where do you get the software resscan for the resmed adapt? I seem to have much worse apnea at home sometimes instead of in the lab

apnea2142 wrote:where do you get the software resscan for the resmed adapt?

http://www.resmed.com/int/assets/html/service_support/resscan_software/resscan3.16-register.html

JohnBFisher wrote: "Papit, I think it is time to request a referral to a neurologist that specializes in sleep medicine. You need someone that can help sort out the central apnea issues. I don't know if the increased gastric problems have anything to do with the central apnea. It's possible that it is confusing some chemo-receptors. Additionally, even if you have sleep onset central apneas, if they are long enough they should be addressed.

“That the amount you sleep has decreased is a warning sign that you are not sleeping well. (Been there, done that!)

“Since you continue to have untreated central apneas and they are most of the events, it should be treated. You will need to insist on this. Not all doctors understand that a central apnea is just as bad - if not worse on the cardiovascular system. The O2 desaturations cause serious problems including (but not only) high blood pressure, cardiac problems, stokes, etc. . . . "

Thanks, John/Avi/Pugsy, for your directness. I will take that advice. The cross-talents of a neurologist and sleep medicine MD doc could be just the ticket. Here's why I think that too:

As I related in earlier posts, I have polymyalgia rheumatica. That and my "severe overall obstructive disordered breathing (RDI 68) that is associated with . . . oxygen desaturations to 80%,” were both diagnosed in Nov. 2011 (by separate docs). They are each aware of both conditions.
I have been treated for the polymyalgia (with prednisone). One of the reasons why I love this site is the open sharing of personal medical information by so many contributing members. Late today I came across another thread about " Central Sleep Apnea - More info?,” started by Morfenmom, viewtopic.php?f=1&t=76618&p=700479&hilit=fibromyalgia#p700479. He reports in his thread that, “The fact that I have central SA surprised the doc but then as he was taking my history (Fibromyalgia . . .) he said it made more sense.” A lookup of my and his “myalgia’s” suggests some neurological commonality. So that may be a promising track to ask the neuro/sleep doc about. Thank you, Morfenmom.

Additionally, the doc is trying to wean me off the prednisone now that the symptoms (aching joints and fatigue) have disappeared. This “weaning” is a tricky business that is not always successful. The symptoms began returning when I got down to a very low dosage level on our first attempt to get off the drug, a potent steroid. We’re now deep into the second attempt. My body/brain may once again be rebelling as I again approach those low weaning levels where the symptoms returned. Could my recent rising trend in central apneas be reflective of that ongoing rebellion? Wouldn’t surprise me. We’ll see.

Readers who have elevated central apnea may be interested in reading two articles posted by Teachcsg, one from Respironics, http://www.healthcare.philips.com/us_en ... efault.wpd and one from ResMed, http://www.resmed.com/us/documents/CSA- ... -sheet.pdf Also, they should know that Maxdarkside's posts persuaded me to get a pulse oximeter. I believe all of us should have one to at least check their oxygen saturation levels with an overnight data report from time to time, which is how I was using it until recently when I began seeing a worsening trend. Now I record the data nightly and get a full report like the one shown earlier in this thread.

avi123 wrote: "Papit, I agree with John Fisher that you should be re-tested b/c of the hi number of CAs, and also to qualify for an ASV. How come your ResScan Leak graph above is less jagged than your graphs from before? It was like this:



"Seek A Doctor who is holding an MD in Neurology, or Cardiology, and also holds an MD in sleep medicine.
What large town in VA is near you, I could try to locate a few such Docs. If you're ready to drive to Raleigh then Doctor Perkins is the Doc to see:

" http://www.raleighneurology.com/special ... p-medicine "

Thank you, Avi. I'll keep your doc resources in mind if I can't find one around northern Virginia. I also may drive to Baltimore if I can find neurologist/sleepmedicine doc there.

I have no idea why the graph patterns on the two graph to which you refer look differently. I'm satisfied with the leak graphs that both company's software produce for me because they both refect relatively minor leak levels.

avi123 wrote:... If you're ready to drive to Raleigh then Doctor Perkins is the Doc to see:

http://www.raleighneurology.com/special ... p-medicine ...

I personally see Dr. Paul Peterson of Duke Neurology of Raleigh:

http://www.dukehealth.org/physicians/paul_c_peterson

But this just points out that in most university towns you will find excellent doctors to help with sleep issues.

John, were Duke Neurology of Raleigh do the PSG overnight testing?

Probably this is the place which is in Durham, nc

http://www.dukehealth.org/repository/du ... lcome2.pdf

Papit, polymyalgia-rheumatica is really tough:

http://www.mayoclinic.com/health/polymy ... -and-drugs

Last night I used only the CMS 50F pulse oximeter, no xpap for the first time since beginning it last November. I did this experiment, hopefully, to see whether it might interrupt the rising trend of my central apnae and recently declining oxygen saturation readings. Obstructive apnea has remained very low.

Results: Not good at all. After 7 hours of sleep with two awakenings, I awoke somewhat more groggy than usual. It was more difficult to get out of bed. I apparently pulled the pulse oximeter off after an hour, repositioned it a few hours later and got only two hours of data for the night.

