OSCAR chart to grade please? Newguy

[ozij]

Yes that was what I meant, though I'm not at all sure I understand it....

[Miss Emerita]

The periodic breathing doesn't look especially sinusoidal, and I'm not spotting anything that could address RobySue's good question about whether the hypopneas are obstructive or central. RobySue, what do you think?

I see that Gene has left EPR at 2. CAs have abated somewhat anyhow. Gene, did you consider turning EPR down or off, as Pugsy had suggested?

With the many medical issues in play, getting the medical team to pay attention does seem very important. Gene, what ways do you have to communicate with your physicians? Can you use a portal and email them? Or do you have to talk with an office manager? Or ? Getting the information through about both your AHI and your O2 levels is something I hope there's a way to do.

[Rubicon]

From my point of view, the entire contents of the SD Card needs to be examined. Upload it to dropbox or similar. These little snippets and overhead views (aka "SkyLab") do not offer help figuring out what is happening.

[robysue1]

From my point of view, the entire contents of the SD Card needs to be examined. Upload it to dropbox or similar. These little snippets and overhead views (aka "SkyLab") do not offer help figuring out what is happening.

I agree with Rubicon here.

What that snippet tells me is that there's a lot more work that needs to be done to investigate what's really going on with GeneMpls's very real problems.

To GeneMpls, if it were me, I'd let Rubicon see the contents of the SD card by uploading them to something like dropbox and giving him access. It's not really that hard to do, but if you want step-by-step instructions, just pm me and I'll be happy to give them to you.

[GeneMpls]

I actually did turn off the EGR for a couple nights and did not see any difference [also did not really know what I was looking for]- I have a large number of balls in the air- we leave for the Keys on the first of the year and I have a large property that I am selling before then and a lot of stuff to arrange and equipment to fix. When I feel good enough I have to really hustle [for an old phart]. So I am easily distracted, we do have a file transfer service as we send and receive large graphics files in the Sign shop.
I am on a new puter so it is not set up and will take a bit of searching for the details. I know, poor baby... I can send my doc files but I cannot get him to look at them- I have an appt with a different doctor but getting in to see anyone [sleep doc or heart valve surgeon] is like pulling teeth. I someone wants to look at them I will send them.
I spent a lot of time on the ApneaBoard and never connected with anyone, so I really appreciate the attention I am getting. Gene

[dataq1]

The periodic breathing doesn't look especially sinusoidal, and I'm not spotting anything that could address RobySue's good question about whether the hypopneas are obstructive or central.

With the many medical issues in play, getting the medical team to pay attention does seem very important. Gene, what ways do you have to communicate with your physicians? Can you use a portal and email them? Or do you have to talk with an office manager? Or ? Getting the information through about both your AHI and your O2 levels is something I hope there's a way to do.

and @ RobySue1
You raise a couple of interesting points, that lead me to ask this question: To be identified as Period Breathing, or it's subset Cheyne Stokes, does the waning portion need to terminate in an apnea (either obstructive or central)?

The second thing you've said here Miss, reminded me of a couple of experiences I've had when giving information to doctors. I was somewhat taken aback when my sleep doctor flat out said that my OSCAR data was unreliable. On further discussion, it seems the he (and his associates) prefer to be suspicious of medical equipment that they (or the hospital) has not recently validated as accurate and calibrated. He explained that he knows nothing about how my medical equipment has been operated or maintained. (he has no particular problem with the "clock" showing hours of use - but that is mainly for the benefit of insurers not for the medical team).

In short, If I wanted to show him how my OSA has changed over time (gotten better or worse), he would believe a new sleep study, conducted under the hospital's auspices, but is reluctant to rely on quantification by equipment of unknown background, accuracy or maintenance.

They summed up by saying " We will look at your Sleepyhead and Oscar charts and data because we want to be polite, but will not use them as the basis of a medical recommendation"

[Pugsy]

I actually did turn off the EPR for a couple nights and did not see any difference [also did not really know what I was looking for]- I

They idea with turning off EPR was to see if the number of flagged CAs/central apneas reduced and/or the CSR flagged stuff reduced...
and the one example you shared showed no centrals and no CSR flagged stuff.

Might want to consider a longer trial with EPR off.

I don't know if the hyponeas (which are still quite numerous) are obstructive in nature or central in nature but it also might be worth trying a little more fixed pressure to see if the hyponeas reduced in number or not.

[Rubicon]

I have a large number of balls in the air-

Yeah well my balls are up in the air too so if you want to take advantage of my offer you got till Tuesday.

Otherwise have dataq1 do it.

[ozij]

Rubicon wrote: ↑Sun Nov 13, 2022 21:10
From my point of view, the entire contents of the SD Card needs to be examined. Upload it to dropbox or similar. These little snippets and overhead views (aka "SkyLab") do not offer help figuring out what is happening.
I agree with Rubicon here.

What that snippet tells me is that there's a lot more work that needs to be done to investigate what's really going on with GeneMpls's very real problems.

To GeneMpls, if it were me, I'd let Rubicon see the contents of the SD card by uploading them to something like dropbox and giving him access.

Yes.

[ozij]

I was somewhat taken aback when my sleep doctor flat out said that my OSCAR data was unreliable. On further discussion, it seems the he (and his associates) prefer to be suspicious of medical equipment that they (or the hospital) has not recently validated as accurate and calibrated. He explained that he knows nothing about how my medical equipment has been operated or maintained. (he has no particular problem with the "clock" showing hours of use - but that is mainly for the benefit of insurers not for the medical team).

