.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
-SWS
Posts: 5285
Joined: Tue Jan 11, 2005 7:06 pm

Re: Dr Krakow--Have you had appt/consult with him?

Post by -SWS » Wed Jan 26, 2011 12:36 pm

SleepingUgly wrote:
-SWS wrote:
SleepingUgly wrote: -SWS, I will pay you 60 free Kindle downloads if you let me in the club.
Hmmm... THAT said, I would be up to nearly 140 downloads on my Kindle-for-Android app... and that's very enticing, indeed.
Good, because I was afraid I was going to have to resort to sleeping my way into this club. Oh crap, I think for that joke, I am probably going to have pay jnk something.
It is with a saddened heart that I must inform all "That-Said Phrase User's Group" candidates that all acceptance-committee Kindles are now mysteriously broken. It appears someone pulled the wires and scrambled the circuitry inside each Kindle. Oh how I hate when that happens.

But not to fret, my friend... My understanding is that the TSPUGAC just declared an emergency meeting to discuss new acceptance criteria!

User avatar
SleepingUgly
Posts: 4690
Joined: Sat Nov 28, 2009 9:32 pm

Re: Dr Krakow--Have you had appt/consult with him?

Post by SleepingUgly » Wed Jan 26, 2011 12:45 pm

-SWS wrote:It is with a saddened heart that I must inform all "That-Said Phrase User's Group" candidates that all acceptance-committee Kindles are now mysteriously broken. It appears someone pulled the wires and scrambled the circuitry inside each Kindle. Oh how I hate when that happens.

But not to fret, my friend... My understanding is that the TSPUGAC just declared an emergency meeting to discuss new acceptance criteria!
I hope this isn't some kind of ploy to get me in the sack. Don't you want to go to Rush with your friends, jnk and Muffy?
Never put your fate entirely in the hands of someone who cares less about it than you do. --Sleeping Ugly

-SWS
Posts: 5285
Joined: Tue Jan 11, 2005 7:06 pm

Re: Dr Krakow--Have you had appt/consult with him?

Post by -SWS » Wed Jan 26, 2011 1:11 pm

SleepingUgly wrote:I hope this isn't some kind of ploy to get me in the sack.
Ploy? No way! ...At least not from the well-respected TSPUGAC. No, I'm pretty sure the Kindles were all destroyed by some run-of-the-mill anti-idiom terrorist group.
SleepingUgly wrote:Don't you want to go to Rush with your friends, jnk and Muffy?
Thankfully the anti-idiom terrorists spared all the iPods and MP3 players---in their great haste I'm sure. Anyway my understanding is the TSPUGAC now favors downloading Rush MP3 songs and dispensing with the frivolous concert---at least for now. Sheesh! Committees!

And darn those run-of-the-mill anti-idiom terrorists...!

-SWS
Posts: 5285
Joined: Tue Jan 11, 2005 7:06 pm

Re: Dr Krakow--Have you had appt/consult with him?

Post by -SWS » Wed Jan 26, 2011 1:39 pm

Secret agent girl, please forgive our fictitious foray in silliness above. I think many of us are happy and hopeful for you as we await this development:
secret agent girl wrote:I went to the sleep lab today and picked up a CD of my sleep study data. There's a folder on it named SandmanExecutable with a bunch of subfolders. I assume you don't need any of those uploaded, right? The other folder has my name with 2 subfolders: VIDEO and (name) Split 2. Do you want all that stuff?
NotMuffy wrote:Don't need SandmanExecutable. Upload the other folder in its entirely except for the Video file.
secret agent girl wrote:I'm working on that now, and will PM you with the link.
I know I sure am... Good luck! And thanks, NotMuffy, for having a look.

User avatar
secret agent girl
Posts: 574
Joined: Tue Nov 10, 2009 2:15 pm

.

Post by secret agent girl » Wed Jan 26, 2011 2:10 pm

.
Last edited by secret agent girl on Sun Feb 06, 2011 10:10 pm, edited 1 time in total.

User avatar
NotMuffy
Posts: 962
Joined: Wed Sep 16, 2009 6:56 am
Location: Dunno. GPS is dead.

Re: Dr Krakow--Have you had appt/consult with him?

Post by NotMuffy » Wed Jan 26, 2011 9:32 pm

Oh, yay!

Snowing again!

For a second there, I thought maybe it forgot!

The study shows severe sleep fragmentation, especially at the beginning. The diagnostic hypopneas have a very central flavor (no real flow limitation) yet the concomitant snoring events certainly make the case for obstructive component. The desaturations are significant enough that they really need to be treated.

