Here are my OSCAR results

[Fejsbukpejdz]

So here are the newest results...

I am a little bit confused...

I increased his pressure but results seem worse now.

[Fejsbukpejdz]

Here are more detailed examples of what is going on...

On the image called "is this okay 2" it shows a segment that has "periodic breathing".
I wonder what that means?

[Fejsbukpejdz]

His min pressure was set to 8... Now I am thinking of increasing it to 10?! What do you guys think?

[Dog Slobber]

Leave it alone for a few days.

How long has it been on 8, one day?

If the minimum pressure was 4, and you increased it to 8 and the AHI went up, then why would you conclude that it should be moved up again to 10?

There are two many variables at work for one night to be meaningful.

[khauser]

His min pressure was set to 8... Now I am thinking of increasing it to 10?! What do you guys think?

Periodic breathing: https://www.sciencedirect.com/topics/ve ... 20seconds.

We all have good and bad days. You need to allow time for adjusting, and to gather a better (larger) set of data.

He spent a large time at the minimum pressure so I would not increase it personally, at least not yet.

BTW if alcohol is consumed it will definitely muck with breathing. I know from experience.

[Fejsbukpejdz]

I have one question... is the learning of this machine "cumulative" and data derived?

In other words, if I take out this memory card and insert a new one without anything on it...

would it affect how the machine works?

[khauser]

I have one question... is the learning of this machine "cumulative" and data derived?

In other words, if I take out this memory card and insert a new one without anything on it...

would it affect how the machine works?

I don't think the machine uses the SD card for anything other than reporting. Some providers don't even include the SD card.
You should be able to use another card, but it can't have other data on it or the machine will probably reject it, or so I have read.
- Kevin

[Dog Slobber]

These machines don't learn or make changes based on historical therapy. Every session is a new session not influenced by past sessions.

One exception is the DreamStation's Opti-Start, where it will start a session at the previous 90% pressure, and EZ-Start, where it limits pressure settings for new patients.

EZ-Start is such a bad idea it should be outlawed.

[Fejsbukpejdz]

I agree... I was just talking to a friend of mine why is Dreamstation so stupid compared to esMed AirCurve 10 VAuto when it comes to picking up flow limitations or maybe I am wrong?!

I saw some reviews and I am new to this but I wondered if A.I. could be used to learn each patient and how he breaths so the machine would work for example with a feedback P.J. to learn about the position of the patient and what to expect.

Such P.J. would be very cheap to make and such sensors are in our phones so easy to make.

I am really optimistic about that but letting the machine even A.I. with newest Nvidia tech "learn" from trial and error on a patient is... idk...
What I learned about A.I. playing with it for some projects since I can program phyton and c++, I've learned that it is very very very slow to learn certain tasks and requires thousands of failures to strike the right string.

And to be honest how do you hook up someone and let A.I. learn about that persons breathing... Person might be having worst time of his life until it happens lol.

On the other hand I am no expert in A.I. field.

Sophisticated methods exist which I have no idea of and have not worked with.

Still, medical licensing is what makes all these things expensive. In its core, those things are actually cheap devices. Clinical trials, licensing etc is 1. monopoly over market 2. standards have to be met.

Still how come there are such crappy machines by Philips out there?

I worked at insulin reserach facility for the EU licensing and we worked only with 2 major companies ‎Lilly and Novonordisk.

You know basic insulin is so easy to make people made it in their basement in WW2.

Now these companies really hold the monopoly and they set standards.

I was always puzzled by the amount of stupid rules they made up for us to put in clinical trials. I worked directly with patients testing the insulin on patients and then the clamper in the team would test sugar levels and Kalium levels every 5 minutes to see what is going on.

The results around the whole medical stuff are ridiculous! No one has money to fund that nor market control and contracts that will make that kind of investment pay off.
They really hold the grip over it.

Then I saw it in the news how expensive insulin got in America and I saw one heart breaking story of a single mother rationing her insulin.
It made me feel horrible...

All in all, I really thing big tech companies especially leading in 5G and A.I. will make advacements here in this field in the upcoming decade or so.

I firmly believe that is true.

Machine can work as it does and maybe just combine data about specific body position and then through time learn when it should expect problems to pop up more often.
Despite knowing how horrible my A.I. attempts were to do just some simple projects, I am very optimistic what Nvidia Huawei and Intel can do...

[Fejsbukpejdz]

I have one question... is the learning of this machine "cumulative" and data derived?

