Encore Basic v Encore Pro

[Chalkie]

I have downloaded and installed Encore Basic to my new Windows 10 machine.

According to the notes I read in the Apnea Board Software download section, this is the correct version for Respironics BiPAP S/T C Series machines? 

The notes said Encore Pro was only suitable for Respironics Dreamstation machines, but I am checking in case something has changed since they were written.

Am I good to go with Basic?

[Sleeprider]

I think your Respironics BiPAP ST-C is a System One series machine and should be usable with Encore Basic and even better #Sleepyhead. I would avoid using EncorePro due to the huge database overhead and increased security. Do give #Sleepyhead a try as well. It has a much more useful graphic interface. Here is a link to the latest version with downloads for Linux, Mac and 64-bit Windows http://OSCAR Official Download Page ----> CLICK HERE ./testing/1.1.0

Chalkie, we have never seen data or sleep test information from you. Can you tell us more about the apnea problem you are treating? Is you problem central or obstructive/restrictive? Are you using a backup rate on the ST-C? I don't mean to alarm you, but the UK is, relatively speaking, in the stone-age for treating apnea disorders. The social medicine system restricts your access to appropriate advanced bilevel machines and the doctors and consultants seem fairly clueless about anything but plain vanilla obstructive sleep apnea.

[Chalkie]

Hi Sleeprider

Thanks for your message. I have tried Sleepyhead and would love to use it but it just does not seem to be compatible with my machine. It only gives stats for pre-midnight, at best. No one seems to have an answer.

Please see some images showing some data from my machines.





As you can see I have both OSA and centrals.
 
I have just sent the SD card to Respironics so should have more recent data soon.

I am starting to trial the  Dreamwear full face mask this week.

Any feedback much valued, especially with regard to what I might ask the sleep doc on Wednesday.

And any ideas on how to get Sleephead working also much appreciated.

I am meanwhile tapering Clonazepam (prescribed for Periodic Limb Movement Disorder) and the way it sent my AHP soaring when I started making t8iny cuts to my dosage is a real eye-opener (see the second image: started tapering on 3 November 2017 and look what happened to the AHI after 1 Nov 17...

btw I don't disagree about your comments on the NHS. The sleep nurse actually once said to me "I don't know what t do with you".

[Sleeprider]

If you could move to a modern Resmed Aircurve 10 ASV or Philips BiPAP SV Auto I think you would have much higher efficacy and full data. I just don't understand why you are on a ST machine unless you have some kind of restrictive lung disease. It is not intended for treatment of complex apnea, it is specifically for COPD.

[jaswilliams]

If you could move to a modern Resmed Aircurve 10 ASV or Philips BiPAP SV Auto I think you would have much higher efficacy and full data. I just don't understand why you are on a ST machine unless you have some kind of restrictive lung disease. It is not intended for treatment of complex apnea, it is specifically for COPD.

That’s the NHS for you, Chalkie did you try any other machines and how is it going with your sleepnurse now ?


I purchased my own S9 Resmed Vpap Adapt to treat my central apnoea and my trust is happy for me too keep using it as it is providing effective therapy (proven following an overnight study on my own machine) not sure they will ever put to the CCG for funding of an ASV

[Chalkie]

Th4e sleep nurse now ignores my calls unless I persist. 

I am going to ask for an ASV again on Wednesday when I see the sleep doc.

[Sleeprider]

You frequently have less than 50% patient triggered breaths. This means that you are relying on the backup timed breath for half of your breathing. The old ST provides the same pressure support for every breath and this usually makes central apnea worse in complex apnea patients because the high ventilation rate washes out CO2 and reduces respiratory drive. The impact is visible in the high tidal volumes in your data. In spite of the use of backup rate, you still have a high AHI because you are dependent on the fixed pressure support to breathe. The machine is not adaptive, but sets your pace and applies the same pressure on every breath.

With ASV (adaptive servo ventilation), the machine provides a low EPAP pressure that automatically rises if you have obstructive apnea. EPAP is what keeps your airway patent and prevents OA. The ASV provides a minimum pressure support, usually 3-cm for comfort, so a common result without apnea is 7.0/4.0 (IPAP/EPAP) which is a very comfortable low pressure. The ASV also has a maximum pressure support up to 15 cm higher than EPAP. During a central apnea, or hypopnea, the machine applies just enough pressure support to ensure your breathing volume and rate remains normal. The pressure support is there when you need it, as much as you need (adaptive), and stays out of the way when you don't need it. There are some very good videos on Youtube that graphically show how ASV works. Obviously, this is much more comfortable and effective for treating complex apnea.

If you have the financial resources to purchase your own machine, then you should, and we will help guide you to new and used machines that can be had at a reasonable price. If you must rely on NHS, you will need to be persistent to get what you need. Supplier #2 is a great resource to buy your own machine new or used, and they will ship internationally and warrant your purchase. You should look for the Resmed Aircurve 10 ASV, or Resmed S9 VPAP Adapt. If you get the older S9, be sure it has ASV Auto mode.

[Chalkie]

Hello again Sleeprider

I will definitely push for the ASV machine when I see the sleep doctor on Wednesday.

It sounds as if the BiPAP is making my apnoea worse, although nights without it seem worse still.

How serious is <50% patient triggered breaths? I neede about ten hours' sleep per night to feel even halfway human.

The doctor may argue that my apnoea was "well-controlled" until November 2017, when I began cutting benzos.
It sounds as if pressures of 6-17 are way too high. They were pushed up further, to 10-20, and even 12-22.

I think other than that it is best to leave my pressures as they are and persist in trying to get used to the Dreamwear mask.

I have an appointment in late February at a major London hospital to see a specialist who treats both apnoea and PLMD so will ask him if I get nowhere with the doctor locally. 

I would be interested in a list of suppliers - I may be able to afford second had.

btw I have installed Encore Basic added myself as a patient and downloaded the data, but am not clear how to view it. What do I need to do? 

[Sleeprider]

People without central apnea will trigger close to 100% of breaths. The machine is backing up your breathing, but you no way to gauge whether those breaths are adequate without data or wearing a SpO2 oximeter. If we could see a respiration flow rate chart, I think we might see a lot of problems where the machine is triggering breaths. It's certainly better to have backup, but ASV won't cause nearly as many central events because it normally maintains a low pressure support, but it's there when you need it. The way flow is delivered is very different as well. The ST produces a square sine-wave flow. It increases pressure fast, hold it and then reduced pressure. The pressure delivery of a Resmed VPAP looks like an ocean wave.

Here is a chart posted by another member and it shows how the Auto ASV changes pressure to prevent events. In this chart the red pressure line is the pressure the machine is delivering, the blue chart is mask pressure and the flow rate line in black shows the user's breathing flow rate. You can see the machine is set to EPAP min of 6.0, which is the bottom of those pressure charts. The minimum pressure support looks to be 3.0 and that is what is delivered most of the time. The machine frequently increases IPAP pressure to prevent hypopnea and central apnea. In this case there are no events recorded, but the machine is intercepting them by providing as much pressure as is needed to maintain respiratory volume and timing, without getting in the way when that is not needed. In this case the user had limited his maximum pressure support to about 8.0 which was not enough for certain events http://www.apneaboard.com/forums/Thread-...ile-on-ASV The purpose of showing this chart is to show how the ASV adapts to changing needs through the night and on a breath by breath basis.

[Chalkie]

Interesting. I am going to request a copy of my data download from the sleep doctor and if I can find respiratory flow data I will post it.