input on my EncorePro report please

Goofproof wrote:

Snoredog wrote:

MikeRobert wrote:I guess I am showing my ignorance here. According to a leak rate site that I found on the forum, the vent rate for a Hybrid @ 15cm is 60L/M. Do I have bad info? Or am I misunderstanding it?

No you are correct, that mask has a much higher leak rate than other masks.

And that is why I wouldn't waste my money on it, unless it came with a new Remstar APAP, that had a modified flow rate of twice normal. You can't design a mask leak higher than the pump can handle. that doesn't make sense to me but they still get customers.

So I guess my next question to either Goofproof or Snoredog would be, is using a hybrid with my auto bipap like the proverbial "pissing in the wind", I went to it because of mouth breathing and wanting to get away from taping. I seem to be doing ok with it, although my HI indexs are higher than when I taped, so I seem to be doing what I always thought I was, alot of mouth breathing.
Sorry to drag this away from its original topic.

Hey friend, this is very relevant to the topic. Keep posting.

I'm just too chicken to do the taping thing when my hybrid is so comfortable. I've found the nasal interfaces put pressure on my nose and gums, no matter how good a fit, no matter how loose the straps. I have crowns on top front teeth, and it's just painful for me. The chinstraps are problematic for me, as they cup the chin, and in order to wear snugly, the least bit of pressure on my chin, along the gums, is unacceptable. I've got a skin graft on the lowers in front, which is barely holding its own, and I cannot stand the pain of the chinstrap there, either.

So, if I want to try an different mask, as part of the tweaking process, I will be forced to tape. Of course, at the time I do that, I'll be changing only one variable at a time to see what works. That is a bit down the road I think. Let us know how your experimenting goes.

girlsaylor

I increased my EPAP number in response to y'all's experience in reading the reports, and this morning's AHI was 2.0. Pressures were 15/8.5. I'm taking both my Advair and Prilosec OTC at night as well as in the morning. So the combo of changing pressures and aggressively treating my GERD and lung disease seem to be the answer.

The addition of the nighttime doses of my meds was done a few days ago, and I immediately got AHI numbers between 3.3 and 3.9. I re-read the posts on this thread again and decided to go for a bit of increase on the EPAP pressure last night. Won't make any more changes for several days to see if this pattern holds. Once it is confirmed, we may revisit the pressures once again.

Funny thing was...the board-certified sleep doc/pulmy I had a consult with last week wanted me to ditch the nighttime doses of Advair and Prilosec OTC, even after I told him the return to my nighttime dosages of meds brought my AHI down a full 3.0 points nightly. Go figure.

I am going to expand my geographic range for travel to find a good, knowledgeable sleep doc. Tho this one was a tad better, he wanted me to stop the one thing that made an immediate improvement in my AHI. Now, why would I want to go backwards? Because the meds weren't his idea? Is this an ego thing or what? I am sooooo confused.

I just want to get this working consistently well so that I can get back to spending my time on other things, and just put the mask on at night and go, lol.

I am still using my Hybrid mask, as it's the best fit for me thus far, and most importantly, no dental pain.

I did hit the upper limit of IPAP pressure, 15, two times last night, with the 8.5 EPAP change. Do you folks think this 15/8.5 is good or should we tweak a bit more? Once the pressure is settled, I'll do it with the meds, then withdraw the meds, one at a time, to see if I can maintain the low AHI. (I'm not convinced by the sleep doc, but I can definitely humor him for a few days I guess).

girlsaylor

Did your 15 cm's happen when you had a higher than normal leak? envision a vertical like on the report and see what happened.

Also on the Gerd, You might try raising the head of the bed 2 or 3 incher with wood blocks, couldn't hurt. Jim

I opened my report and viewed again before answering, Goofproof. I cannot see any correlation with leakage and the two short periods of the 15 cm pressure. So I don't know if raising the IPAP any further would help.

Others suggested a higher EPAP setting. As I had it at 8 1/2 last night, I'm thinking in a few days I'll try setting the EPAP to 9 to see if the smaller range allows the machine to clear the apneas easier. Seems from only one night that raising the EPAP from 8 to 8 1/2 was beneficial.

