what einstein said

[Julie]

The size of your brain, only I'm not sure there's a ruler small enough to do that.

[LSAT]

The size of your brain, only I'm not sure there's a ruler small enough to do that.

+1

[Goofproof]

The size of your brain, only I'm not sure there's a ruler small enough to do that.

+1

Use CM, they are for smaller units, and the math is easier, just don't mix and match them, you won't be able to find your rocket or sat. Jim

[Goofproof]

What Voltaire said: "The art of medicine consists of amusing the patient while nature cures the disease."

[LSAT]

The size of your brain, only I'm not sure there's a ruler small enough to do that.

=========

tiny little minds like yours sling insults to help them cope with reality

The reality is that you seem to have an answer to everyone's question...but....most are irrelevant.

[HoseCrusher]

When startled the body responds with the fight or flight response that releases some hormones that are helpful during the intensity of fighting or flight. After the event is over the body slowly gets rid of the hormones and brings everything back into balance.

On a subconscious level stopping breathing triggers the fight or flight response. If there is little drop in O2, the trigger is mild. If there is a substantial drop in O2 the trigger is substantial. The difficulty comes from trying to determine how many mild triggers add up to a substantial trigger. Also, constant mild triggers add up to disrupted sleep and you don't get the rest sleep is supposed to provide.

O2 levels, heart rate, effort to breathe, and body movements all are different pieces to the puzzle along with the AHI values.

I don't think it is good to overly focus on one piece of the puzzle. You need to step back and view the bigger perspective.

As far as other things to measure goes... I think while you are trying to figure out what is going on a journal is a very valuable thing to have. In reviewing your progress you can then formulate questions that will lead you to answers so you can find your way to restful sleep.

[Goofproof]

When startled the body responds with the fight or flight response that releases some hormones that are helpful during the intensity of fighting or flight. After the event is over the body slowly gets rid of the hormones and brings everything back into balance.

On a subconscious level stopping breathing triggers the fight or flight response. If there is little drop in O2, the trigger is mild. If there is a substantial drop in O2 the trigger is substantial. The difficulty comes from trying to determine how many mild triggers add up to a substantial trigger. Also, constant mild triggers add up to disrupted sleep and you don't get the rest sleep is supposed to provide.

O2 levels, heart rate, effort to breathe, and body movements all are different pieces to the puzzle along with the AHI values.

I don't think it is good to overly focus on one piece of the puzzle. You need to step back and view the bigger perspective.

As far as other things to measure goes... I think while you are trying to figure out what is going on a journal is a very valuable thing to have. In reviewing your progress you can then formulate questions that will lead you to answers so you can find your way to restful sleep.

Very Wise! Jim

[jnk...]

not everything you measure matters

That sums up nicely why there is no need for most with simple OSA being treated with PAP to measure O2.

not everything that matters can be measured

That sums up nicely that home machines do not measure quality of sleep, since sleep can be disrupted by many factors--not just breathing.

and arent most of our RAD/sleepyhead numbers just surrogates and even suppositions about what really happens

Home treatment machines provide trending data. Nothing more. Nothing less. VERY valuable for assessing changes to treatment parameters. But not a representation of what is actually being treated.

wouldn't the spo2 levels be one of the most important things that has to be measured to get meaningful results

Only for a small subset of patients dealing with specific blood gas issues far beyond simple OSA. That is because O2 is relatively easy to fix with pressures much lower than what is needed to stabilize the airway for good sleep.

all the xHI numbers for mild serious etc are all somewhat arbitrary based on averages that nobody is

Medical science is what it is. Find ways to get use from it, since there is no way economically to customize it on a per-patient basis at this point in history.

isnt O2 minimum more important than some number of HIs ?

Only for a small subset of OSA patients dealing with issues far beyond OSA. Otherwise, remember that OSA is primarily a sleep issue, and that breathing can be bad enough to disturb sleep even though O2 is established as within normal range.

isn't max heart rate a lot more important than number of apneas

Not for most, no.

is there anything else we should be measuring

The idea with home-machine-reported data is to tweak to the point of getting it as "good" as it can get, as "low" as the numbers can get, but not worrying about getting it any better/lower than that. But one should do so without ignoring amount of sleep, amount of exercise, nature of diet, and nature of lifestyle, since those tend to have a profound effect on well-being. In a sense, the effect of those measurable factors becomes fully unmasked once PAP therapy has stabilized the airway enough for breathing to no longer be the primary factor lessening the overall quality of sleep.

[chunkyfrog]

Primarily, the INSURANCE companies focus on compliance, even though its relevance is marginal, just because it is cheap.
One would HOPE that airlines and transportation companies would broaden their view, for public safety, if for nothing else.
We may have a long wait.

