Auto Data Interpetation

GoofyUT wrote:You make another really thought-provoking point. Market forces SHOULD be in play, and it is within our grasp to make that happen.

I like the thought, Chuck. How do we bring market forces to bear in some meaningful way? The only answer I can think of is the one that gets applied here on a 24/7 basis. As you and I both know though, it works only on the DME end of the problem, not the individual physician, which it seems to me, is the root problem.

Regards,
Bill

GoofyUT wrote:RG-
I by and large agree wholeheartedly with you, though as a clinician myself, I am curious about what goes on during various times during the night.

I'm no clinician of any kind, nor anything in the health care field. But I'm a VERY curious, wanna-know all the details person...especially when it comes to a treatment I'm using on myself. So, yeah, I do want software. However, having used the Autoscan software with several ResMed machines, I just didn't find that particular software to be as helpful as the other brands of machines' software. Not "more helpful enough" than the efficacy data in the LCD to make it worth buying Autoscan...not to me, anyway.

GoofyUT wrote:in terms of understanding the direct effect of various pressures on various events, it would take the detail data in the time domain to reveal that. Or, am I wrong about this?

Dunno. I do know that the way Autoscan displays hypopnea info on its graph was next to useless for me to look at. Example... when you have one hypopnea, Autoscan draws a blue line horizontally all the way across from the time the one hypopnea begins, until the end of that hour...even if the hypopnea lasted only a minute and was the only hypopnea that happened in that hour. Makes it look like you had an hour-long hypopneic situation. From the graph, you can't tell if you had one hypopnea or a string of them in any given hour. So....if a person wants detailed data in a time domain, I don't believe the Autoscan chart would be what they're looking for.

That chart was the most useless of any of the machine software charts I've looked at. But...that may be just a matter of the way I like to see info displayed. Someone else might like it fine.

GoofyUT wrote: I am curious as well about my sleep architecture, though I know that the S8 won't be able to tell me that.

Yeah, would be nice to see that kind of thing. You're right...no autopap, cpap, bipap, can show us that. And I don't guess they're gonna make an EEG add-on for these machines any time soon.

rested gal wrote:

GoofyUT wrote:
Rastaman, I'm a big believer now in looking at other possible health issues if an autopap frequently has to use whatever maximum pressure a person sets for the top AND the AHI is not coming down below 5. I'd be looking for possible untreated or undertreated acid reflux disease. If throat tissue and/or vocal cords are being bathed in acid during the night, there will be swelling and rigidity of tissue that air pressure can't push aside. That might not be the case for you at all, but it's something to consider.

The following threads are about a person (loonlvr) using a REMstar Auto, but would apply to any autopap if GERD is an issue:

viewtopic.php?t=1800
Mar 10, 2005 subject: What is the REMStar Auto really doing?

viewtopic.php?t=1914
Mar 18, 2005 subject: What's REMStar Auto Really Doing? - new thread

viewtopic.php?t=5551
Nov 05, 2005 subject: SUCCESS AT LAST-GERD,420E, PRILOSEC AND BENADRYL

Well, it does seem to be going down. I do take Nexium for acid reflux actually. I just started it. Before that It was Prilosec OTC, and before that it was Prilosec prescribed by my doc until OTC came out and they started denying it, I've also take Ranaditine prior to that. Nexium seems to be working very well.

Beyond that, and it could very well be that, are these numbers per HOUR or per night? Am I having 7.5 an hour? Compared to 124 per hour, and that's why I'm guessing it's per hour, that's much much much better, steller in fact, but not below normal ranges.

In order for my insurance to cover Nexium I had to go through our mail order company.

I need to make an appointment to discuss my sleep results with my regular doctor. And I need to call him and discuss my last physical results because I still haven't heard from him on any of that.

rested gal wrote:

Rastaman wrote:I was able to download the data to the card successfully

Now, I just need to decide if that reader and software is worth it. For now, it doesn't seem necessary. What do you think?

Nope, I don't think the Autoscan software is something that would add enough to what you already can see in the Efficacy data on your ResMed machine to be worth buying that software.

Just find someone (perhaps on the message board) who can read and printout the card's data for you, if your doctor or DME can't. One printout of several days worth of data from the card will let you see the only thing of interest (imho) that you can't already see through the machine's window....how much time the machine is spending up at your maximum pressure setting...in the pressure graph.

Other than that, you're getting all the juicy info you need, in the Efficacy data displayed on the machine itself.

Probably not necessary to run it by anyone else. I guess I'll just worry about it if the sleep doc or insurance company needs it. At this point I doubt it.

Thanks a bunch!

Got a question for you though. We have no idea if 13 on the Remstar Plus M series was working or not because we have no data to go by. We know the sleep doc or the tech or someone picked 13 as my number though. Was it enough? I then try a different manufacturer, so I'm no longer comparing apples to oranges anymore, and now the fluctuation of 8 to 17 sounded good to them. Fine. Who knows if this is better? Me? I feel much better than I did previously without CPAP ofcourse but today I can't detect if I felt better on the straight CPAP vs the APAP. I guess time will tell. This is one of those hard to know type situations. I mean if 13 was better for me overall, then this unit has straight cpap built-in, so either way I can pick the correct option.

