CPAP Metrics - Vibratory Snore

I am a long time CPAP user, and just visited my sleep doctor, and we reviewed my results off my CPAP via the Encore Pro 2 software. I was puzzled by the vibratory snore index moving from from 2.3 to now 243. My Doctor states he does not look at that an the critical metrics such as AHI are well in normal limits and I am doing fine. He states that maybe I should try some new masks, and see if that does not reduce the number.

Should I be worried? What is Vibratory Snore Index and dose it matter? How can reduce the number?

Here is the rest of my data in 6 month blocks:

1H 2010 2H 2010 1H 2011 2H 2011
Compliance 100% 100% 100% 100%
Pressure 14 14 15 15
Periodic Breathing 0.20 0.30 0.30 0.30
Clear Airway Apnea Index 0.10 0.60 0.30 0.30
Obstructed Apnea Index 0.40 0.90 0.80 1.00
Hypopnea Index 1.40 0.80 0.60 0.70
RERA Index 0.50 0.50 0.40 0.50
Average AHI 1.90 2.30 1.70 2.00
Flow Limitation 0.00 0.00 0.00 0.00
Vibaratory Snore Index 2.30 19.20 106.80 243.90
Average % in Large Leak 2.00 0.80 0.00 1.40
Average Large Leak Mins 5:16 3:47 0:14 6:55


Thanks, Bear 100

Bear,
Howdy. I'm just firing off the first thing that came to mind.

Could those numbers reflect something other then snoring...specifically a little but of mouth leaking causing some lip buzzing or mouth farts

Your leak numbers are pretty good though, so that might not be the case.
Jamis

Could be? But would not some other number be reflected?

I use a chinstrap, denture cream to seal my lips and other custom strap over my mouth. I am by nature a mouth breather and the full face masks leaked too much for me. Thus my home made solution, which totally prevents leakage around the mouth.

I am trying the REMZzzs mask liners that others have suggested to improve and avoid any mask farts. My Doctor also suggested I experiment dropping pressure from 15 down to 13 (which is supported by my recent sleep study).

Bear 100

Bear100,

Have you got a bed partner? If so, ask him/her about whether the snores are real or not.

The System One does seem to be pretty sensitive to nonsnoring noises getting flagged as snores. But that may or may not be the case here.

It's interesting that the VSI numbers skyrocketed between 2H 2010 and 1H 2011. Anything change in your sleeping environment around then?

Are your VSI numbers in the 100's on most nights? Or is it hit or miss?

Do you feel like you're waking yourself up with snores? If you have a bed partner, is s/he waking up because of your snoring? Because if you are, then the obvious answer to "Are they a problem?" is YES.

But if you're feeling fine and sleeping fine and your bed partner has no complaints about your snoring, then you can leave well enough alone and not worry about this issue.

Great set of questions:
- My wife hates the CPAP, so we now, unfortunately have different rooms.
- The Vibratory Snore Index does vary, in the 4 months it has been been below 80 and as high as 627, for average of 243. I checked some of my other numbers such as RERA or AHI also go up and down, but in very tight ranges and none seem to be in pattern with any other including vibratory snore.
- I did narrow down the start of the increase of vibratory snore, it was roughly (within a week or so) of a new mask, hose, strap etc. (exact same models as the old one). Will get another set ASAP.

Bear 100

Maybe it's just me, but if your nightly numbers are good (minus the Snore Index), and you FEEL good, than I'm not sure that I would be too concerned.

On the other hand though if you can link it to the new stuff, I might investigate that.

Wow... your wife is in a different room now? That's sad. What about the device didn't she like? Too quiet without you snoring?

Bear100 wrote: Could be? But would not some other number be reflected?

Perhaps not. Air leaks that create sound indicate that it's sneaking through under pressure and might be little enough air volume to not reflect on your leak numbers. Though your preventative measures sound pretty thorough. It'll be interesting to see what the pressure drop does.

Ask the wife if she could peak in on you during the night to see if you're snoring or if it's something else.
Jamis

The Doctor had the same feeling, the other numbers are good. Vibratory Snore is a metric that is not consider medical but something the the CPAP machines have been doing. Thus no big worries. Try new mask etc. see what happens. I would just feel better to make sure all my numbers are low.

My wife dislikes the sound, but more importantly I think she hates seeing her husband all strapped in an hooked to a machine.

I will try to get her in to check. I will also get the new equipment ordered ASAP.

Bear 100

Maybe you should pull the Dennis Hopper routine from Blue Velvet with your wife.

http://www.youtube.com/watch?v=5_5sQyHnbY4

Perrybucsdad wrote: Maybe you should pull the Dennis Hopper routine from Blue Velvet with your wife.

Wouldn't work, his lips are glued shut with denture cream...
J

I have a question: What kind of HOSE are you using? Is it by chance the Performance hose from Phillips Respironics? If so, this could be part of the issue.

I had the same problem with my VS Index going through the roof. Finally figured out the flimsy plastic that this hose is made of must be making a little more noise than the standard hose. When I swap back to the standard hose, my numbers go back down to 40-60. It's nothing to be concerned about if this is the case...... just a noisy hose... lol

Please let me know if you can confirm this..... I'd like to know if I'm the only one....


Jeff

Wow, I never considered the hose. I have seen some hoses to be more flimsy than others. The different DMEs just bring in different ones, as they are not specified by the Doctor. Just figured the more flexible ones would not last as long, never figured on they would have any impact on the machine.

I am getting everything new (mask, headgear, chinstrap, hose, filters) and will replace one item at a time. Let you know then.

Bear 100

I'm thinking the VS number is about vibrations picked up from hose vibrations for whatever reason. Could be snoring, could be friction caused by moving around during sleep and picked up from hose movement. For me, VS numbers haven't correlated to a good/bad night's sleep.

I use the Performance hose. It is the same hose I have used for over 2 years now. I occasionally will have a few snores but nothing on the magnitude you are reporting. I might buy part of the VS being hose noise but I am not sure I would put all the blame on it but I have no proof either way.

My husband has reported that he sometimes hears me snore ever so lightly (not earth shattering like I did) and when I look at the reports I see a slight increase in snores from my norm. I won't even have any leaks worth noting.

If you don't have any flow limitations or events with the snores.....then maybe unimportant.
One of these days I am going to try to experiment with hose noise and see if I can create some "snores" with the hose. It is next on my "to do" list.

Pugsy wrote: If you don't have any flow limitations or events with the snores.....then maybe unimportant.
One of these days I am going to try to experiment with hose noise and see if I can create some "snores" with the hose. It is next on my "to do" list.

Bear's profile shows he's using a System One Pro. Since he can't run in Auto mode, he won't get any Flow Limitation tick marks recorded in his daily event table or on top of the waveform data since the PR machines records the FL tick marks only if they're running in Auto for some reason. For reasons that I cannot understand, PR has made the unintelligent choice to report this intentionally missing FL data on the events table with a nice empty line and reports the FLI = 0.0 night after night after night when the machine is in CPAP mode. Which easily leads a user to believe that there cannot possibly be a FL problem: I was literally shocked when my PA switched me from straight BiPAP mode to BiPAP Auto last March and all of a sudden FL ticks started popping up in my nightly data.

Likewise, none of the VS ticks will show up as overlays on the wave form data since the System Ones record those ticks only when running in Auto mode.