Sleep Doc Liked My Data

[Slartybartfast]

Went to see my pulmonologist this afternoon for my 6-month checkup.

Took hard copies of ResScan data reports to which I had appended oximetry reports from my CMS 50E, showing several nights where I alternated between my prescribed 11 cm fixed pressure and 9 cm minimum pressure in Automatic mode.

The doc shook my hand and asked how everything had been going, so I filled him in on my history. I didn't expect him to remember me after 3 months. So I reminded him that I had come to him with a chronic non-productive cough, having had bronchitis six times in the prior 9 months, feeling horrible, not knowing what was wrong, until the sleep study he ordered showed I had severe OSA. I got on CPAP, and all my symptoms went away immediately. While I was talking he was leafing through my file, nodding his head and making a few notes here and there.

Then I opened my briefcase and took out the ResScan reports. He suddenly paused, and stiffened a little. "You have software for your CPAP? Where did you get it?"

"The internet is your friend." (Evil grin)

"Okay. Hmmm," as he started leafing through the reports. Then I showed him that I had several nights of back to back data with the prescribed 11 cm fixed and my preferred 9 cm APAP settings, both with oximetry data to show that they are equally effective.

"We gave you an automatic machine?"

"No, I wanted an automatic machine, so bought my S9 Autoset online out-of-pocket."

"OK. Where did the oximetry data come from?"

Then I took out my CMS 50E and handed it to him. "I bought a pulse oximeter to verify that my therapy was just as effective in my own bed as it was here in your lab. I figured one night's data might not be predictive of what happens with me at home in my own bed. Remember, I'm a researcher, and I like data."

"You're an engineer, then?"

"No. Chemist. Pharmaceuticals." He nodded his head, remembering we had talked before. He scribbled that down, along with the name of the company I work for.

He looked through his file and found the titration report. "Here it is. CPAP 10.5 to 11 cm. And your machine's data shows . . . 10.8 cm 95th percentile. That's not bad for a machine to agree so closely to what we came up with." He was grinning broadly by this time. I knew I had turned the corner with him.

Then I turned the oximeter on and clipped it to my finger. The Doc's eyes grew wide when he saw all the information on the colorful display. He looked for all the world like a kid who had seen seen a new toy that he had to have. "It's even got a pulse wave. I've never seen one of these except on a monitor in the hospital. That's great. Where did you get this?"

"Just Google ‘Contec CMS 50E’ and several vendors will come up. It's only about $130." Doc wrote down the information. I gave it to him and he clipped it on his finger.

I showed him the menu and the settings and he asked, "So how did you get the printout?"

"It comes with software. You just plug it into a computer with the USB cable and download the data.”

"No Way! Software included? For $130? That's amazing."

"And if you want to collect the data in real-time, it even has Bluetooth."

“Bluetooth, too? I can't believe this. We don't have anything like this here. Everything we have is hard wired. Do you know what we would have to pay for something like this?

"Several hundred dollars?"

"Try several THOUSAND dollars! Wow, I can't believe it." He was grinning and exploring the menu features. (I expect some online vendor will get an order shortly)

Several minutes later, fully understanding what I had been doing since he saw me last, Doc looked over all my data and pointed out the few spikes that dipped below 88% SPO2. "Those are nothing. I wouldn't worry about those. Your oxygen saturation is always around 95%. That's excellent. Night after night. Very consistent. It shows your therapy is working. And here, you see your pulse went up a little here, and later down there? I bet that's when you rolled over on your side. You probably went to sleep on your back, here, and then when you rolled onto your side your pulse dropped. They ought to make a position sensor for this, too."

We talked back and forth for a while. I was his last appointment of the day so he had plenty of time. We talked about the data reports, about how he doesn't like the the idea of the software identifying "centrals," since central apneas can't be diagnosed without EEG data, and the "centrals" likely being an artifact of the CPAP therapy, anyway, so why should they count toward the AHI, and if you hook a rabbit up to a ventilator it will stop breathing on its own because the CO2 level remains too low to initiate breathing which mimics a central apnea, myoclonic jerks now being termed "sleep starts. . ." We went back and forth, each finishing each other's sentences for a while. I gathered that he was comfortable with my level of understanding of the therapy.

The take home messages from all this were:

Doc complimented me on taking the time to quickly learn what the therapy is all about, then getting a pulse oximeter to verify that it was working. He said that outside of a sleep lab you really can't know whether your CPAP therapy is effective without oximetry data. And having the reports with oximetry data brought in to him like this makes his job a lot easier, and his patients would also do better if more of them showed such motivation.

[BernieRay]

My pulmonologist will likely respond the same way to start with. I'm not sure he will open up as much as your's did, but as long as I keep his nurse on my side, the two of us should be able to handle him. When I got my S9, he wanted me to get the Elite, I told the nurse I wanted the Autoset. I got the Autoset. I also asked her if she would get an Rx for ResScan for it. Supposedly, the doc said "why does he want it?", to which she replied, "Just sign it". I also have the rx. It helps to know who really runs the office!

Did he have any trouble visually syncing the ResScan data with the CMS 50E report? I've been seriously thinking of getting one, but I wasn't sure how easy it would be to tie the 2 together for, say, a particular OSA event. Also, does it stay on overnight? I sometimes move around and thought I might knock it off my finger pretty easily.

Anyway, congratulations on a great visit! I don't see how it could have gone any better, short of him giving you a gold bar!

[Slartybartfast]

Wonder if that nurse is the Doc's wife. I've seen great synergy when a couple like that are working together.

