Help interpreting waveforms

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
ajack
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Re: Help interpreting waveforms

Post by ajack » Mon Feb 19, 2018 9:39 pm

from the links, referencing the 95%, It isn't in dispute, you are discounting the significance of the data given by sleepyhead, you must think they put up the median, 95% and max pressure for fun.

The Use of Auto-Titrating Continuous Positive Airway Pressure for Treatment of Adult Obstructive Sleep Apnea
An American Academy of Sleep Medicine Review
Richard B. Berry MD,1 James M. Parish MD,2 and Kristyna M. Hartse PhD3
1Malcom Randall VAMC/University of Florida, Gainesville, Florida; 2Mayo Clinic, Scottsdale Arizona, 3Sleep Consultants, Fort Worth, Texas

APAP devices allow transfer of pressure over time information
to a computer for analysis. Some reveal only the percentage
of time at each pressure while others record more detailed information
such as leak and persistent apnea/hypopnea counts. Given
sufficient and reliable data, the clinician could then review the
data and decide on an appropriate fixed pressure. Two common
alternatives are to identify either the maximum pressure or a
pressure only rarely exceeded (95th percentile pressure). The
95th percentile pressure (P95) is the level of pressure exceeded
only 5% of the time. Most devices will display a plot of the percentage
of time each pressure is applied and will compute pressure
statistics (Pmean, P95, and Pmaximum) over a selected number of
days. The ability to store more than one night of data is useful, as
more than one night may be needed to effectively select an appropriate
fixed pressure. However, longer periods of titration may
potentially increase cost. In most published studies, investigators
viewed some form of raw data to eliminate periods of high mask
leak or determine if the titration was technically adequate. Many
devices respond to high leak with increases in pressure often up
to a set maximum pressure.


p95 = 95%

The APAP combines the Titrate Mode with new Auto Mode to effectively adjust the
pressure for maximum comfort, with the premise of effective treatment. To get a accurate
P95 pressure, Titrate Mode is applicable for the first 1-2 weeks during the use. Based on
the P95 pressure, MAX APAP is determined. It is suggested to set the MAX APAP little
higher(1or 2 cm H2O) than P95 pressure. And based on the Pmean pressure, Treat P is
determined. It is suggested to set the Treat P little lower(1or 2 cm H2O) than Pmean
pressure. It can improve patient’s compliance with more accurate and humane pressure
range.

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palerider
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Re: Help interpreting waveforms

Post by palerider » Tue Feb 20, 2018 12:12 am

ajackass wrote:
Mon Feb 19, 2018 9:39 pm
from the links, referencing the 95%,...

"It is suggested to set the MAX APAP little higher(1or 2 cm H2O) than P95 pressure.

And based on the Pmean pressure, Treat P is determined. It is suggested to set the Treat P little lower(1or 2 cm H2O) than Pmean
pressure.
It can improve patient’s compliance with more accurate and humane pressure range."
Since you couldn't figure out what you screwed up understanding, I underlined it for you.

Note. "Pmean != P95" well, at least, not necessarily, though it is mathematically possible.

Your assertion "I'd actually lower your min epap, till you are 1-2 below your epap 95%" is baseless as well as being not supported by the information you've referenced.

Which bit of this aren't you getting?

Furthermore, those 'shortcuts' are for use when all yo have is the Pmean and P95, not when you have as it says before that, "sufficient and reliable data", which we do, there's no need to use the "two common alternatives". as it says IN THE DOC.

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Last edited by palerider on Thu Feb 22, 2018 9:12 pm, edited 1 time in total.
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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

ajack
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Re: Help interpreting waveforms

Post by ajack » Tue Feb 20, 2018 12:53 am

It's not my fault you don't understand the terms

Pmean is the median pressure, seen as 'MED'; in sleepyhead, this manufacture suggests having the min 1-2cm under the median and the max 1-2cm above the 95% for a few weeks to determine the 95% number. To then change to a fixed pressure of 95%. as referenced in the other link as well.

as to my suggestion on having the min 2cm under 95% with dreamstations is because they are a dumb machine, compared to the resmed and remstar, (resmed clone) dreamstation needs to be closer to the 95% number. I would even be happy with suggesting 1cm below, as long as the min is a bit below 95% you then know you aren't over pressure. Having the max a few cm above 95% gives the machine room to move on a bad night. the dreamatation doesn't respond as well as resmed and remstar, when it is set just below median

again, why do you think the manufactures and those that conduct sleep research use these numbers, it isn't for fun. I'm still waiting for you to expand on your statement "Basing min pressures on the 95% pressure is a rookie move.'
Would you like me to send an email on your behalf to the mayo clinic who are doing the study, I can ask them to contact you here, so you can enlighten them on their rookie mistake?

