What to do? (Morbius: Your input, please?)

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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BleepingBeauty
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Re: What to do? (Morbius: Your input, please?)

Post by BleepingBeauty » Sat Apr 18, 2015 6:11 pm

Morbius wrote:
BleepingBeauty wrote:I have the report, and that's what it says. I have to believe it was monitored. If it's impossible that there was no snoring during his study, I guess that means the equipment simply failed in some way to report it.
Or (and this is the absolutely key point) everything is central, and not obstructive.
If that was the case, how could that sleep study have reported only one Central all night and severe Obstructive apnea? Can home sleep studies seriously be that unreliable?
So upload everything you have. Looking at the bad night at 11 could offer more clues. Clearly, without knowing if it's central or obstructive, or a split (most likely-- I'm still thinking big central component although less than a minute ago...)

...because the EF is normal. It sure would have helped if it were 40% (helped me anyway. Horrible for him).
Upload everything I have? I don't have any wave form data from the 11th (that bad night at 11); Encore will only allow me the wave form data from the previous night, so the 11th is long gone. Or maybe I'm missing something re: how to get the data now?
Absolutely need oximetry data. If that mess is still causing wicked desats (and it should) we need to attack this in a big way.
Okay, I'll ask my neighbor to send me my recording oximeter. Again, I'm not sure if Dad will tolerate yet another piece of equipment to wear all night, but I'll do my best to impress on him that it's important.
And what is sleep and wake is certainly not clear either. Given the situation, one would imagine that 25% of the sleep time is wake. Or more. Or less.

Dial wingin' is hopeless without at least one more bit of data- effort channels. So the BEST answer is get more home studies with the CPAP on. Use something like ApneaLink Plus or NoxT3.
I don't know if it's even possible to have another covered diagnostic study done, with their insurance. I believe the insurance would have covered an in-lab titration, but Dad's level of confusion and general state of mind made that impossible. If it means paying for another study OOP, I'm sure my mother will absolutely refuse to do it. But I'll speak to Dad's GP office on Monday and see what they say... I'd really rather not deal with the insurance company directly, considering the bullshit I've been through with them already.

<snip>
Morbius wrote:However, with that wicked PB you got there, there's got to be at least some increased chemoresponsiveness.

Or darn, forgot:

Low or wax/wane O2 sats could generate that PB, so supplemental O2 could fix some stuff.
I'll ask about getting an O2 concentrator for Dad when I speak with his doc's office. Oy, one more thing for my mother to crank about...

Thanks again, Dave.
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

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Pugsy
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Re: What to do? (Morbius: Your input, please?)

Post by Pugsy » Sat Apr 18, 2015 6:20 pm

If you just upload the SD card contents (there is nothing in the SD card itself that has personal information in there as all it has is a machine serial number and the data files) then Dave can use whatever software he wants to use to see the wave form data (and it's all still on the card even though your Encore Basic doesn't make it available) and he can use Pro if he wants to and go back and see all the waveform or he also can use Sleepyhead if he wants to go that way.

Just copy the SD card contents of that P-Series folder and then compress/zip it...upload to Dropbox (it is safe and I use it all the time) for Dave to grab it...once he has it you can then remove it from dropbox if you wish but there's nothing on that SD card that ties to your father at all unless someone wants to try to match up serial numbers of machines to people and a master list of both would be needed and there's nothing to gain anyway.

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Morbius
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Re: What to do? (Morbius: Your input, please?)

Post by Morbius » Sat Apr 18, 2015 6:34 pm

BleepingBeauty wrote:I'll ask about getting an O2 concentrator for Dad when ...
When (and if) the oximetry shows he needs it.

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Morbius
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Re: What to do? (Morbius: Your input, please?)

Post by Morbius » Sat Apr 18, 2015 7:09 pm

BleepingBeauty wrote:I don't know if it's even possible to have another covered diagnostic study done, with their insurance.
This is not a diagnostic study-- it will be a treatment study. Setting the APAP with a wide range to see the response at all pressures. The obstructives will show increased effort, the centrals will show none, so you can see the difference a mile away.

Since some HSTs (like the NoxT3) allow multiple nights, if you can run it for say 3 nights, hopefully you can solve the mystery of all those events at high pressures (and in order to get effective treatment you're talking about going to pressures like 18 cmH20+ if they turn to be obstructives, and you really need to know what's needed before you go that route).

But this goes back to my original point, what's really the goals? If it's just to make things a little better, and the oximetry is >90%, then maybe all those tick marks aren't all that important.