One of the questions he asked me was how I keep the oximeter on my finger all night. He asked if I taped it on. I told him I just clipped it on and, while I slept well, I was aware it was there on my finger and was careful not to disturb it. You can tape it on if you like, but I've worn mine a dozen times and it's never come off. And, yes, it records all night. You just set the start time a few minutes ahead of what your clock says, and when you clip it on, it starts recording. The data printout has time marks on it, so it's easy to correlate with the ResScan report. I have Adobe Acrobat on my work computer and simply import the Oximetry report into the .pdf that ResScan creates, so it's pretty seamless.

My RN-wife says any doctor who's worth anything would be thrilled to have a patient taking an active part in his therapy. That said, there are plenty of dorks out there, and we all know that a little bit of knowledge can be a dangerous thing. So it's imortant to keep learning and make sure your Doc knows that you defer to his/her judgment.

[BernieRay]

Wonder if that nurse is the Doc's wife.

ROTFLMAO

Thanks for the info, sir. I think it's time I order one.

[KatieW]

Wonderful (and rare) sleep doc. And congratulations on managing your therapy!

[Pugsy]

Wonder if that nurse is the Doc's wife.

Nah, just one smart nurse. I used to be a nurse for an orthopedic surgeon. We had great working chemistry and a good friendship but to live with him and THEN work with him. Too much.... We used to joke about having a "thing", then about the same time would shake our heads and say no sense in messing up a good working friendship.

Good job on your visit with your doctor.

[Slartybartfast]

Thanks for the good comments. One more thing that I forgot about. We were discussing the poor long-term compliance that is reported for CPAP users. His take on that was that just about anyone can write a prescription for CPAP equipment. A GP, even a dentist or psychiatrist. And many prescriptions are written without a sleep study, and even more, without followup. He said when you take into account all the people out there who are essentially orphaned after being given a prescription, it's no wonder many of those units end up on a closet shelf. And that contributes to the lousy long-term compliance reported in the literature. He said there's no substitute for a proper sleep study and periodic followup. Of course, he runs a sleep lab, so take that for what it's worth.

[Blackjackcat]

Thats great that you stay on top of your therapy. Just curious, is it common for the average patient to use a oximeter at home? Do you think more should do so?

[Slinky]

Ah, SlartyBartFast, my first thought was whether she was his wife too!!!! And I think I am in love .... w/your sleep doctor. *sigh*

[Slartybartfast]

Thats great that you stay on top of your therapy. Just curious, is it common for the average patient to use a oximeter at home? Do you think more should do so?

The average patient? No. but there are a bunch of us who check our oximetry from time to time. Not every night, just once in a while. It's just like a diabetic patient taking insulin. You can go day to day taking a fixed dose, but you won't know how well it's working unless you test your blood.

As I wrote above, my Doc said that having oximetry data is the best practical way to verify that your therapy is doing what it's supposed to do, outside of having another sleep study. Where, by the way, they will verify your oximetry by clamping an oximeter onto your finger.

The purpose of CPAP therapy is to ensure that your airway stays open so you can get enough oxygen while you sleep. All the other benefits flow from that.

[avi123]

[quote="Slartybartfast

As I wrote above, my Doc said that having oximetry data is the best practical way to verify that your therapy is doing what it's supposed to do, outside of having another sleep study. Where, by the way, they will verify your oximetry by clamping an oximeter onto your finger.

The purpose of CPAP therapy is to ensure that your airway stays open so you can get enough oxygen while you sleep. All the other benefits flow from that.[/quote]

It's interesting that my pulmonologist put the emphasis on the "sleep architecture" and nothing else but REM< REM< REM. Well the nurse put the O2 clip on my finger as soon as I entered the office. It showed 96%. But sadly we can't measure, at home, REM stage, YET

[Blackjackcat]

Thats great that you stay on top of your therapy. Just curious, is it common for the average patient to use a oximeter at home? Do you think more should do so?

The average patient? No. but there are a bunch of us who check our oximetry from time to time. Not every night, just once in a while. It's just like a diabetic patient taking insulin. You can go day to day taking a fixed dose, but you won't know how well it's working unless you test your blood.

As I wrote above, my Doc said that having oximetry data is the best practical way to verify that your therapy is doing what it's supposed to do, outside of having another sleep study. Where, by the way, they will verify your oximetry by clamping an oximeter onto your finger.

The purpose of CPAP therapy is to ensure that your airway stays open so you can get enough oxygen while you sleep. All the other benefits flow from that.

Thanks, this maybe something I add in the future to help see if therapy is working like it should.

[Blackjackcat]

[quote="Slartybartfast

As I wrote above, my Doc said that having oximetry data is the best practical way to verify that your therapy is doing what it's supposed to do, outside of having another sleep study. Where, by the way, they will verify your oximetry by clamping an oximeter onto your finger.

The purpose of CPAP therapy is to ensure that your airway stays open so you can get enough oxygen while you sleep. All the other benefits flow from that.

It's interesting that my pulmonologist put the emphasis on the "sleep architecture" and nothing else but REM< REM< REM. Well the nurse put the O2 clip on my finger as soon as I entered the office. It showed 96%. But sadly we can't measure, at home, REM stage, YET[/quote]


Interesting that your pulmonologist puts the emphasis on REM. That would be great if we could measure that at home.

[Slartybartfast]

Well, you sort of can. If you look at your heart rate/SPO2 profile with the software that comes with the oximeter, you can see 4 or 5 episodes of erratic SPO2 levels during the night. My pulmonologist said those are the periods of REM sleep. So you can get data during REM sleep. You just have to work at it a little to dig it out from the rest of the data.

[Slartybartfast]

Here you go.

You can see the areas of erratic breathing.
From that you can get the start and end times, and the go into your xPAP software and note what was happening with your breathing during those times.
It takes some digging, but the data is there.

Usually any events I have are associated within those intervals. Doc says that pattern is consistent with what he sees in the lab during patients' REM sleep.