A review of the mixed apneas show most to be central. A closer review may end up calling all of them central.

REM is astoundingly clean.

Whadz this mean:

This study looks like a clear CompSAS. Central apneas (with significant desaturations) appear with application of PAP in unstable NREM and disappear entirely in REM.

Normally, one would run and get the ASV. However, your early DLs show the SDB to be fairly stable (as noted, CompSAS can resolve over time). It may have been helpful if you had an S9 to keep better track of centrals, but if they ain't there, it then becomes academic.

There's 3 things that are treated in SDB: desaturations, struggling against closed airway and disturbance in sleep continuity. You don't appear to have the struggling against a closed airway kind of SDB, and the desaturations are generally mild as rated by the Flemons criteria. Sleep continuity, however, is awful and is probably even worse on xPAP where arousals progress to wake. Sleep efficiency is abysmal across the board.

While the point of the articles posted earlier, as well as
NotMuffy wrote:I think one needs to look at the net result of their entire approach in order to arrive at a rational decision.
was that if, after a good faith effort of xPAP, underlying SDB isn't too bad, and one is doing significantly worse than before treatment, well then maybe the right thing to do is just pitch the thing.

However, you've got a lot of events there, and your old DLs show great success in treating them. Until sleep efficiency can be improved, tho, the SDB improvement will be lost in the shuffle.

By way of comparison, sleep efficiency of:

>95% is excellent
>90% is good
>85% is "normal" ("they" say. I'd say 90%)
<75% is poor.

So anyway, I think your goal at titration is to use whatever PAP comfort mode works; stay on the low side of pressures because of the apparent CompSAS tendency; and use medication if necessary (it should be able to be determined objectively what the medication effect on PSG is)(course, there's something to be said about the "Hey! I feel BETTER!" analysis).
"Don't Blame Me...You Took the Red Pill..."

User avatar
secret agent girl
Posts: 574
Joined: Tue Nov 10, 2009 2:15 pm

.

Post by secret agent girl » Wed Jan 26, 2011 10:05 pm

.
Last edited by secret agent girl on Sun Feb 06, 2011 10:21 pm, edited 1 time in total.

jnk
Posts: 5781
Joined: Mon Jun 30, 2008 3:03 pm

Re: Dr Krakow--Have you had appt/consult with him?

Post by jnk » Wed Jan 26, 2011 10:11 pm

secret agent girl wrote:What's DL mean?
Download.

User avatar
secret agent girl
Posts: 574
Joined: Tue Nov 10, 2009 2:15 pm

.

Post by secret agent girl » Wed Jan 26, 2011 10:24 pm

.
Last edited by secret agent girl on Sun Feb 06, 2011 10:10 pm, edited 1 time in total.

User avatar
NotMuffy
Posts: 962
Joined: Wed Sep 16, 2009 6:56 am
Location: Dunno. GPS is dead.

Re: Dr Krakow--Have you had appt/consult with him?

Post by NotMuffy » Thu Jan 27, 2011 5:31 am

See, here's the problem with 50 inches of snow here:

There's no place to put it.

I mean, pulling out of driveways and intersections is an adventure when there are 8-foot snowheaps on either side. You have to ease out to see anything, and it can be a little disconcerting when you're in the middle of the road and see the sanding truck bearing down on you at 90 miles an hour.

Anyway, those are great questions and should spark enough discussion to get us to the croci.

BTW, did you spend any time on CPAP? That DL should be put under the microscope.
secret agent girl wrote:”REM is astoundingly clean.” means no SDB during REM? That’s odd, isn’t SDB worse in most people during REM?
Don't forget, you were being treated (at your peak pressure) and on your side at the time, but that said (Damn!) your REM is sparkling, and this is exactly what happens in CompSAS.

Image
Image
secret agent girl wrote:“The desaturations are significant enough that they really need to be treated.” and “the desaturations are generally mild as rated by the Flemons criteria.” How do these two things fit together? Isn’t xpap the only way to treat desats?
xPAP is the "best" way to treat obstructive SDB. SDB has a sliding scale of severity ("IMHO")(and apparently a few other people) that is not based exclusively on AHI:
The severity of sleep apnea can be categorized as mild, moderate, or severe on the basis of the apnea-hypopnea index. Mild sleep apnea is defined by an apnea-hypopnea index from 5 to 14, an oxygen saturation of at least 86%, and minimal daytime disability. Moderate sleep apnea is defined by an index from 15 to 30 or an oxygen saturation of 80% to 85% and significant work or social dysfunction due to drowsiness and loss of concentration. Severe sleep apnea is defined by an index greater than 30 or an oxygen saturation of 79% or less and incapacitation due to the sleep disorder.
Definitions

This gives a number of combinations, so again, my point is, perhaps the decision to treat is not always crystal-clear in some patients. If a patient desats to 60%, has hypertension and a history of falling-asleep-at-the-wheel autombile accidents, the decision is easy-- "If you don't use CPAP, you'll be dead in five years. Pay the receptionist on the way out."

