Fraudulent sleep study?

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USMCVet
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Fraudulent sleep study?

Post by USMCVet » Sat Feb 17, 2018 12:20 am

The more I think about this the more I don't believe it. I'm tired and not at the top of my game so please play a reasonable devil's advocate if you can.......

So her are some average nights recently for me.
https://i.imgur.com/TVcdq5X.jpg
https://i.imgur.com/20uqspq.jpg
https://imgur.com/a/WAKHM

So all of a sudden with nothing different except it was a sleep study night scored manually I have a ton more events?

I get headaches while sleeping during study and chest pains localized over heart when I haven't with auto settings?

It's weird and even my provider couldn't explain during appointment why my ahi was so high at 8 when my 90% with and ahi less then 1 has been in the 7 range. She was baffled lol.

I guess I honestly don't have much trust in medical community and trust you all more.

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ajack
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Re: Fraudulent sleep study?

Post by ajack » Sat Feb 17, 2018 1:16 am

You don't have a 10cm chart yet?

I would trust the lab before a machine..you really did have 6 H apnea in 25 minutes on 8cm and 3 H apnea in 78 minutes at 9cm, I guess you can put some of it down to coincidence. You are looking at a snapshot of time. It could have gone the other way.

I do actually also like 10, because it had REM and you were on your back, 2 of the things that can show trouble in a lab test,

now let me bag out the lab, look along the minute line, this is the total time at that pressure. You were on 10cm for 28 minutes.
Doing all night at a pressure in your own bed and pillow, can and does give different results sometimes, compared to the study. The study checks a lot of other stuff and should always be done. Once the study gives you a tick, I think you can tune a machine better at home, taking several weeks to get to the final pressure settings and your spo2 meter. Your tidal volume and minute vent is also a great help.

Your 9cm may actually be 10cm in a lab (see how I did that :)
10cm on a lab machine may be different to your machine, they have a surprisingly large margin of pressure error, look in the clinical manual

also the home machines tend to have a higher result, as the study discounts apnea that don't have a desaturation. Yours went the other way and the home machine recorded less,

anyway after all this waffle, I'd stick the machine on min 10

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Re: Fraudulent sleep study?

Post by USMCVet » Sat Feb 17, 2018 1:51 am

Thanks for the opinion! I do really appreciate it even though it's contrary to my own. I know almost nothing!

The machine they used looked like an S9. My 02 that looked better since 02 already looks worse since being off it for 24 hours. For example it was just 91 to 92%.

I do plan to take a sp02 measurement tonight work 10cm pressure and ramp starting at 4cm for 20 min and cflex of 3.

One thing I have noticed which is confirmed by sleep studies os that first half of night I am in deepest sleep. During this time my 02 is lowest in general.

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Re: Fraudulent sleep study?

Post by ajack » Sat Feb 17, 2018 1:57 am

with flex 3, I'd have min 12, that will give about 10 for the o2

If you go for another study, I'd stop the o2 and cpap for a few days. To get a base reading of o2 and apnea. It isn't going to be an issue, because you know how to adjust your machine and you have a recording spo2 meter that is accurate enough. it will work out over the next week or so.

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Re: Fraudulent sleep study?

Post by USMCVet » Sat Feb 17, 2018 1:58 am

This is my current sp02 awake without supplemental 02 in over 24 hours....

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Re: Fraudulent sleep study?

Post by USMCVet » Sat Feb 17, 2018 2:00 am

ajack wrote:
Sat Feb 17, 2018 1:57 am
with flex 3, I'd have min 12, that will give about 10 for the o2
Don't forget every other pressure gave me better sp02 then 10cm which they set me up with

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Re: Fraudulent sleep study?

