Got Data! Interesting Conclusions

[Snoozin' Bluezzz]

Well, I received my used Remstar Auto, figured out how to set it up, download reports and now have three days of data. I went to this trouble because I didn’t trust my sleep study and medical folks. Hmmmm, that will show me.

If this machine is functioning properly (some small questions about that) it appears to confirm my sleep study and what the medical folks have been saying.

I have mild OSA relieved by a pressure of 8cm H2O. I’ll be doggoned! I started in auto and that didn’t work very well for some reason. Went to 8 the 2nd night and had an AHI of 1.4 which was distorted by a leak test on the humidifier connection, real AHI was likely .4 (a hypopnea, no apnea). Went to 7 last night and had an AHI of 1.2 (1.1 hypopnea and .1 apnea) which was not distorted by any testing. Snores dropped dramatically but 1st night was CL2 (perhaps why Auto misbehaved), 2nd night was Swift and last night was Headrest so snores might be because of interface change. I am going to zero in on 8-9cm H2O range and retry auto with the Swift and/or Headrest to see if CL2 was creating the problem. I know I am creating too many variables by mask switching but I am really striving to get sorted out on the Headrest because it is so comfortable.

It is good to get data!

SB

[Goofproof]

To get reliable data you can make sense of, you need 3 or 4 nights doing the same thing the same way. It sounds like you are chasing Cats. You have to Pen one, Before you chase the others.

I know we can't wait to see results, I am the same way, but to make sense of the numbers we have to get avg numbers. Night to night the way we feel enter into our sleep and effects it. Jim

[Snoozin' Bluezzz]

Yeah, I know, I really do understand that. What I was struck by though was my uncertainty about the sleep study and the initial data really supporting it.

I'll steady it out and compare Headrest to Swift. I think I need to see if the CL2 was causing the Auto problems on the first night and then trust the Auto if it works as it should. Otherwise I have to do it the hard way, one slow step at at time.

Thanks for the feedback. It really is helpful to keep me focused.

SB

[snork1]

To get reliable data you can make sense of, you need 3 or 4 nights doing the same thing the same way. It sounds like you are chasing Cats. You have to Pen one, Before you chase the others.

I know we can't wait to see results, I am the same way, but to make sense of the numbers we have to get avg numbers. Night to night the way we feel enter into our sleep and effects it. Jim

Good point!
which reinforces my feeling that Official "sleep studies" are very odd. They base the entire treatment of people for their next year or two of treatment on a couple of hours of sleep in a setting in which its ALL variable from what you will experience at home.

Seems like at a MINIMUM, sleep studies should be run in the lab for supporting "details" then send people home with an auto and pulse ox and the doc should analyse THAT data after a few days in light of the sleep study results. Instead of the usual slam, bam, thank-you-ma'am approach that sleep studies seem to be done in.

[NightHawkeye]

Seems like at a MINIMUM, sleep studies should be run in the lab for supporting "details" then send people home with an auto and pulse ox and the doc should analyse THAT data after a few days in light of the sleep study results. Instead of the usual slam, bam, thank-you-ma'am approach that sleep studies seem to be done in.

Uh-huh . . ., well let's think about this. A holter monitor costs what, $500 or so for 24 hours? Then the doc charges another what, say $250 to "interpret" the data, which has already been interpreted by the company supplying the holter monitor. (So all the doc really does is charge you $250 to read you the results already prepared for him.) The good news for the cardiologist is that anything which shows up in data is another potential source of revenue, possibly even a bonanza.

Compare that with sending a patient home with an APAP and oximeter. (Assume these are an integrated unit which can provide data to a centralized data processing laboratory, otherwise, the poor doc has no hope of understanding any of it.) When your physician gets your home results back, that's generally the end of his revenue stream. What's he gonna tell you to do other than the following?
1) raise pressure
2) lower pressure
3) get better mask
4) keep mask attached to face

So now I'm thinkin': No money in it, not gonna happen.

