New UARS patient? Standard Sleep Study NORMAL.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Sludge
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Re: Does the drop in HI, AI, AHI mean she should be using a mask

Post by Sludge » Mon Jul 21, 2014 5:06 am

justinjustin wrote:
Physician wrote:Follow up of her values.

She has been using nasal pillows, but last night she used a Mirage FX nasal mask.

It sounds likely that she'd been mouth breathing (possibly because of nasal congestion, or just adjusting to therapy), which can cause breathing disturbance/arousals and thus increase the AHI because the nasal pillows can't address these.
I have bafflement.

Are not the same issues present with a nasal mask that exist with pillows?
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Sludge
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Re: Does the drop in HI, AI, AHI mean she should be using a mask

Post by Sludge » Mon Jul 21, 2014 5:09 am

Physician wrote:She has been using nasal pillows, but last night she used a Mirage FX nasal mask. Her values changed last night in that her HI, AI, and AHI dropped from the prior three nights. Why ?
I would like to propose that it's because the nasal mask has slightly different deadspace/washout characteristics.
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Sludge
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Re: Does the drop in HI, AI, AHI mean she should be using a mask

Post by Sludge » Mon Jul 21, 2014 5:16 am

Sludge wrote:
Physician wrote:She has been using nasal pillows, but last night she used a Mirage FX nasal mask. Her values changed last night in that her HI, AI, and AHI dropped from the prior three nights. Why ?
I would like to propose that it's because the nasal mask has slightly different deadspace/washout characteristics.
Except for the fact that they're like REALLY slight...
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Sludge
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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by Sludge » Mon Jul 21, 2014 5:26 am

Sludge wrote:
justinjustin wrote:I'm sorry you seem rather skeptical about his value....
Why are you sorry?

I can never understand why people say that.

Anyway, what about the esophageal pressure transducer?
I take it there was no esophageal pressure transducer then, huh?
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Pugsy
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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by Pugsy » Mon Jul 21, 2014 6:10 am

Physician wrote:
Liters per second ? The LCD screen reads in L/min., right ?

The S8 machine shows L/sec on the LCD screen. 0.4 on the S8 machine LCD display is equal to 24 L/min on ResScan or S9 display.
It's the S9 machines that show L/min on the LCD screen.

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justinjustin
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Re: Does the drop in HI, AI, AHI mean she should be using a mask

Post by justinjustin » Mon Jul 21, 2014 8:45 am

Sludge wrote:
justinjustin wrote:
Physician wrote:Follow up of her values.

She has been using nasal pillows, but last night she used a Mirage FX nasal mask.

It sounds likely that she'd been mouth breathing (possibly because of nasal congestion, or just adjusting to therapy), which can cause breathing disturbance/arousals and thus increase the AHI because the nasal pillows can't address these.
I have bafflement.

Are not the same issues present with a nasal mask that exist with pillows?

Apologies, I had a lapse in attention and assumed it was typical nasal -> FFM story.

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justinjustin
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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by justinjustin » Mon Jul 21, 2014 8:46 am

Sludge wrote:
Sludge wrote:
justinjustin wrote:I'm sorry you seem rather skeptical about his value....
Why are you sorry?

I can never understand why people say that.

Anyway, what about the esophageal pressure transducer?
I take it there was no esophageal pressure transducer then, huh?
No, there was not.

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Physician
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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by Physician » Mon Jul 21, 2014 8:49 am

Pugsy wrote:
Physician wrote:
Liters per second ? The LCD screen reads in L/min., right ?

The S8 machine shows L/sec on the LCD screen. 0.4 on the S8 machine LCD display is equal to 24 L/min on ResScan or S9 display.
It's the S9 machines that show L/min on the LCD screen.

Yikes. Will look again in two days.