• And yet this doctor "trusts" a non-checked, non-calibrated machine to supply an unknown level of continuous positive air pressure to his patients every night.
• Does he demand you send your machine for monthly (or weekly? or daily?) calibration to make sure it's functioning as it should?
• Does he insist you use only fixed pressure - since who knows how badly the unreliable, non calibrated, unmaintained machine is working?

They summed up by saying " We will look at your Sleepyhead and Oscar charts and data because we want to be polite, but will not use them as the basis of a medical recommendation"

The epitome of defensive medicine, making sure you will never have grounds for a malpractice suit.

In short, If I wanted to show him how my OSA has changed over time (gotten better or worse), he would believe a new sleep study, conducted under the hospital's auspices, but is reluctant to rely on quantification by equipment of unknown background, accuracy or maintenance.

In other words, in his own opinion he is so good and accurate in his one time reading of your sleep in the hospital lab that he needs no feedback at all to gauge the quality of your on-going therapy. He is ready to let you use a machine that he prefers to be suspicious of, on a nightly basis! What arrogance!!!

For most of the people coming to this forum, "how my OSA has changed over time (gotten better or worse)" is not the issue. It's "how well I'm sleeping with this mask on my face and how well I'm feeling when I get up".

[dataq1]

The epitome of defensive medicine, making sure you will never have grounds for a malpractice suit.

Yes, I agree that it is defensive medicine. They seem to be saying that they will not rely on data obtained from a source that may evaluate the raw data differently, or may not even have the capability to provide the similar raw data . That actually makes sense to me, as the data on indices from a home machine may not match the data obtained from a sleep study due to differences in interpretation. (lab sleep studies apply a different standard to identify hypopneas as contrasted with a Resmed / Respironics algorithms as an example).

For most of the people coming to this forum, "how my OSA has changed over time (gotten better or worse)" is not the issue. It's "how well I'm sleeping with this mask on my face and how well I'm feeling when I get up".

That well may be true, that "people coming to this forum" are content to self-evaluate subjectively their sleep, but it also appears that many people are equally concerned with their objective/quantitative data ( AHI and each of the individual indices as an example)

I only related my experience with this team of doctors to relay the notion that they may have a different perspective on the quality of data, when the data comes from a source that they are not confident with.

Now that I think about it further, I do remember having to get repeat blood work (as one example) when transfering between a GP and a specialist, or the urologist who would not accept a specimen that was obtained at home.

Call it ultra-precautionary if you will, but it may not be such a bad policy.

[Pugsy]

And yet this doctor "trusts" a non-checked, non-calibrated machine to supply an unknown level of continuous positive air pressure to his patients every night.
Does he demand you send your machine for monthly (or weekly? or daily?) calibration to make sure it's functioning as it should?
Does he insist you use only fixed pressure - since who knows how badly the unreliable, non calibrated, unmaintained machine is working?

No one has heard of ResScan software here????
No one bothered to verify that the data on the machine's LCD happens to match anyone's software?
No one even trusts ResMed???

Yet a doctor will tell someone to use this potentially life saving machine and not really bothered that in his mind he can't trust it to do its job or provide proper therapy? Duh, about as successful as a doctor throwing a bottle of insulin at a patient and tell them to not worry about doing the finger sticks because "he doesn't trust what the glucometer shows."

If a medical professional doesn't really trust after market data there's nothing stopping them from using machine manufacturer provided software.....if they want to do.

[robysue1]

And yet this doctor "trusts" a non-checked, non-calibrated machine to supply an unknown level of continuous positive air pressure to his patients every night.
Does he demand you send your machine for monthly (or weekly? or daily?) calibration to make sure it's functioning as it should?
Does he insist you use only fixed pressure - since who knows how badly the unreliable, non calibrated, unmaintained machine is working?

No one has heard of ResScan software here????
No one bothered to verify that the data on the machine's LCD happens to match anyone's software?
No one even trusts ResMed???

Yet a doctor will tell someone to use this potentially life saving machine and not really bothered that in his mind he can't trust it to do its job or provide proper therapy? Duh, about as successful as a doctor throwing a bottle of insulin at a patient and tell them to not worry about doing the finger sticks because "he doesn't trust what the glucometer shows."

If a medical professional doesn't really trust after market data there's nothing stopping them from using machine manufacturer provided software.....if they want to do.

And if a PAPer wants to use ResScan for themselves, it is available over at apneaboard.com.

Of course, ResScan is not as easy to install or use as Oscar is, but still: If your doc won't trust Oscar because it's a piece of 3rd party software that he's never heard of, handing him a ResScan printout of daily data (including the flow rate) should put a stop to a doctor's reluctance to look at data presented in Oscar with the claim that the data "can't be trusted."

[dataq1]

No, it's not that no one trusts Resmed, but even Resmed acquired lab data is manually edited (or at minimum checked) to attempt to avoid false-positives.

I suspect that a physician does have hopefull confidence that a therapy device is providing the prescribed therapy, specifically that the differential pressure sensors maintain calibration, but are less confident that the algorithms used to assess events are foolproof. As I remember, you have previously said that the exact algorithms are proprietary, and not necessarily given full explanation (or leave some things unclear)

As well, the consideration of the legitimacy of events assessed during SWJ. The doctor or algorithm has no idea if the patient is actually sleeping or not - in home generated data.

Hence precaution in "counting numbers'" .

Probably much more value in seeing trends, (for example, the frequency of Periodic Breathing or CSR over a extended period of time)

Again, I only related my experience with this team of doctors to relay the notion that they may have a different perspective on the quality of data, when the data comes from a source that they are not confident with.

[jimbud]

dataq1

In conclusion:

Ignore any/everything this jerk has to say.

JPB