got my data :)

[Pugsy]

And you had one desaturation.

And interesting how your RDI was exactly 15.

What do you think?
Did they stretch the truth in an effort to
1. sell a machine and get insurance to foot the bill since doc and sleep lab are sleeping together
2. sell a machine to hopefully help with the patient's symptoms

[sleepstar]

However, I would question Events 5 and 6. Sure the flow looks terrible for a prolonged period of time (~73 and 89 seconds, respectively) but why is there not a concomitant desaturation? Given what happened in the Event 1 I would have predicted a substantial desaturation. Yet, nothing! Was it a signal problem? Maybe mouth opened at that time (perhaps they had a nasal-only pressure cannula). The abdominal and thoracic channel activity do not support that degree of obstruction either (look at the areas where valid hypopnea occurred).

And indeed, if we are to Zoom In (Alice talk for amplify signal) on those 2 events:



while it is clear that amplitude reduction has occurred, the events bear closer resemblance to Event 3 (the significant flow limitation occurring only in the center of the "scored" hypopnea).

were there arousals there? looks like some pretty classic REM breathing

[sleepstar]

also looks like a bit of auto scoring from alice lol. with the duration of those events...
and some great positioning of the thermistor. heh.

[mollete]

And you had one desaturation.

And interesting how your RDI was exactly 15.

What do you think?
Did they stretch the truth in an effort to
1. sell a machine and get insurance to foot the bill since doc and sleep lab are sleeping together
2. sell a machine to hopefully help with the patient's symptoms

Well, "IMHO", any "stretching of the truth" should have been shared with the patient.

TS, "Da Rules" do not allow for "stretching of the truth".

TS2, I suppose a look at Amy's insurance might shed some light. If a CPAP machine was clinically indicated:

• At RDI 15 they'd probably pay for it no questions asked;
• At RDI 5 - 14, they might pay for it with additional documentation (one of which would/could be EDS, but with Epworth at 7, you could not make that case); or
• At RDI < 5 (or more appropriately AHI < 5 and a bunch of RERAs) you could try to make the case for UARS, but some insurers might not buy that act.

[Pugsy]

Well, "IMHO", any "stretching of the truth" should have been shared with the patient.

I also think that she should have been given the options and explanations and the whys and maybes.
Given a choice or voice in things.

I won't even go down the "patients shouldn't have a voice" road. Like we are all too stupid to understand this whole "complicated" process so why bother trying to explain things to morons.

[pandatx]

Molette, are you saying I shouldn't even be trying to get acclimated to the CPAP b/c I don't really need it?

[sleepstar]

Molette, are you saying I shouldn't even be trying to get acclimated to the CPAP b/c I don't really need it?

If you were feeling tired and you're feeling a benefit from CPAP, that is fantastic.

I had a lady today with an AHI of 3.5 who feels completely amazing on CPAP. She had what we call "subcriterion events" - they can't be "officially" scored according to the rules, but they sure are disturbing her sleep.

Also, if you have a partner who is irate about some snoring.... they love these little CPAP things

[pandatx]

you make good points

xo

[mollete]

Molette, are you saying I shouldn't even be trying to get acclimated to the CPAP b/c I don't really need it?

Small "m", two "l"'s, one "t"!

Well, that would constitute DWing (see chapter on DWing), and one of hazards/inefficiencies of DWing is that there may be a number of variables that have not been accounted for.

That said, perhaps a better approach would be to make a List of Things that need fixing. Some thoughts:

• Get Sleep Efficiency to > 90% (yeah, I know, "normal" is > 85%, but let's set the bar high).
• Reduce Awakenings to < 5.
• Reduce Arousals to < 40.
• Keep ESS < 10 (BTW, what is it now? Your NPSG listed it at 7).

And certainly getting Graves' under control (to get that variable off the table) is an important consideration.

[mollete]

also looks like a bit of auto scoring from alice lol. with the duration of those events...

I believe all those "@"s mean manual entry.

Maybe we should do a WebEx to review respiratory events! We could invite their scorer to defend their position!

[pandatx]

so sorry mollete for my bad spelling!

Okay, I like making the list of things to improve. Boy, I can only imagine how I'd feel if my sleep looked like what the goal picture is. That would be amazing.

[khauser]

Small "m", two "l"'s, one "t"!

Not according to your button!

I think a capital M can be forgiven when it's at the start of a sentence, though.

Then again, it isn't my name...

[Drowsy Dancer]

Why "mollete" anyway? Got a taste for Andalusian cuisine?

[mollete]

Why "mollete" anyway?

Kind of a continuation of the "baked goods" theme.