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Sludge
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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by Sludge » Tue Jul 22, 2014 5:50 am

Sludge wrote:
49er wrote:
Yet, it really does not matter if UARS is a valid diagnosis or not. The key to RERAs is "arousals", and If the NPSG is scored correctly, and you're looking at ~>100 arousals for the night, then everyone should know that there's at least something underfoot. Therefore, they should not only be looking at SDB, but "sleep" as well. Consequently:
But the question is do they? I mean if sleep labs aren't looking for UARS in my area as one sleep doctor stated, what motivation would they have to investigate further regarding an extraordinary number of arousals?
If they're an OSA factory?

None.
However, if they are an accredited sleep center, the physician is required to performed an epoch by epoch review and sign an attestation that this has been done.
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49er
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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by 49er » Tue Jul 22, 2014 5:54 am

Sludge wrote:
Sludge wrote:
49er wrote:
Yet, it really does not matter if UARS is a valid diagnosis or not. The key to RERAs is "arousals", and If the NPSG is scored correctly, and you're looking at ~>100 arousals for the night, then everyone should know that there's at least something underfoot. Therefore, they should not only be looking at SDB, but "sleep" as well. Consequently:
But the question is do they? I mean if sleep labs aren't looking for UARS in my area as one sleep doctor stated, what motivation would they have to investigate further regarding an extraordinary number of arousals?
If they're an OSA factory?

None.
However, if they are an accredited sleep center, the physician is required to performed an epoch by epoch review and sign an attestation that this has been done.
Thanks Sludge for letting me know.

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Sludge
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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by Sludge » Tue Jul 22, 2014 5:56 am

Sludge wrote:... required to performed ..
Somebody needs to go to gramma school:

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Sludge
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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by Sludge » Wed Jul 23, 2014 6:28 am

justinjustin wrote:
Sludge wrote:I take it there was no esophageal pressure transducer then, huh?
No, there was not.
OK so pardon my PB (Persistent Bafflement).

If
justinjustin wrote:...he diagnoses ComplexSA + UARS ...
but uses ordinary diagnostic tools;

and uses a machine that is basically on autopilot;

then how is
the real story with respect to my SDB
attained and what exactly are the
answers with Dr. Krakow
?
I mean, if ASV is that much of a comfort measure, and indeed The Answer, couldn't you have saved like 5 grand?
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Sludge
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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by Sludge » Wed Jul 23, 2014 6:32 am

Further, this relates to the OP, cause if
Physician wrote:She had a complete overnight PSG (Sleep Study) which was normal..
and now got her AHI all the way down to 12.1 from 0.0, I mean I'm going

just WTF are you guys doing!?
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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by musculus » Wed Jul 23, 2014 10:18 am

Glad to hear another UARS sufferer get needed treatment. Full face mask might be best for her having recessed lower jaw.

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Re: New UARS patient? Standard Sleep Study NORMAL.

Post by jnk » Wed Jul 23, 2014 12:55 pm

I believe that much of Dr. K's genius isn't so much in what he prescribes or how he diagnoses conditions but in how he finds a way to make insurance pay for what he prescribes.

I also believe he and his "people" have a knack for informing some patients about, and getting them excited about, SDB in general and his team's crafted customized approach for those with multiple sleep complications, medical and otherwise, who have failed badly with more standard approaches.

Do I think that sort of thing is necessary for every OSA patient? No. Do I believe he sometimes stumbles onto ways of being extremely helpful to individual patients with nonstandard sleep problems or PAP-therapy complications? Yes.

5K IS a serious hunk of dough,--but hey, if it turns a life around . . .

Just me.

As for UARS, the only reason a lab would have to look for it is if the patient's payers consider that a valid diagnosis for qualifying to try PAP. Otherwise, why look for a condition that will earn the patient the same rights to try a CPAP as a diagnosis of "heebie-jeebies" would? Payers dictate what conditions are looked for, since payers have more control over treatments than doctors do, in this day and age. In my opinion. And I still don't think all payers are on board with the UARS thing, whether docs are or not.