Regards,
Bill (just following the money, connecting the dots)

[Snoozin' Bluezzz]

I'm not disagreeing with you folks. I'm almost disappointed that my initial results with the APAP are seeming to support my Sleep Study when I was so frustrated with how it was done. That being said, it does appear that the lab may have gotten it right and what are the odds of that,

I do believe that even with the pecuniary motives that MDs etc might have to do ongoing support and follow-up they really miss out on it. If they understood, really understood, sleep medicine and knew what they were doing they would be doing, or coordinating, the ongoing monitoring and analysis - like lab work for Statins, or cancer follow-up, or diabetes follow-up, and there is money in that, instead of forcing it into our hands. I am happy to have it there actually but...

SB

[Brent Hutto]

I know some people think an MD degree is a license to steal money by defrauding those gullible suckers who actually go to a doctor expecting some kind of professional diagnosis and treatment that will help cure disease and improve quality of life. Those people can stop reading here, this message is for everyone else.

My sleep doctor would be the first to admit that a sleep study is an expensive one-night sample of whatever sleep disorders a person might be suffering from. Yet for the majority of people it tells him enough to start a course of treatment that ultimately works (generally CPAP). If that doesn't work his second choice is to send home an APAP and look at a summary of 30 nights of data to get another angle on what's going on. In fact, that's what he did in my case.

The problem with my sleep study was that the lab tech stopped increasing the pressure at 9cm because of what she thought might be "central apneas". I was still experiencing some snoring and residual OSA at that setting so his thought was that an APAP trial would show that something like 10-12cm did a better job of keeping my airway patent. Today I went for my followup and he looked through 30 nights of data (actually 32 nights). Like Snoozin' Bluezzz he was surprised to find that the median pressure was 8cm and the 95th-percentile pressure was 9cm. Only very occasionally did the machine briefly go above 10cm (absolute maximum was 11.0cm) and the "residual AHI" reported for that 30-night period was 13, identical to the residual RDI at 9cm in my titration study (for my money, an APAP-AHI most closely equates to a PSG-RDI than PSG-AHI).

He thinks a good bit of that residual will be resolved if I can fix my mouth leak problems. But I've looked at my data enough to know that I have a residual of 5-8 events per hour even when my leak rate is darned close to zero. So we discussed some further followup of my GERD, perhaps it's not being treated as completely as I think by Pepcid even though I have zero subjective symptoms. Worst case, if my APAP 7-12 treatment never gets me all the way down under AHI=5 I'm still doing a lot better ESD-wise and otherwise.

So Mr. SB isn't the only person out there to get surprisingly consistent results from a hard-to-believe PSG night and the data gathered by an APAP.

[NightHawkeye]

He thinks a good bit of that residual will be resolved if I can fix my mouth leak problems. But I've looked at my data enough to know that I have a residual of 5-8 events per hour even when my leak rate is darned close to zero. So we discussed some further followup of my GERD, perhaps it's not being treated as completely as I think by Pepcid even though I have zero subjective symptoms. Worst case, if my APAP 7-12 treatment never gets me all the way down under AHI=5 I'm still doing a lot better ESD-wise and otherwise.

Brent, have you taken an oximeter home to determine if the residual events are significant? My residual AHI hovers just under 5, but most of those are labeled hypopneas and are not significant in terms of oxygen saturation. Yours might not be significant either. Have you checked? An oximeter would tell you whether or not they were (and make snork1's case for him. )

I know some people think an MD degree is a license to steal money by defrauding those gullible suckers who actually go to a doctor expecting some kind of professional diagnosis and treatment that will help cure disease and improve quality of life. Those people can stop reading here, this message is for everyone else.

Please don't take offense, Brent. I fully realize that the medical world is full of folks with good intentions, God bless 'em. But, it is, unarguably, also an industry motivated at its very core by money. That's just a fact. Personally, I believe the money aspect of the business is a good thing. Just look at socialistic models of healthcare for comparison.

I wish though that consumers of health care were treated like consumers are in any other business. If they were, then distinguishing between good and bad physicians would be much easier than it is, and there would probably be little need for a board such as this. You might also consider that the very thing which enables this board to exist is money.

Regards,
Bill