On the Gerd, good suggestion. I live on a sailboat with fixed berths. So my GI doc had me get a wedge to prop myself. It's more like a 7 inch slope. Works well enough, except I find sometimes I slide downhill.

Thanks for the thoughts.

girlsaylor

girlsaylor wrote:I opened my report and viewed again before answering, Goofproof. I cannot see any correlation with leakage and the two short periods of the 15 cm pressure. So I don't know if raising the IPAP any further would help.

Others suggested a higher EPAP setting. As I had it at 8 1/2 last night, I'm thinking in a few days I'll try setting the EPAP to 9 to see if the smaller range allows the machine to clear the apneas easier. Seems from only one night that raising the EPAP from 8 to 8 1/2 was beneficial.

On the Gerd, good suggestion. I live on a sailboat with fixed berths. So my GI doc had me get a wedge to prop myself. It's more like a 7 inch slope. Works well enough, except I find sometimes I slide downhill.

Thanks for the thoughts.

girlsaylor

Something should show when you run that line down your page, OA's, H's, Snores or pressure rise. One of those should have caused the pressure to go high. If you can keep your AHI down and get enough hours, that's Ok.

You may need a bathtub mat on the wedge for friction. That's what's nice about hospital beds, you can have a bend at the legs to keep you from sliding, but then you can't sidesleep, it's always something. Jim

Waves hitting the boat, would be restful, almost as good as rain on a tin roof.

girlsaylor wrote:I opened my report and viewed again before answering, Goofproof. I cannot see any correlation with leakage and the two short periods of the 15 cm pressure. So I don't know if raising the IPAP any further would help.

Others suggested a higher EPAP setting. As I had it at 8 1/2 last night, I'm thinking in a few days I'll try setting the EPAP to 9 to see if the smaller range allows the machine to clear the apneas easier. Seems from only one night that raising the EPAP from 8 to 8 1/2 was beneficial.

On the Gerd, good suggestion. I live on a sailboat with fixed berths. So my GI doc had me get a wedge to prop myself. It's more like a 7 inch slope. Works well enough, except I find sometimes I slide downhill.

Thanks for the thoughts.

girlsaylor

Not going to do you any good if IPAP is already bumping up against the IPAP maximum of 15cm. There is a minimum of 3cm cushion or ball between IPAP and EPAP. When EPAP bumps up against IPAP because it is at its maximum (IPAP cannot increase any more) then EPAP is also limited to going any higher because of the 3cm (minimum) PS cushion. So the EPAP will not be allowed to go higher to address remaining OA events until IPAP is allowed to go higher. Think of the difference between IPAP and EPAP as a 3cm tennis ball, if a OA occurs, EPAP will increase to take care of it next time it is seen (unless) IPAP is already at its maximum. The same can happen with EPAP settings on the down side, if EPAP is prevented from going any lower because the minimum is set too high then IPAP won't be able to drop either.

it is shown IN your report, IPAP 90% is 15cm because it cannot go any higher, EPAP is at 12cm because it cannot go any higher. So your 90% pressure shown on that report is BOGUS because of the maximums set on the machine. I bet you have PS set at default 3cm (range is 3cm to 8cm). NOT that you need to change PS, you look at your report and see OA remains high than liked and EPAP addresses that event, then you increase EPAP (but you MAKE SURE it can do that by adding the PS value to EPAP and making sure it is allowed to move up.

and as Snoredog wrote the other day:

Now that I look at it again, I would increase the IPAP to 16cm. That period between therapy hour 1 to 2 is flat-lining meaning the pressure bumped up against the Maximum set limit for over an hours period just after therapy hour 1. If you look directly below that you will see a run of OA's that correspond with the pressure increase, while the leak did increase roughly the same time, I think the OA's are what drove it up.

If you watch the simulation of how that algorithm works, it "moves" IPAP and EPAP together with the PS "space" between, it moves either IPAP or EPAP based upon the "type" of event seen. OA's are taken care of by EPAP settings. Hypopnea is taken care of by the IPAP settings.

So you are not going to see any better AHI until you increase the IPAP setting to 16 or higher. Leave EPAP alone, fix the OA's first then see what happens to the HI's.