In other words, if I take out this memory card and insert a new one without anything on it...

would it affect how the machine works?

I don't think the machine uses the SD card for anything other than reporting. Some providers don't even include the SD card.
You should be able to use another card, but it can't have other data on it or the machine will probably reject it, or so I have read.
- Kevin

https://www.youtube.com/watch?v=RtAF7DpDnjc&

Can anyone tell me if this is flow limitation? In other words would BIpap be a better option here?
I'd be thankful because I can't bring the AHI further down and he keeps waking up as well as his oxygen keeps droping from time to time...

[khauser]

I'm not sure why you quoted me on that one ... hopefully people will figure out you were not replying to me and follow your link.

I don't have the expertise to answer your question.

-Kevin

[Fejsbukpejdz]

I'm not sure why you quoted me on that one ... hopefully people will figure out you were not replying to me and follow your link.

I don't have the expertise to answer your question.

-Kevin

+
ohh haha sorry, you look like a veteran in these things

Always trust a man with beard.

Yeah I hope someone else sees it. Since I am thinking that it indeed is flow limitation, I am thinking about getting a Bilevel for my brother.. TO be honest, money is not an issue and I am not going to wait for the insurances and the procedures to give me the machine. I will buy it and gladly throw this Dremstation in trash. It wasn't wasted money... In fact, we learned a lot about his breathing so it was worth it.

I am thinking about this: https://www.resmed.com/us/en/healthcare ... 0-sta.html

I think ultimately solution for him is maybe a surgery if he has upper airway resistance syndrome.

We managed to bring his AHI down but his flow seems limited. I am not an expert but I saw some diagrams and charts and I am thinking in that direction.

HE wakes up less but still keeps waking up.

You can see his flow rate hits 8 literally and stays there at this point. After that the arousals start.

You know what sucks? Dremstation does not see that as a problem at all..

Now I watched his normal breath before he dips into deeper sleep and it ranges from +35 to -35.

And here we talk about +8 to -10.

Further more I noticed which is paradoxal... His flow limit gets worse without A flex.

Which means changing the pressure and adjusting for breathing works good for him.

So logical conclusion is?! BiLevel would jump in there better than FLEX function and hit those spikes up a little bit so they do not look like flattened hill but hopefully like Matterhorn

Now bipap is not a perfect solution either because I think if it is a classical UARS it would require surgery and possibly even after the surgery>> bilevel.

Hard parts which can be operated on can be operated on.

Soft tissues that need to tense up a little bit can not be operated on.

Surger and post surgery bilevel will most likely be his therapy.

What is the problem with my theory?

Maybe I am such a noob and have no clue about this and what I look at is not even flow limitation.

When you make such extensive theory, either you're right or completely wrong. From my personal experience I was often wrong when I made such far fetched claims and assumptions.

Yet... why would flex help him so much?
Why are the tops so flat?

How come I can't find any diagrams with 8 flow rate and consequent arousal and to be honest quite often waking up?

Flow rate gets smaller and smaller. This flattening gets worse and worse and worse and lower and lower and then after 10 or 20 minutes he wakes up.

Dreamstation picks up often nothing.... Maybe vibratory snore at the end when it gets messy or obstructive apnea if the pressure is too low.


So idk... let's see what some of the gurus here have to say if they see it.
Maybe what I was looking at is completely normal and I'm just talking non sense...

[lrob123]

Is there supposed to be audio with that YouTube video? I couldn't hear any. If you are going to post a video, it might as well include audio so you can tell us what you are wondering about instead of just pointing a cursor.

I think a video is fun to have (I was interested to see it, but wanted audio), but everyone here is also going to want to also see the Oscar chart screenshot in the standard format that is described in the 'newbie' sticky post. In other words, turn off the calendar and order the charts in the suggested order. And make sure we can see the AHI at the top left. And people are going to want to see the Event Flags and Flow Rate charts zoomed out so we can see the entire nights data (although you can upload some additional screenshots zooming in also). If you want people on this forum to respond to your posts, posting the screenshots exactly as recommended is important.

Also, please add the equipment description of your brother's machine and mask and its pressure settings to your profile so it shows at the bottom of every one of your posts. Again, this will increase the chance of the regulars wanting to respond to your posts.

