Please comment on my ResScan data

[atab]

Thank you Pugsy. Last night was especially bad. I feel awful today. I will definitely share what comes about tomorrow. It is OK to tell them that I have software, isn't it? They were not very happy that read the LCD screen. But their point was that I come to wrong conclusions by looking at partial data. Now I have all the data!

atab

[Pugsy]

Last night was especially bad. I feel awful today. I will definitely share what comes about tomorrow. It is OK to tell them that I have software, isn't it? They were not very happy that read the LCD screen. But their point was that I come to wrong conclusions by looking at partial data. Now I have all the data!

You haven't changed any of their settings. I don't see where they can remotely complain. Also puts you in an educated position to see what they come up with.

Your choice on if or when you want to tell them you have the software. Me? I would probably give them a little time just to see where they head with their ideas. But that is me.. No sense in ruffling feathers unless absolutely necessary. Sometimes these people get so bent out of shape because their "turf" gets stepped on that they forget why they are there which is to help you.

Now that you see your data you can ask some very intelligent questions and they won't have a clue where you came up with them...... Unless you want to share.

[atab]

So I met with my RT. A guy with "CRT, RPSGT".

Didn't tell him I have software. Told him I felt terrible on the 12th. And didn't get any sleep on the last night (13th). Last night numbers are good, because I couldn't sleep. I didn't want him to come to wrong conclusions by seeing those numbers. I asked him to check data on 12th. He initially said that only summary data is there. (12th is just the day before yesterday). Then said he'll see what he can do. Came back and said my numbers are very good. 12th was fine, he said (12th is the one with two events with 60 and 55 posted above). I am trying to say that I feel tired and sleepy whole day, he keeps on saying therapy has worked very well. He says my pressure is around 11 and the current setting is perfect. ( My 95th percentile for last 7 days, starting from most recent are 10.4, 11.8, 11.2, 10.4, 11.8, 11.6, 11.6. I told him that may be it takes too long to get to 11 from 6, and he says that it is instantaneous, and 6-12 is perfect. And the famous phrase: "I have been doing this for many years." So, my pressure is left at 6-12. According to my RT, I am doing fine. I may be getting sinus headaches due to lack of humidity, he says; "raise the humidifier setting." I told him that I can't get higher than 1.5 mark due to rainout (this is with a ResMed hose cover). He thinks that my humidifier does not work properly and getting it checked out. I don't understand the logic there. I am setting at the threshold of rainout (I wakeup with rainout at setting 2). Shouldn't he be giving me wisdom like this forum: try covering it more, have the machine at a lower level, use heated hose, etc.

So, "I am doing fine" and no further sleep clinic appointments are scheduled. There is a follow up Dr appointment in October. I have separately made an appointment with a specialist researcher in the field. That is one month away. I will try to break off from these people then.

atab

[Pugsy]

I told him that may be it takes too long to get to 11 from 6, and he says that it is instantaneous, and 6-12 is perfect. And the famous phrase: "I have been doing this for many years." So, my pressure is left at 6-12. According to my RT, I am doing fine.

Geezz, the guy is an idiot.. Even Respironics web site explains that the pressure increase only goes up in small increments. Given this is his line of thinking I wouldn't believe him if he told me the sun rose in the East every day.

http://sleepapnea.respironics.com/techn ... erformance

My doctor just confirmed this very thing to me earlier this week. Auto units take time to implement the pressure increases and thus we must have the minimum pressure close enough that the response time will catch the buggers. Seems like I read somewhere that it can take a couple of minutes to go up one or two cm in pressure (can't swear to exact time but something along those lines) From 6 minutes to 12 minutes..... Heck, the event is done and gone by then.

How long do you get to keep this machine??? While you got it, increase the minimum for a few nights just to see what happens. Given the techs reluctance to even look back past last night, I bet they will never know... Picture me shaking my head in disgust at that guys attitude and knowledge...

[atab]

Hi Pugsy,

He didn't talk about machine switching. May be he forgot. I didn't raise the question.

I am going on a vacation trip next week (with CPAP). When comeback, I will raise the lower pressure to 8 and see how it goes.

atab

[FoxNewsFan]

Hovering mouse over the vertical line works. I managed to change scales the Alex pointed out. Thank you both. Here is the last night graph on improved scale:

Some comments.

Your pressure went to zero both times just when you had a big leak. I don't know if you noticed this.

I don't have your machine but I use the same mask as you and I have NEVER had such a low leakage rate as you do. My mask leaks every time I turn on my side or roll over, etc. My machine compensates for the leaks and I usually have zero apneas.

I suspect something might be wrong with your machine in regards to leaks.

I know it's hard but if a "professional" tells you something which is obviously wrong, do not return. When I first picked up my machine my RT almost broke it trying to get the humidifier off. He had obviously never seen my machine yet he was being paid to teach me all about it.

I notice some of our ResMed "experts" haven't chimed in yet. Suggest you search ResMed on this forum and see who really knows their stuff and PM them.

Ed

[jdm2857]

Ed --

The leak spikes and pressure drops are almost certainly when atab removed his mask with SmartStop enabled on his machine.

As for the low leaks, I'm guessing you have a non-ResMed machine. ResMed machines have settings for ResMed mask and automatically subtract the mask vent rate from the displayed leak. Other machines display the total leak and so never show a leak rate of zero.

And that the fair and balanced news.

[FoxNewsFan]

Ed --

The leak spikes and pressure drops are almost certainly when atab removed his mask with SmartStop enabled on his machine.