I offer this to try to explain why you (and others) feel worse with treatment and promote an understanding of the compliance issue.

That said, (AAAAHHHHHHH!!!) eventually we'll post some epochs to show what specifically what can be addressed in your case to try to fix SBD and (hopefully) improve sleep. I think the general philosophy should be low-level pressure and whatever adjunct necessary for comfort.
secret agent girl wrote:Can it be determined what causes “arousals progress to wake” and “sleep efficiency [to be] abysmal across the board”? What might it be? I think I’ve understood you to say that it would be treated with drugs--sleeping pills?
Sleep aids are one solution. However, I would strongly recommend that you get an 8-week plan of what and where you want to go with that with your physician. You can use some of them long-term safety. I also think you need a heavy dose of CBT (insomnia discussion to follow)(as well as sleep hygiene discussion).

Blanket Judgement Statement:

Perimenopausal women have bad sleep.

Another one of those Gifts from God.

Gotta run.

LOL.

Whoops!

Gotta shovel first.

Lemme tell ya, buying new shoes is like washing your car in re: predicting the weather.

The Big Guy certainly has a great sense of humor!!
"Don't Blame Me...You Took the Red Pill..."

User avatar
secret agent girl
Posts: 574
Joined: Tue Nov 10, 2009 2:15 pm

.

Post by secret agent girl » Thu Jan 27, 2011 6:01 am

.
Last edited by secret agent girl on Sun Feb 06, 2011 10:10 pm, edited 1 time in total.

User avatar
NotMuffy
Posts: 962
Joined: Wed Sep 16, 2009 6:56 am
Location: Dunno. GPS is dead.

Re: Dr Krakow--Have you had appt/consult with him?

Post by NotMuffy » Thu Jan 27, 2011 6:43 am

secret agent girl wrote:The question I woke with is do you have any changes to the 4 week plan you outlined?
Actually, if you're referring to

viewtopic/p560542/viewtopic.php?f=1&t=5 ... th#p559154

that was not a "plan" per se. I wanted to see a pattern of CPAP utilization and if CompSAS had resolved, and I thought you were using it more than "not".

Here's something funny! The inclusion of O2 saturations in determining OSA severity was not included in the Flemons paper, but rather created by (LOL) back in 2005 to create a hybrid scale (only the AHI and EDS were actually attributed to Flemons)

http://www.apneasupport.org/post-11410.html

Now it seems like quite a few people are using it and attributing it to Flemons, but I don't think that's correct.
"Don't Blame Me...You Took the Red Pill..."

User avatar
secret agent girl
Posts: 574
Joined: Tue Nov 10, 2009 2:15 pm

.

Post by secret agent girl » Thu Jan 27, 2011 7:09 am

.
Last edited by secret agent girl on Sun Feb 06, 2011 10:10 pm, edited 1 time in total.

User avatar
NotMuffy
Posts: 962
Joined: Wed Sep 16, 2009 6:56 am
Location: Dunno. GPS is dead.

Re: Dr Krakow--Have you had appt/consult with him?

Post by NotMuffy » Thu Jan 27, 2011 3:46 pm

secret agent girl wrote:If you think seeing current data will provide some useful info, I'll continue using the machine and post the data.
Absolutely. The previous DLs are quite dated, so taking a look at where you are now is essential. I'd like to specifically see the FL graph in detail.
secret agent girl wrote: Can you get an idea from an S8 if CompSAS has resolved, or does that take NPSG-level data?
The presence of CompSAS should be able to be determined by the S8 DLs. Generally, it takes a while to resolve (perhaps a month or so).

That said, your NPSG doesn't seem to show an FL pattern, even on ambient, so it shouldn't show anything in the DL; and your prior S8 DLs really did not show a CompSAS pattern to speak of (AHI was well-controlled, with the exception of a couple days where it drifted up a bit).

That said, insuring that these things are properly controlled really needs to be done.
"Don't Blame Me...You Took the Red Pill..."

User avatar
secret agent girl
Posts: 574
Joined: Tue Nov 10, 2009 2:15 pm

.

Post by secret agent girl » Thu Jan 27, 2011 4:44 pm

.
Last edited by secret agent girl on Sun Feb 06, 2011 10:11 pm, edited 1 time in total.