Post by ajack » Sat Feb 17, 2018 2:15 am

I'm thinking 12 with flex, gives you an out when they ask why you changed the setting and added flex. If it wasn't for the peep and o2, I wouldn't bother. I'd use 10 and see how it went. I can understand you wanting to use flex, it is a shock to the system, when you use pressure.
I understand you are scared that without supplemental o2 your levels are going to plummet, If you are concerned with the results over the next few nights, it's back to the doctor. you know not to mess around.

from memory, you normally have a base of 92-93% with that meter, without o2? so you are down 3, It depends if the 92% is accurate. You may actually be sitting at 95% ?
Take it with you next time you go to VA, If you ask nicely, you can use their hospital spo2 and your meter and see what the reading is. It may be quite different.
I would trust the lab spo2 meter and they all showed an okay average above 90%. It may be skewed because you were recently using o2. i assume the lab knew this?

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Last edited by ajack on Sat Feb 17, 2018 2:27 am, edited 1 time in total.

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Re: Fraudulent sleep study?

Post by USMCVet » Sat Feb 17, 2018 2:26 am

My concern is Dr death at VA trying to screw me because I have reported her at Least 4 times.

My pulse oximeter showed higher readings then the VA one I used overnight that got me oxygen. My oximeter and the study one both show lower sp02 in beginning of night when I sleep the deepest.

Deep breaths get me better 02 but normal breathes lead to lower 02. I think my tidal volume is issue.

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Re: Fraudulent sleep study?

Post by USMCVet » Sat Feb 17, 2018 2:27 am

Yes lab knew I was using 02 but don't think it was considered.

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Re: Fraudulent sleep study?

Post by ajack » Sat Feb 17, 2018 2:30 am

OKAY, so you trust your meter to give accurate enough data, It looks like it' might back to the doctor that gave you the supplemental o2. just sitting around awake should be over 92%. 88% is the trigger level. sleep is normally lower than your awake numbers, but you still want over 90%

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Re: Fraudulent sleep study?

Post by USMCVet » Sat Feb 17, 2018 2:34 am

I trust it enough since everyone else I have use it is at 97 to 99%. I'm using CPAP now and fixed ramp and I'm at 97%. Was just at 87% prior to turning on CPAP. Tonight will tell though

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Re: Fraudulent sleep study?

Post by ajack » Sat Feb 17, 2018 2:50 am

Well that's one bit of good news, you should feel better going to sleep tonight. It was a big swing.
The lung doctor may shed some light, when you see him.

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Re: Fraudulent sleep study?

Post by NightWatch23 » Sat Feb 17, 2018 5:39 am

This thread illustrates, I think, part of what really frightens me about this whole process. It seems to me, after looking and many of my charts in Sleepyhead, that not only are some night different than others, but sometimes I have good parts of a night, and it's not the same part twice. Yes, I've made changes, but when I stuck with the settings they chose after my first lab study, which had 100 minutes of sleep, and, coincidentally for this thread, was 10 cm H20, my AHI went down a little, but the aerophagia was awful, and I couldn't stay asleep for more a couple hours most nights. (ETA: I stuck with it for 16 miserable days with no improvement).

It seems to me like they are making guesses based on small data samples. It seems like bad science, not quality medical care.

Are they suggesting that you set your machine based on 28 minutes of one night of study? What if those minutes just happened to be when you were at the right sleep stage for breathing right? Even my messed up charts show half hours that look good sometimes. Or am I misunderstanding how this works because I'm sleep deprived?

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Re: Fraudulent sleep study?

Post by RicaLynn » Sat Feb 17, 2018 7:09 am

It seems to me like they are making guesses based on small data samples. It seems like bad science, not quality medical care.
Which is exactly WHY this forum exists: to help YOU, the patient, dial in your treatment after some trial and error with the sleep study as a starting point. You *can* tweak you pressures to make them work for you, regardless of what your DME tells you.

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Re: Fraudulent sleep study?

Post by TedVPAP » Sat Feb 17, 2018 9:54 am

In-lab data is high quality, but the amount of data is limited. Limited data is better than nothing but understand that uncertainty is high.
For example, my average AHI is ~0.5. On a particular night it was 0.91. Zooming in on a particular 30 minute period gave an AHI of 15.2.
I encourage everyone I know to examine their data using sleepyhead.

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