[robysue]

not everything you measure matters
not everything that matters can be measured

While this is true, it's also true that we measure what we can easily measure and hope that what we can measure can provide a meaningful proxy for the important things that cannot be directly measured.

and arent most of our RAD/sleepyhead numbers just surrogates and even suppositions about what really happens

Yes, but trending data provides real insight into whether the xPAP is doing its one and only job of preventing enough OAs and Hs (and RERAs and snoring) so that it is possible to get a night of sleep that is not disturbed by sleep disordered breathing. In other words, if the AHI data is consistently bad, it's reasonable to assume that the xPAP therapy has not yet been optimized. If the AHI data is consistently good, but the sleep remains bad, it's reasonable to assume that there's more disrupting the person's sleep than just plain old, ordinary OSA.

wouldn't the spo2 levels be one of the most important things that has to be measured to get meaningful results

Not if you are a person whose events are mainly associated with arousals rather than O2 desats. There's a reason that the AASM has two working definitions of hypopnea: While Medicare insists on a 4% O2 desat for scoring an H, there is data that shows that repeated, numerous reductions in airflow that are followed by EEG arousals can be a major source of nonrestorative sleep. Since many insurance companies are willing to accept "hypopneas with arousal" and RERAs as valid sleep disordered breathing events, most sleep labs will track "hypopneas with arousal" and RERAs as well as OAs and "hypopneas with 4% O2 desats". Sometimes these labs will distinguish between a (Medicare) AHI and an RDI---a respiratory-related disturbance index---that includes the "hyponeas with arousal" and the RERAs in the count of events. And if a lab calculates an RDI, the diagnosis of OSA may depend on the RDI rather than the (Medicare) AHI, particularly in symptomatic patients.

all the xHI numbers for mild serious etc are all somewhat arbitrary based on averages that nobody is

As are any other numbers from the world of medicine. Is there really a quantitative difference between a blood pressure that consistently runs 141/91 (officially "high" enough to treat) and a blood pressure that consistently runs 139/89 (officially "borderline" and only needs to be "treated" with lifestyle changes)?

But back to sleep disordered breathing: The fact that some people are highly symptomatic when their AHI is between 5 and 10 and others are not is reflected by the fact that many sleep doctors will inform people with very mild OSA (like my husband) that the choice between "treat with CPAP" or "don't worry about it, but try not to sleep on your back" is really up to the patient. In my husband's case, his overall diagnostic AHI was a bit more than 5, supine AHI was about 10, but he was extremely symptomatic in terms of daytime sleepiness. Hubby took almost 9 months to make the decision to get a CPAP, largely because he'd seen my difficult adjustment period. But after a week of starting xPAP, hubby was symptom free and sleeping very well at night.

isnt O2 minimum more important than some number of HIs ?

Answer is, it depends. It depends on whether the vast majority of your untreated Hs are associated with arousals or with O2 desats or both. It also depends on whether there are other medical causes for the O2 problems. For example, if you happen to have both serious COPD and moderate to severe OSA, fixing the OSA may not improve the min O2 numbers if the COPD is not adequately treated.

isn't max heart rate a lot more important than number of apneas

Given the fact that a person with normal sleep has a highly variable heart rate in REM, this is probably NOT a good proxy measure for how well xPAP is treating ordinary OSA. It is an important variable that is tracked and studied on diagnostic sleep studies.

is there anything else we should be measuring

The gold standard is the answer to the subjective question, How do you feel?

If you feel good and your data looks good, it's time to enjoy life and quit worrying about the nightly variations in AHI and what kinds of things can't be measured in regards to your SDB.

If you feel lousy while using xPAP, then additional investigation into why your sleep remains bad should be done. If there are obvious problems that show up in the data, that's a starting point. If the machine recorded data looks good on paper, the question becomes what should be investigated? If your diagnostic sleep study showed prolonged periods of time with O2 levels below 90%, then it's reasonable to slap a recording oximeter on to see if the O2 is still dropping significantly when events get by the xPAP defenses. If your diagnostic sleep study showed lots of spontaneous arousals, then that's got to be looked into. If there's any chance that the untreated SDB was masking a problem with PLMD or RLS, those have to looked at more carefully. If there's evidence of substantial "wake after sleep onset" (WASO), then sleep maintenance insomnia needs to be considered. If excessive daytime sleepiness is the main residual problem, then its worth considering whether the patient has both narcolepsy and sleep disordered breathing.

[CapnLoki]

not everything you measure matters
not everything that matters can be measured

Although often quoted, there's no record that Einstein ever said this. The saying:
"Not everything that counts can be counted,
and not everything that can be counted counts."
has been attributed to Sir George Pickering', a British physician, and many have repeated it. It was claimed that Einstein quoted Pickering on his blackboard.

[jnk...]

"Quote Investigator: QI suggests crediting William Bruce Cameron instead of Albert Einstein. Cameron’s 1963 text 'Informal Sociology: A Casual Introduction to Sociological Thinking' contained the following passage. . . . : 'It would be nice if all of the data which sociologists require could be enumerated because then we could run them through IBM machines and draw charts as the economists do. However, not everything that can be counted counts, and not everything that counts can be counted.' " --http://quoteinvestigator.com/2010/05/26 ... -einstein/

"Not everything said is definitively sourced. And not everything definitively sourced is worth saying."--Einstein's editor.

"Everything sounds more authoritative when you imagine it coming out of a famous guy's mouth."--Anonymous.