As for the low leaks, I'm guessing you have a non-ResMed machine. ResMed machines have settings for ResMed mask and automatically subtract the mask vent rate from the displayed leak. Other machines display the total leak and so never show a leak rate of zero.

And that the fair and balanced news.

Hard to tell what you are talking about.

Atab says, "I have another question: Why is that, at one time, AutoSet pressure is showing zero? My latest graph has zero for about 20 minutes continuously. I did not take the mask off."

Also, my equipment is listed under my name.

Ed

[PST]

I would say that there is no doubt atab's mask is coming off. It is very common to take it off and not remember, but the spike in the leak rate and the drop in pressure to zero is a signature, like jdm says. The great thing is that he put it back on.

It looks very clear that there are some times of the night when the current pressure settings aren't coming close to doing their job. Those apnea events are frequent and incredibly long. The only place I've seen anything like that was when my doctor showed me the graph of my pre-therapy sleep study, and that didn't have so many events in the 45 second and up category.

I was sitting here a few minutes ago playing with a new toy -- a pulse oximeter -- just seeing what it would do to my oxygen saturation to hold my breath for 60 seconds. You really notice after a minute of not breathing, and the oxygen saturation dropped below 90. I wouldn't want to try 17 breath holdings over the course of an hour. I think atab should use every resource at his disposal to get his doctor to look at those graphs right away and change his pressures. The distribution makes it appear that it may be only in some positions or some sleep states that he needs the higher pressure. APAP may therefore be perfect for him, but the 6-12 range is too low. I'm more inhibited than many people here about self-adjustment, but if I couldn't get some quick attention from my crack team of specialty physicians and veteran respiratory technicians, I'd move both my lower and upper pressures higher myself.

[tattooyu]

I have a ResMed S8 Autoset II, and every time I shut the machine off in the morning, then take my mask off, it still shows a spike in the leak rate in ResScan. Now, I don't use a full face mask, but my leak rate is 0.00 l/s nearly every night. ResMed machines only show the leak rate above the intended ventilation rate of the exhalation port of the mask.

However, atab, you should speak to your doctor about your results in my opinion. Not only are there far too many apneas, but they are pretty long. The number of apneas you have remind me of my graphs before I dialed in my pressure. However, my longest apnea ever was only 20 seconds. Make sure to ask your doctor if your sleep study showed any central apneas (as opposed to obstructive). I have a feeling that if you bump up your pressure, you may see far less apnea events.

Please consult with your doctor when you can.

[atab]

Thank you all for your very valuable comments. I am learning here everyday.

There are two leak spikes and corresponding pressure drops on the chart. The second one, I think, is a result of my taking mask off in the morning. This is the only graph where I noticed a pressure drop with some duration. Other days show spikes of pressure drops which are probably due to my adjusting the mask. I usually pull the mask away from face and re-seat it. So, on that day, may be I took off the mask without remembering. But, shouldn't the leaks also stay high in that case?

I am fairly certain that I have oxygen desaturation. I get headaches. More importantly I can't concentrate. I have basically become a zombie. ( And my RT says I am doing great.)

Keep in mind though, the graph I posted was one of my worst days. Before that there were some good days.

I have decided adjust the lower pressure to 8 myself. I will check for few days to see whether I get better data. That graph was night before, and the last night I barely slept. This may be due to the bad night before that. That whole day and whole day today are exceptionally crappy. But numbers last night were good. My apneas are higher on REM, last night I probably had no REM. So no apneas.

Thanks again for your help and concern.

atab

[atab]

However, atab, you should speak to your doctor about your results in my opinion. Not only are there far too many apneas, but they are pretty long. The number of apneas you have remind me of my graphs before I dialed in my pressure. However, my longest apnea ever was only 20 seconds. Make sure to ask your doctor if your sleep study showed any central apneas (as opposed to obstructive). I have a feeling that if you bump up your pressure, you may see far less apnea events.

Please consult with your doctor when you can.

Tattooyu,

Thanks. I have my sleep report in front of me. I will scan this later. But this is what it says:

By Event Classification
Central Mixed Obstructive
count count count
Apneas, NREM 4 0 3
Apneas, REM 1 0 31
Apneas, Total 5 0 34

Events:
Count
Hypopnea, NREM 6
Hyponeas, REM 5
Hypopneas, Total 11

I will scan and pot this tonight.

atab

[atab]

The leak spikes and pressure drops are almost certainly when atab removed his mask with SmartStop enabled on his machine.

OK, I missed this part. So, if SmartStop is ON, the machine does not record leaks because it is stopped? I will check whether mine is ON. I did not set it.

atab.

[Pugsy]

My apneas are higher on REM, last night I probably had no REM. So no apneas.

atab

You know it is possible that you do get to REM but the machine manages to curtail the events. Maybe on the bad nights the events are just extra stubborn... Just thought. I know some nights I will see a cluster or two and some nights (the good ones) I might just have a single random event showing in what would appear to coincide with REM stage. Last night my pressure needs went to 18 and I still had 2 clusters. Night before last the highest pressure was 13, no clusters at all and I had 9 hours of sleep, so I know I hit REM some time then.

I can't seem to figure out what makes some nights easy and some nights I get those really hard to tackle events.
My leak rate during those times is often zero. Maybe I happen to roll on my back and they hit and that might make the combination worse. Just a little puzzler for me that I am trying to sort through.

[billbolton]

.... it still shows a spike in the leak rate in ResScan.

That is normal with Resmed flow generators and happens no matter how you "stop" treatement.

Cheers,

Bill