I would say if money is no object (sounds like your family has $$$), then go ahead and buy the Resmed Bi-level (BiPap), ideally the one most people here prefer which is the : ResMed AirCurve 10 VAuto BiLevel Machine with HumidAir Heated Humidifier. But don't throw the old Philips one away, it is good to have a backup if the other one malfunctions and you need to have something while it is getting fixed or waiting to be replaced. The Philips machine isn't 'crappy', it is pretty good but not perfect, and its algorithms might not be as good as the ResMeds for some people.

Your brother's numbers don't look too bad to me. I also have a Philips Dreamstation and I know what you mean about it marking hypopneas inexplicably if you zoom in on the Flow Rate chart, and it seems not to flag as events things that do look like flow restrictions. I think the solution is don't zoom in on the Flow Rate chart and obsess over it for now. But sure, go ahead and buy the Resmed (AirCurve 10 VAuto) BiLevel, you can afford it and its charts might look more logical and not drive you crazy. The ResMed's 'auto' algorithm might work better for your brother. But I'm guessing with the Resmed, you will still see things that don't make sense. I think any machine is going to have falsely flagged events and things that are wrong on its Flow Rate chart due to sensors not being perfect and the sensors' accuracy expected margin of error, and lots of blips that occur because a person has a slight arousal during sleep.

People here did not think my O2 dropping occasionally to 91-92 was a problem. Brief downward spikes can be caused by a momentary loss of contact, you only need to worry about the longer lasting drops in O2 into the 80's from what I've been told.

Your suggestions about artificially highly intelligent CPAP machines are very good but are futuristic right now (although maybe companies like ResMed are busy working on this). Maybe in a few decades, CPAP machines will have a lot more AI features and be able to learn and adapt to the person, but that isn't the reality today.

It's nice that you are curious and want to understand everything you see. You have an inventor's mind. But I don't think it is going to be possible to make sense of each event flagged on the Flow Rate chart right now, at least on the Philips, so I think spending much time on that will be pointless. As Pugsy says, it is good to be able to tell on the Flow Rate chart if the person is probably asleep versus awake, and ignore the 'probably awake' events.

Also, with your brother's improvement, I don't understand why you would even consider surgery. Any surgery has its risks. Why would you want to do that if just using a CPAP/BiLevel machine solves his issues? Almost everyone here has apnea and we are not all running out to get surgery.

[Julie]

Surgery of any kind is usually not looked at well here - it certainly keeps the ENTs happy, but patients tend to 'improve' only for a short time - most of the time revert to needing Cpap again anyway, but things do not necessarily go as smoothly as they would without the surgery having been done. Most UARS patients use Cpap, and not badly at all. They don't have surgery that I'm aware of. Again, I feel you're rushing things, maybe because you've involved yourself in your studies, etc. and may be using your brother (a little bit?) as a lab rat. You also keep trying to diagnose things from the graphs that you don't fully understand yet, and it really would do you both a favour to wait a while, even though I know you want to help him... time is a better arbiter of what will work well and what won't than your grasping at idea straws.

[Fejsbukpejdz]

Surgery of any kind is usually not looked at well here - it certainly keeps the ENTs happy, but patients tend to 'improve' only for a short time - most of the time revert to needing Cpap again anyway, but things do not necessarily go as smoothly as they would without the surgery having been done. Most UARS patients use Cpap, and not badly at all. They don't have surgery that I'm aware of. Again, I feel you're rushing things, maybe because you've involved yourself in your studies, etc. and may be using your brother (a little bit?) as a lab rat. You also keep trying to diagnose things from the graphs that you don't fully understand yet, and it really would do you both a favour to wait a while, even though I know you want to help him... time is a better arbiter of what will work well and what won't than your grasping at idea straws.

I understand...

However I just read the email our pulmunologist sent us today.

She said she was not able to pick up such stuff on her polysomnography we did a few nights ago. BUT sleep study we have comming should. She says she looked for obstructives and hypopnea events which are included in AHI.

She said such things are not included in AHI and insurance will not cover the costs here for the machine, yet her opinion is since those flow limitations and consequent arousals keep happening for hours that it takes horrible toll on his sleep, much worse than a few obstructives he has. She did not do EEG either but she says she can imagine that messing up the sleep stages.

So she said buying a machine is my choice to make but she thinks it is the only choice I have since insurance will not cover it. She also thinks buying the dreamstation was a a semi good decision because he finally got SOME sleep.

She sent me this and said machine we use can not do this. I post the attachment

I will post more pictures from his OSCAR the pictures I have sent her..