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cby1
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Re: Help interpreting waveforms

Post by cby1 » Tue Feb 20, 2018 5:57 pm

As requested by some of you, here are some shots from months ago on my Airsense 10 CPAP. Although the AHI is not that bad, you see some clusters where the pressure is pinned at 20. Also look at the FL chart - not so good.

Image

Image

An attempt at a constant (and lower) pressure:

Image

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palerider
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Re: Help interpreting waveforms

Post by palerider » Tue Feb 20, 2018 8:27 pm

ajackass wrote:
Tue Feb 20, 2018 12:53 am
It's not my fault you don't understand the terms

Pmean is the median pressure, seen as 'MED'; in sleepyhead, this manufacture suggests having the min 1-2cm under the median and the max 1-2cm above the 95% for a few weeks to determine the 95% number. To then change to a fixed pressure of 95%. as referenced in the other link as well.

as to my suggestion on having the min 2cm under 95% with dreamstations is because they are a dumb machine, compared to the resmed and remstar, (resmed clone) dreamstation needs to be closer to the 95% number. I would even be happy with suggesting 1cm below, as long as the min is a bit below 95% you then know you aren't over pressure. Having the max a few cm above 95% gives the machine room to move on a bad night. the dreamatation doesn't respond as well as resmed and remstar, when it is set just below median

again, why do you think the manufactures and those that conduct sleep research use these numbers, it isn't for fun. I'm still waiting for you to expand on your statement "Basing min pressures on the 95% pressure is a rookie move.'
Would you like me to send an email on your behalf to the mayo clinic who are doing the study, I can ask them to contact you here, so you can enlighten them on their rookie mistake?
You're a clown.

"remstar, resmed clone" Respironics remstar... resmed clone, eh?

clown.

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Last edited by palerider on Thu Feb 22, 2018 9:13 pm, edited 1 time in total.
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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

ajack
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Re: Help interpreting waveforms

Post by ajack » Wed Feb 21, 2018 2:34 am

so you think mayo is a clown too? It seems we are at an impasse and you are resorting to abuse. where you can't acknowledge your lack of knowledge about 95% pressure. so be it.

as well as the manufacture, The links I posted about the studies, for repultable American Academy of Sleep Medicine Review
https://aasm.org/resources/practicepara ... rating.pdf
The Use of Auto-Titrating Continuous Positive Airway Pressure for Treatment of Adult Obstructive Sleep Apnea
An American Academy of Sleep Medicine Review
Richard B. Berry MD,1 James M. Parish MD,2 and Kristyna M. Hartse PhD3
1Malcom Randall VAMC/University of Florida, Gainesville, Florida; 2Mayo Clinic, Scottsdale Arizona, 3Sleep Consultants, Fort Worth, Texas

also
https://aasm.org/resources/practicepara ... rating.pdf
Practice Parameters for the Use of Auto-Titrating Continuous Positive Airway
Pressure Devices for Titrating Pressures and Treating Adult Patients with
Obstructive Sleep Apnea Syndrome


An American Academy of Sleep Medicine Report
Standards of Practice Committee of the American Academy of Sleep Medicine
Michael Littner MD,1 Maxwell Hirshkowitz PhD,2 David Davila MD,3 W. McDowell Anderson MD,4 Clete A. Kushida MD, PhD,5 B. Tucker Woodson MD, FACS,6
Stephen F. Johnson MD,7 and Merrill S. Wise MD8
1VA Greater Los Angeles Healthcare System, and UCLA School of Medicine, Sepulveda, CA; 2Baylor College of Medicine, Houston VAMC Sleep
Disorders and Research, Houston, TX; 3Baptist Medical Center, Little Rock, AR; 4College of Medicine, University of South Florida, Tampa, FL; 5Stanford University Center of Excellence for Sleep Disorders, Stanford, CA; 6Department of Otolaryngology and Communication Sciences, Medical
College of Wisconsin, Milwaukee, WI; 7Saint Patrick Hospital Sleep Center, Missoula, MT; 8Departments of Pediatrics and Neurology, Baylor College
of Medicine, Houston, TX.

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Last edited by ajack on Wed Feb 21, 2018 2:55 am, edited 1 time in total.

ajack
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Re: Help interpreting waveforms

Post by ajack » Wed Feb 21, 2018 2:41 am

cby1 wrote:
Tue Feb 20, 2018 5:57 pm
As requested by some of you, here are some shots from months ago on my Airsense 10 CPAP. Although the AHI is not that bad, you see some clusters where the pressure is pinned at 20. Also look at the FL chart - not so good.
I would think you have a positional apnea with the clusters, on those charts, you may still be having them with the vauto. I would get a $10 foam cervical collar, to keep your airway straight, use a flat pillow and then review your chart. It will tell you one way or another and save a week of messing around if it is chin tucking, etc.

on the vauto, you can open the max up to reach 25, I don't know if it would help.

