Post
by robysue1 » Tue Nov 01, 2022 1:36 pm
GeneMpls,
The most notable things I see in what you've posted are:
1) The fact that turning EPR off significantly increased the number of hypopneas, but the number of OAs and CAs remained about the same. Turning EPR off also eliminated the breathing being scored as "CSR" breathing. The number of hypopneas seems to have tripled after turning EPR off. That increase in hypopneas is quite troublesome, but it is also counter-intuitive. The usual assumption is that hypopneas are obstructive in nature, but turning EPR off actually provides a very small (2cm) increase in your exhalation pressure. And intuitively that should either have not affected the number of hypopneas or it should have lead to a minor decrease in their numbers. But that slight increase in exhalation pressure really should not have lead to a tripling of one type of an obstructive event. I really wish Rubicon would take a close look at your data and weigh in.
2) The handwritten note on the sleep study that gives a script for fixed CPAP at 15 cm with EPR = 2. How was that original script determined? Did the sleep doc just pull those numbers out of his rear end? Or was there some kind of titration done? (A week trial in APAP would count as a titration study.)
Taken together, these bring up the following questions:
1) Why was the pressure decreased from 15 cm to 12cm? In one of your earlier posts you said that your doctor had reduced your pressure from 15 cm to 12 cm, but you never told us why. In other words, did the sleep doc ever look at the data recorded by your machine when you were using 15cm? If so, did he order the pressure decrease based on something he saw in that data?
2) There are a lot of unclassified apneas scored on the sleep test; what is their significance? It appears that the sleep doc that wrote the script for 15cm at the top of the sleep test just assumed that most of those are obstructive events. In other words, the interpretation of the study and the official diagnosis is "Severe Obstructive Sleep Apnea." But should those unclassified apneas have just been assumed to be obstructive? Or perhaps, to put it another way: Since your current machine is scoring a ton of centrals, should those unclassified apneas on the sleep test be looked at more closely with an eye to figuring out whether you might just have mixed sleep apnea.
3) Or if most of those unclassified apneas scored on the sleep test are actually obstructive, could that mean many of the CAs your machine is scoring are actually OAs that are being mislabeled? (Perhaps Rubicon could go through your data posted to SleepHQ looking at those CAs to tease out whether he believes they are really CAs or OAs.)
4) Since then number of Hs tripled when EPR was turned off, are all of those new Hs obstructive? Or could some (most) of them be central in nature? The answers to these questions also tie back to why the pressure was decreased by the doctor in the first place and the significance of the large number of unclassified apneas on the sleep study itself.
In other words, there may be more going on here than plain vanilla OSA that just needs more pressure to fix the problem.
Joined as robysue on 9/18/10. Forgot my password & the email I used was on a machine that has long since died & gone to computer heaven.
Correct number of posts is 7250 as robysue + what I have as robysue1
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