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Re: What to do? (Morbius: Your input, please?)

Post by BleepingBeauty » Sat Apr 18, 2015 9:41 pm

Pugsy wrote:If you just upload the SD card contents... <snip>
Okay. Dad's already using the machine tonight, so I'll see if I can't get that done tomorrow. I may PM you if I can't figure out what the hell I'm doing.
Morbius wrote:
BleepingBeauty wrote:I'll ask about getting an O2 concentrator for Dad when ...
When (and if) the oximetry shows he needs it.
Oh, okay. I'll wait until we see what the oximeter has to say, then.
Morbius wrote:
BleepingBeauty wrote:I don't know if it's even possible to have another covered diagnostic study done, with their insurance.
This is not a diagnostic study-- it will be a treatment study. Setting the APAP with a wide range to see the response at all pressures. The obstructives will show increased effort, the centrals will show none, so you can see the difference a mile away.

Since some HSTs (like the NoxT3) allow multiple nights, if you can run it for say 3 nights, hopefully you can solve the mystery of all those events at high pressures (and in order to get effective treatment you're talking about going to pressures like 18 cmH20+ if they turn to be obstructives, and you really need to know what's needed before you go that route).

But this goes back to my original point, what's really the goals? If it's just to make things a little better, and the oximetry is >90%, then maybe all those tick marks aren't all that important.
I would hope a "treatment study" would be covered, but with Humana, who knows? I don't know that this NoxT3 (or another like it) would be approved. I guess I'll find out...

As to your original point, the goal (for me, anyway) is to improve Dad's quality of life. As I said earlier, I'm already seeing improvement during the day, and I'm sure he would agree with that; he's *much* better than he was when I first got here (before his sleep study and getting the machine). I keep telling him that once he's getting truly effective therapy, he'll have a better chance of recovering from his surgical/hospital/rehab nightmare last September-November. I truly believe that the therapy is helping, even if it's far from optimal; I just don't want to push him so far that he balks at the whole process and gives up on using the machine altogether.

I wrestle with whether I should just be satisfied with the fact that he's willing to wear the mask and use the machine. Maybe I should leave him alone about trying to zero in on the right settings and/or other potential needs (like O2). I know my mother will roll her eyes if I get the oximeter and ask Dad to wear it, and gawd only knows how she'll feel if Dad ends up needing a concentrator... Their bedroom already holds more medical equipment than she wants to see (a walker, a wheelchair, all the meds, now the xPAP and the mask). A concentrator added to the mix would just make her day.

Her support in these endeavors would be really helpful, but it's just not there, and I don't want her negative influence to give Dad the not-so-tacit approval to give up on therapy altogether. But to be fair, I've asked her outright if she sees a difference in Dad, and she's had to admit that she does. She also started laser treatments on her hand today to try to break up the scar tissue resulting from her having shingles in January. That tells me that her overall attitude has adjusted to a more positive outlook lately, as she's hopeful about the treatments being able to help, because she was totally convinced that she'd never regain the use of that hand (and bemoaned that fact regularly). So maybe she'll pleasantly surprise me on this.

Ever the optimist, I am.
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

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Re: What to do? (Morbius: Your input, please?)

Post by Morbius » Sun Apr 19, 2015 4:40 am

BleepingBeauty wrote:
Pugsy wrote:If you just upload the SD card contents... <snip>
... tomorrow.
Great.

It will also be important to review Patterns of Use, because when I'm looking at this day

Image

and seeing ~15 hours of utilization, I'm thinking "Y'know, maybe tick marks aren't the biggest issue here".

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Morbius
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Re: What to do? (Morbius: Your input, please?)

Post by Morbius » Sun Apr 19, 2015 4:48 am

BleepingBeauty wrote:If that was the case, how could that sleep study have reported only one Central all night and severe Obstructive apnea? Can home sleep studies seriously be that unreliable?
Home sleep studies can be very reliable.

It's the people who are interpreting them that aren't.

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Re: What to do? (Morbius: Your input, please?)

Post by BleepingBeauty » Sun Apr 19, 2015 11:12 am

Morbius wrote:
BleepingBeauty wrote:
Pugsy wrote:If you just upload the SD card contents... <snip>
... tomorrow.
Great.