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Pugsy
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Re: Help interpreting waveforms

Post by Pugsy » Wed Feb 21, 2018 8:57 am

Hey ajack....the report showing the machine maxing out at 20....that was a report from back when he was using the AutoSet. It can't go higher.
That's how come he got the VAuto. He needed more pressure.
His reports when he first posted are showing the VAuto going past 20 and the settings are indeed max 25.
Look back to his very first post and the machine type and settings.

Hmm...looks like someone edited out their boo boo. So you guys might not see what I was talking about since I didn't quote it.
Note to self...don't make that mistake again.

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palerider
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Re: Help interpreting waveforms

Post by palerider » Wed Feb 21, 2018 11:58 am

Hence, clown, limited comprehension, no attention to detail, misses important nuances.

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cby1
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Re: Help interpreting waveforms

Post by cby1 » Wed Feb 21, 2018 3:06 pm

OK, lively debate ;-) - I'd like to ask a related question to the original. When I scroll through my wave forms, I notice a phenomenon where the form is flat or nearly so between breaths for less than 10 seconds. This tends to occur in the latter part of my sleep period (which admittedly is not at all consistent these days - that needs to be fixed).

Image

Is there a way to set up a Custom flag in SleepyHead that would flag periods that would be CAs, but are less than 10 seconds? Say something like >5 sec and <10? It would be great to see them in the Events tab and charts in the same way as "regular" events.

Not 100% sure what I would do with that other than to try to structure my sleep time, medications, whatever to try to avoid conditions/periods where there are a lot of them. I sometimes have the sense that I wake from these during very fragmented dreams, take a breath, and have a rapid pulse. If I have a lot of these < 10 sec things, it's probably not helping my cause.

Thanks.

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Pugsy
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Re: Help interpreting waveforms

Post by Pugsy » Wed Feb 21, 2018 3:27 pm

cby1 wrote:
Wed Feb 21, 2018 3:06 pm
Is there a way to set up a Custom flag in SleepyHead that would flag periods that would be CAs, but are less than 10 seconds? Say something like >5 sec and <10? It would be great to see them in the Events tab and charts in the same way as "regular" events.
You can do custom event flagging but it won't separate CAs, OAs or hyponeas...just will give you a user defined flag of some sort to look at.
Preferences/CPAP tab and lower left corner.
When I played with it I had a dickens of a time getting it to show up though. I forget what I finally had to do. Sorry.

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palerider
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Re: Help interpreting waveforms

Post by palerider » Wed Feb 21, 2018 9:18 pm

cby1 wrote:
Wed Feb 21, 2018 3:06 pm
Is there a way to set up a Custom flag in SleepyHead that would flag periods that would be CAs, but are less than 10 seconds? Say something like >5 sec and <10? It would be great to see them in the Events tab and charts in the same way as "regular" events.

Not 100% sure what I would do with that other than to try to structure my sleep time, medications, whatever to try to avoid conditions/periods where there are a lot of them. I sometimes have the sense that I wake from these during very fragmented dreams, take a breath, and have a rapid pulse. If I have a lot of these < 10 sec things, it's probably not helping my cause.

Thanks.
Yes, there are a couple of flags that you can set. under file/preferences, turn on the 'custom CPAP user event flagging', and set them up however you want. then you'll need to do a data/rebuildcpap data to get them to show up... at that point you should get flags for them on the flags strip.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

cby1
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Re: Help interpreting waveforms

Post by cby1 » Wed Feb 21, 2018 9:50 pm

Thanks guys - will try it out. Any gotchas on the data rebuild?

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Pugsy
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Re: Help interpreting waveforms

Post by Pugsy » Wed Feb 21, 2018 9:57 pm

Yeah...that was what I had to do to get the User Flags to show up...the rebuild.
Nothing bad happened and turning them off was a lot easier than making them show up.
You might not even have to do the rebuild thing but just thought I would warn you just in case they don't show up right away.

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ajack
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Re: Help interpreting waveforms

Post by ajack » Wed Feb 21, 2018 10:53 pm

it seems you also have a reading comprehension issue, would you like to read my post again? I did say the vauto can go to 25. It has cleared it, I don't know if long term it will help. it doesn't alter the point that they could be positional and need less pressure if the airway is open? For me, it's worth trying a collar and seeing.

Do me a favour and add me to your ignore list. in every forum there is someone will mega posts, that sets up their sign and tent, but still knows nothing. Have you got your head around 95% yet?

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Last edited by ajack on Wed Feb 21, 2018 11:20 pm, edited 2 times in total.