No one seems to be very sure if their apap was superior to their cpap here. Some studies indicate that certain aspects can be better with apap but again, some doctors disagree. So I'm left wondering. If one knows they're getting the best possible therapy, they can relax and accept that the therapy couldn't be any better than this.


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Rastaman wrote:are these numbers per HOUR or per night? Am I having 7.5 an hour? Compared to 124 per hour, and that's why I'm guessing it's per hour, that's much much much better, steller in fact, but not below normal ranges.

The numbers are averaged out -- per hour. In a single night, you could be having no events at all during some hours, and quite a few events during, say, just two hours... perhaps during your second hour of sleep and during your sixth hour of sleep.

The events (apneas and hypopneas) are added together. That total is divided by the number of hours you were asleep. That's your AHI (apnea/hypopnea index.) It's an average per hour.

Yes, indeed...considering what you started with at the diagnostic part of your sleep study, an AHI of 7.5 on cpap treatment means you're doing absolutely great, Rastaman!! Bet you're feeling a whole lot better.

Let's just say by this time at night I would've been falling asleep at the computer. Now, I'm just thinking about going to bed because I know I'll feel better in the morning I hope the numbers continue to drop.

I'm keeping a daily log. And even know my Swift Mirage Nasal Pillows sometimes hurt my nose cartilidge the overall benefit of this mask is pretty nice. It's lightweight and easy to take apart and put back together. I watched the video for the activa and thought the Swift is so much easier to take apart and put back together.

That being said I wouldn't mind trying another mask in say 6 months since that's what my insurance allows for. In the meantime I can change out my pillows 2 a month which I think is very good, IF I need them. I just started using my mediums after using smalls for awhile so that should last awhile.

I made the changes to 8.5-13 pressure and got the following after 3 nights:

90% pressure was in the 11.5-12.4 range with 2 nights as 12.4.
Max Mask leakage dropped each day to end at 105.
Avg Mask leak stable at about 40 for all 3 nights.
Snore index dropped dramatically to 5 at 8.5cm down to 1 at 12-13cm.
Flow limitation index is under 1.
Dependence of Apnea/Hypopnea on pressure improved but there seems to be some anomalies: AHI at 4-6 for pressure of 9-12. At 13 AHI went to 14, OAI to 13.5, and HI to 2.

The above looks like I need to set the machine for 8.5 to 14 and try that for a few nights to see what happens.

What do you think?

Pat

Hi Pat,
Something I missed in your first post, and is relevant here too:

In a nightly auto report AHI per pressure can very misleading, espescially when you spend little time at those pressure. What you see as anomalies, are actually results of mathematical facts, nothing to do with the effieciency of your therapy.

Example:
Suppose you spend 1/2 an hour during the night at a pressure of 14. The machine bumped you to 14 because during that whole night, you had two apneas that needed that pressure to solve them. 3 apnea in 1/2 an hour would give you an average of 6 an hour for the time you spent at 14 - but it's a meaningless number, since it is based on that measely little half hour. ("Index" and "average per hour" mean the same).

That is the reason recommended pressures are based on the percentage of time spent at or below them. In my theoretical example, had you had a pressure of 14 all night long, and slept for 6 hours, those 3 apneas, not avoided by your pressure would result in AI of 3 divided by 6, which would be 0.5

The same is true for the lowest pressures - the less time spent in that pressure, the higher the AHI - for mathematical reasons.

Time spent in apnea at each pressure is far more indicative. As long as the machine is running on auto, I wouldn't even look at the AHI per pressure - because that number is so effected by extremes of time spent in that pressure.

The only way you can user AHI pre pressure to figure out what pressure to use is if you keep you pressure consant for a couple of night, then move to another pressure for a couple of nights, and so forth.

I hope this is clear - if it isn't, bug me till it is.

I can't state this too strongly:
When running a machine in automatic mode, do not base your results on the "AHI at pressure" parameter. It is misleading.

O.

For the first couple of nights on my Autoset Vantage my AHI was 8.4, 7.9, 7.5 but last night it was 17.something. If I'm following your logic, I shouldn't worry. But it just seemed like a high jump to me.

Also, my range is 8 to 17 and the press pressure is 17! I know that's misleading too. I feel pretty good. I'm still wondering about these numbers. Perhaps they really don't mean anything. And I shouldn't worry about it.

Rastaman,
Respironics Encore pro has has a table reporting a separate AHI for each single pressure level during the night. It is those numbers that are - or may be - misleading.

Info about AHI (for the night) and the average pressure for the whole night is different.

If you're describing a change in nightly AHI, I agree with you - it seems like a high jump to me too. I have no experience at all with Autoscan, and can't point you at anything.

I'm glad you're feeling well!

O.

First, my thanks to each of you who tried to guide me in my quest for the right pressure on my APAP. This forum is great!

I set the APAP/CFLEX to 8.5-14.
Snores dropped dramatically to an average of 5/hour. Best ever.
AHI is too high at 8-9, but it came down each of the last three nights.
Most of the other indices were little changed.

I am going to try 3 more nights at 8.5-14 and see if there is more improvement.

It looks like most of my undesireable events occur in the 6th - 7th hour of sleep and I have no idea how to address that problem. Any ideas?

Thanks again. Pat

WOW! REALLY?