Comments from sleep specialist

[Gillian]

Did you ask about the use of ETCO2 in any future studies?

No sorry, didn't know anything about it.[/quote]
At this point it's water under the bridge, but:

BTW you might want to plant the seed of monitoring your ETCO2 when/if you go back for re-titration.

OMT, did you tell them you want End Tidal Carbon Dioxide (ETCO2) levels monitored during your NPSG? That will be critical to assess the extent of underlying disease.

[/quote]

My mistake and no excuses but the fact that I am so out of my depth here and when I get into the docs room emotions get the better of me. I know I'm supposed to write everything down.

What is an NPSG? Is that the monitoring while sleeping? I was thinking of asking if I could have a study done in a clinic. My last one was at home just with a machine.

Now to the oximetry report.
Minimum saturation 44% (He didn't tell me this, it must have been the anomaly he was talking about.
Total durations of study less than 89% (after 8.5 hrs of recording] 16 min 36 sec.
Interpretation; Overnight oximetry on CPAP and room air Brief episodes of desaturation were seen. Clinical review is recommended.

And that is it! I tried to read the data you gave a link for to the ivaps.. Think I more or less understood it. Haven't been able to find anyone in Aus who is selling it though.

Thanks Mollete (hope I've done everything you asked for now, my brain cells must be slowly dying.)

[mollete]

NPSG is Nocturnal Polysomnography, or flashy name for sleep study.

Home studies, for the most part, do not monitor actual sleep, or arousals. If all those respiratory events generate arousals, your sleep quality will be poor, so an in-house NPSG seems like a very good idea.

Can you scan and post the graphs from the oximetry? The report does not state the total number of desaturations. This important to know as it will determine if all those respiratory events have associated desaturations or if the baseline simply drops down for a while. Desaturations are 3 - 4% drops (and do not need to be <89%) so you could have tons of them, especially if your baseline is normal (>95%).

iVAPS (on S9 ST-A) has only been out for a couple months, so you probably won't find one used, consequently the cost makes it an unlikely DWing candidate.

"Clinical review is recommended" is code for "this could be a bad report if the patient has symptoms", which you got, so it might.

That 44% could be the "anomaly" (but that's not necessarily the right word. If it was movement-related, it should be called "artifact").

Starting to get the hang of quotes, eh?

[Gillian]

Zoom in close on the airflow waveform and see how much air you're getting during the events. Sometimes, the machine triggers on something that's weird, but not that worrying. Even though you have a lot of events, at least they're fairly short in duration.

Archangle Which graph do I look at? Sorry to be dumb!
Gillian

Sorry about not being clear. The graph that says "Flow Rate" is the one I mean. It shows your breathing, breath by breath, and is sort of the data that everything else comes from.

[img][/img]

Is this the one you mean Archangle?

Gillian

[Gillian]

Hi Mollete
There were no graphs on that report. I will phone again tomorrow and find out what they can do. I'm sorry to mess you around like this!

Have a good day

Gillian

An iVAPS video:

http://www.resmed.com/epn/assets/multim ... 40x360.mp4

Thanks for the link, I'll watch it tomorrow, my eyes are too blurry now!

Thanks JNK

[mollete]

There were no graphs on that report.

Aha!

Obviously they are trying to hide something!

The Sword of Truth will cut through the flimsy facade!

[Gillian]

There were no graphs on that report.

Aha!

Obviously they are trying to hide something!

The Sword of Truth will cut through the flimsy facade!

Hi Mollete, you were right! He told them to just send me the first page. I,ll leave what I said to your imagination.......so I had to drive down there to get it. So here they are. I have also got my data for that night but for some reason am having trouble posting it. So I will send this off first.


[img[/img]
[/img]

[Gillian]

Hopefully this will be pg 2




Now I'll work on the other data. Hopefully won't take too long.

Gillian

[Gillian]

That's it. My leaks were really lousy that night. I was quite restless because having the pulse thing on my finger is very painful.

Thanks Mollete I await your thoughts with much gratitude for the time given.

Again thanks Mollete, I await your thoughts with much gratitude for the time you are giving to this.

Gillian

PS if you need anything else just let me know. One of these days I'll be an expert at doing all this.

[SleepingUgly]

The last graph was from the same night as the previous oximetry graphs? Leaky.

[archangle]

Is this the one you mean Archangle?

Gillian

Yes, that's it. Zoom in a little more and get a better idea of how many seconds you were breathing, how many seconds you were not breathing, how completely you stopped breathing, etc. Even at that scale, I can see you're at least getting some breaths in.

[mollete]

OK, so the short answer is "50% of the data in that nocturnal oximetry report is ("IMHO") at the least unreliable, so the test should be repeated using a disposable adhesive sensor that won't hurt your finger all night (or if that's what they used, don't wrap it around so tightly)".

The long answer is:

[mollete]

Two things to consider when deciding if an oximetry signal is valid is the plethysmographic waveform (which we don't have) and the pulse rate (which actually looks quite stable and suggests the oximetry data is valid). So at first glimpse, it would appear that you have at least 2 areas of desaturation (red boxes) that we need to get excited about.

That said, the data in those boxes looks is extremely unstable and not of a nature that is compatible with any clinical condition. Indeed, the entire first lavender box looks to have signal instability.

Then in the second box, the saturation is mostly pegged at 100%, which is extremely unlikely (unless you're like 2).

The green boxes finally look like "you".

Third lavender box more artifact.

From a technical viewpoint, all the artifact in the report should have edited out before submission (the 44% minimum, the maximum heart rate of 254, minimum heart rate of 48, etc.).

Do you recall during that study the periods when you knew you were awake?

[mollete]

OTOH, let's say the red boxes are valid, and have to figure out why. The first thought that jumps to mind is that they are REM-related. Of course, one could argue "Well, why are there only 2? And broken up (as though they were one with an interruption)? But then incredibly long for a first REM? And why is there not clear correlation with the breathing waveforms? Indeed, the worst breathing has the best oximetry."

[mollete]

So, as the tangled web becomes more and more... tangled, now is a good time to get back to basics, and ask ourselves (well, yourself anyway):

What is it you're trying to fix?

At the risk of being presumptuous, I'm seeing headaches, fatigue and foggy brain.

OK, well not really "me", per se...

[mollete]

And "A Number That Looks Bad":

More Data and Comments