The 24.1 minutes spent at an O2 saturation below 90% last night is the worst I've seen. The night before it was 9.8 minutes. Leading up to these readings in the days before, it was 4.0, 4.6, 4.6, 4.7, 5.0, 4.8, and 1.6 minutes.

No, I didn't drink any alcohol after dance class and I don't drink often or much. Just my same mix of meds an hour before bed including Mirapex (for restless leg syndrome), Nexium (gerd/reflux) and sometimes Sonata for insomnia (which I have used daily for the past week to help with recent more difficult sleep). I take Prednisone in the morning (for polymyalgia) that I'm winding down.

Tonight's experiment: Skip the Sonata. Get back on xpap.

I have the same problems getting up in the morning in spite of my very good data results. Apparently the two don't have much to do with each other in my case. It takes me till noon to shake up the sleepiness.

Usually, at 11 p.m. I take one 0.5 mg tablet of Alprazolam ER (generic Xanax) plus one capsule 0.4 mg of Tamsulosin (generic Flowmax) to control my urination, and two capsules 300 mg each of Gabapentin (generic Neurontin) for sleep, neuropathy, etc. The Gabapentin is a miracle drug.

Like you ,I also take two tablets of Prilosec daily (instead of Nexium which requires Rx and costs more).



p.s. I was almost certain that taking Gabapentin should help polymyalgia-rheumatica. But I can't yet find proof for it.

avi123 wrote:John, were Duke Neurology of Raleigh do the PSG overnight testing?

Probably this is the place which is in Durham, NC ...

Nope. I go to the SleepWorks site in Raleigh. Their main webpage is:

http://www.sleepworksinc.com/

A map to the location is:

http://g.co/maps/h7x7w

They do a pretty good job. Though, as with any sleep center, if you have any complicated issues, such as central sleep apnea, I recommend talking with the staff before the sleep study.

John Fisher, who does the analysis of the test results in those places of SleepWorks for you? Is it the Duke physician or someone else? Have you noticed that in some locations the Test Clinics are NOT accredited by the AASM?

avi123 wrote:... John Fisher, who does the analysis of the test results in those places of SleepWorks for you? Is it the Duke physician or someone else? ...

As I understand it the lab does the analysis. Again, it is my understanding that a lot of the grunt work is done by computer. However, the doctor reviews the full report and analysis. So, the oversight is quite reasonable.

avi123 wrote:... Have you noticed that in some locations the Test Clinics are NOT accredited by the AASM? ...

Yes, that is true of some of the location. But the one in Raleigh is accredited. They do a good job.

Mark Twain put it better than this but . . . Well, friends, I'm not dead today. I had planned for last night's 'experiment' to resume xpap (of course), but to skip the Sonata for a change. Then I decided to skip all my night time meds (Nexium for reflux, Mirapex for RLS, Sonata for insomnia) to see if my recent much higher CA and worrisome O2 desaturation trends could somehow be interrupted. I was still awake and restless after an hour so I caved, and took all the meds and put my mask back on. Then I fell asleep.

Results: At 0.4 minutes -- best night ever recorded for time spent below 90% desat (Thank you, Lord.). Low O2 desat was 83..CA still elevated at 11.9, down from 17.8 two nights ago, OA: 0.1 (Thank you, CPAP.), Leak: 2.4, AHI: 12.9. I felt better rested this morning. Here's the picture.

Pappit, I don't understand the 6 numbers on top under Event Data, Do you?
Your seem to be higher than my:







Otherwise, it looks good to me.

By the way, how did you enter text in the graph?

Papit, I don't know what happened about a third of the way through the night, but that spike in both desaturation and heart rate looks like an artifact. If you ignore that spike, the rest of the night looks good.

Avi, The software is set up to score desaturation and heart rate events. I believe the toolbox icon allows you to adjust the criteria.

It looks like yours is set for a drop in oxygen of 4% over a period of 10 seconds for the oxygen side, and a change in pulse rate of 6 beats per minute over a period of 8 seconds for the pulse side.

Using that scoring criteria the Event Data tabulates the data.

Total Events is the total events scored using the set criteria. If you change the criteria, the number of total events changes.

Time in Events (min) is the number of minutes that all the events totaled together add up to.

Index (1/hr) is determined by taking the total events and dividing that by the total time in hours that you were recording.

% Artifact is the amount of time in % that the machine recognized the data as an artifact.

Adjusted Index (1/hr) takes the total time and subtracts the amount of time in artifacts. Then it takes the total events and divides it by the adjusted time. This removes the time spent as an artifact and is supposed to give you a more realistic index value.

Jumping to the Analysis Parameters, common desaturation values are 3% or 4% over a period of 10 seconds. The 10 seconds seems to be used all the time. Pulse Event parameters vary depending upon what you are looking for. The 6 beats per minute change over 8 seconds racks up a lot of events and is very sensitive to rolling over in bed and every other movement. More serious heart events begin to be scored using something like a change of 15 beats per minute over 30 - 45 seconds. This value is very subjective and a cardiologist will adjust the parameters to match what he is seeing in relation to the desaturation data and it also depends upon what is trying to be determined from the data.