It will also be important to review Patterns of Use, because when I'm looking at this day

<snip>

and seeing ~15 hours of utilization, I'm thinking "Y'know, maybe tick marks aren't the biggest issue here".
As I think I said earlier, I was encouraging Dad to don the mask anytime he laid down (even just to watch tv) for two reasons: (a) to get him over the claustrophobia and used to the F10, and (b) to ensure he'd have the mask on whenever he nodded off (which he was doing quite often up until recently). So he shows quite a few hours of daily use, although he's usually awake now during the daytime hours. I'm reluctant to tell him NOT to wear the mask during the day until I'm sure he won't be nodding off; but if it's overkill for him to wear it so much, let me know, and I'll tell him to use the machine only at night from now on.
Morbius wrote:
BleepingBeauty wrote:If that was the case, how could that sleep study have reported only one Central all night and severe Obstructive apnea? Can home sleep studies seriously be that unreliable?
Home sleep studies can be very reliable.

It's the people who are interpreting them that aren't.
Well, of course. But snoring isn't a matter of interpretation, is it? Isn't that aspect of the study pretty black-n-white - either it's occurring or it's not?

And it follows that, even if the treatment study is approved, I believe it'll be done through the same company that did the diagnostic study (NiteWatch); if they messed up in the interpretation of the diagnostic study, how much faith can I have in them to interpret another one?

P.S. I did the DropBox thing and have uploaded Dad's data card. Then I went to PM you the link (still squirrelly about posting that stuff openly) and found that I can't contact you privately...
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

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Morbius
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Re: What to do? (Morbius: Your input, please?)

Post by Morbius » Sun Apr 19, 2015 12:10 pm

BleepingBeauty wrote:NiteWatch
As Jaack Dawson would say:
wellwellWell!
It appears NiteWatch uses the T3! And snoring in that is very accurate (if they set it up properly).

No snoring increases the likelihood of everything being central.

Try to get the entire raw data file. Sometimes Noxturnal will be a little generous in OA scoring, so I think we need to see the nail marks.

PM portal open.

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Morbius
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Re: What to do? (Morbius: Your input, please?)

Post by Morbius » Sun Apr 19, 2015 12:15 pm

BleepingBeauty wrote:As I think I said earlier, I was encouraging Dad to don the mask anytime he laid down (even just to watch tv) for two reasons: (a) to get him over the claustrophobia and used to the F10, and (b) to ensure he'd have the mask on whenever he nodded off (which he was doing quite often up until recently). So he shows quite a few hours of daily use, although he's usually awake now during the daytime hours.
So IOWs, during that OA salvo he could be walking (w/walker) down the street for all we know...

Hey, no prob, love a challenge!

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Morbius
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Re: What to do? (Morbius: Your input, please?)

Post by Morbius » Sun Apr 19, 2015 1:01 pm

Image

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BleepingBeauty
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Re: What to do? (Morbius: Your input, please?)

Post by BleepingBeauty » Sun Apr 19, 2015 2:26 pm

Morbius wrote:
BleepingBeauty wrote:NiteWatch
As Jaack Dawson would say:
wellwellWell!
It appears NiteWatch uses the T3! And snoring in that is very accurate (if they set it up properly).
Glad you're familiar with them (the only game in town w/Humana), because I had no idea whether they were good or bad at this. Re: the snoring is very accurate "(if they set it up properly)" - I'm confused. It was a home study, so what is it that they would be "setting up" exactly?
No snoring increases the likelihood of everything being central.

Try to get the entire raw data file. Sometimes Noxturnal will be a little generous in OA scoring, so I think we need to see the nail marks.

PM portal open.
Does "the entire raw data file" mean the data from the study? Or the raw data from the SD card? (And thanks for opening the PM.)

ETA: Just tried to PM, but it wouldn't find you.
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

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Morbius
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Re: What to do? (Morbius: Your input, please?)

Post by Morbius » Sun Apr 19, 2015 4:23 pm

BleepingBeauty wrote:Re: the snoring is very accurate "(if they set it up properly)" - I'm confused. It was a home study, so what is it that they would be "setting up" exactly?
There is a microphone that records sound, but it creates a huge data file so there's an option to turn it off. That said, there is still another snoring channel.

Yes, very familiar with T3. Very good product.

Boy don't those OAs up there have a central flavor? And they don't totally obstruct, so that a good thing, leaves options.

Time to hunt again.....

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Morbius
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Re: What to do? (Morbius: Your input, please?)

Post by Morbius » Sun Apr 19, 2015 4:33 pm

On the 11th:

Image


Image

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Morbius
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Re: What to do? (Morbius: Your input, please?)

Post by Morbius » Sun Apr 19, 2015 4:37 pm

MFA obstructive apnea. That's all CSR/PB in there:

Image