And I was slow to accept just how much leak can affect data. My sleep "professionals" (doctor and RRT) kept insisting how well today's PAPs can compensate for leaks whenever I would try to ask them about my leak rate due to advice from forum members (tho I never told them where the advice came from).

Sleepyjohn- that looks like Cheyne Stokes to me -coincidentally my RT was by the other day and had just been to an inservice on a new machine and drew a picture of Cheyne Stokes respirations. He told me about the new machine he tested, this machine is an entirely a different animal than we have seen before. It's not like a ventilator with a back up rate. When it senses your respirations starting to wane it kicks in until your rate goes back up. Of course, they are very expensive. I think he caused it an ASV and it specific for Cheyne Stokes Respirations. Once again this is not the same as any machine on the market today that we are familiar with.

Slinky wrote:Well, the MOST sleep time was spent at 6 cms so .... w/an AHI of 6.5 at that pressure I'd be inclined to set my lower pressure setting at 6 cms and I'd be inclined to set my upper pressure setting at 13, maybe even 12.

How do you know John was asleep at 6 cm? Do you have a secret copy of his EEG?

Hey, many thanks everyone for your time and advice.

I will post the tech nurse's recommendations when i get them, hopefully tomorrow, and see also what she says about the periodic breathing, which i mentioned to her.

She said that the graphs have to be read manually to confirm what the machine identifies (apneas - what type, periodic breathing etc.) and so it will be interesting to see what she makes of it all.

It feels good to find people like yourselves who will help out a stranger.
Here are 2 photos from this area showing both sides of our wild weather, Happy Sleeping

SleepyJohn wrote:Here are 2 photos from this area showing both sides of our wild weather,

Both are beautiful. Thank you for sharing.

Good point, NightMonkey. Assuming CAN get one in trouble. But since SleepyJohn has A fib .... I'm sure glad he's in touch w/his tech and will be getting an answer from the tech!

Whew! Beautiful pictures, SleepyJohn. Thank you for sharing them.