No Answers Yet For Problems With ASV

[rested gal]

I also had, "one other request. Do you still have the video taken of my room when I was sleeping during the titration study? If so, would it be possible to get a copy of that on a DVD?"

I hope that wasn't what you asked for.

What I was talking about was... a copy of the PSG study itself... all the raw data... all the squiggly lines from all the channels that you were hooked up to... a copy of the entire NPSG (nocturnal polysomnogram) ... the sleep study itself.

I ate some rhubarb sauce on my oatmeal this morning. Maybe I am not as messed up as I thought I was.

Deborah

You're not messed up at all. But I'm not so sure how the oatmeal felt!

[StillAnotherGuess]

I don't know whether this feels more like spitting into the wind or pissing into the wind?

EPAP Min 8
EPAP Max 0
PS Min 4
PS Max 4
Max Pressure 25

Should get you to 8/12 BiPAP mode..

Also, I missed this one earlier. This one would be functionally impossible as well. EPAP max cannot be set to a value less than EPAP min.

Well listen, chump.. For my never having seen the machine, and you not helping to get her machine into BiPAP mode, at least she is on track in BiPAP mode, now.
Problem being that she had MAX Pressure set at 0. If you had explained to her that MAX Pressure 0 would never get her into BiPAP mode, than we may have been ahead of the game many days ago.

[Paper_Nanny]

If I were Paper_Nanny, the questions I would be struggling with right now (outside of the logistical issues with changing PS on her new S1 ASV) would be:
1) Should I continue with the constant pressure-type approach but try a lower pressure in the hopes that it would ameliorate the central apneas? or
2) Should I try some other bilevel-type approach?
3) Given that NotMuffy said "BTW, I am not a big 'Auto' breath rate fan," regardless of the choice between (1) and (2), what should I do with that sucker?

Okay, that helps. The confusion doesn't feel so nebulous, foglike, and suffocatingly close in if I can at least name it. This is what I am confused about. These are the questions I am struggling with.

With regard to Auto breath rate (#3)-- If I don't do "auto", then my choices are "off" or set it to a particular number. I think I will do like Mr. Bill and set it to a number below my "about to fall asleep" rate. I should be able to count that on my wave form data, yes?

As for #1 and #2- Constant Pressure or BiLevel... I do not know. And then I was interrupted by a phone call and now, I do not even know what I was going to say or what I was thinking about or nuffin. Don' know nuffin'. I think I am going to go read some trashy novel and stop trying to think.

Deborah

[rested gal]

Well listen, chump..

[Paper_Nanny]

I also had, "one other request. Do you still have the video taken of my room when I was sleeping during the titration study? If so, would it be possible to get a copy of that on a DVD?"

I hope that wasn't what you asked for.

What I was talking about was... a copy of the PSG study itself... all the raw data... all the squiggly lines from all the channels that you were hooked up to... a copy of the entire NPSG (nocturnal polysomnogram) ... the sleep study itself.

Oh, my!! Yes, that section in quotes up there, that is an exact quote from the e-mail I sent the RT at the lab. I wonder what she will do with that request. So, maybe I leave it alone and a few days after getting the snips of data I requested, I will say I need more than those epoch pieces and could I have all the raw data please.

From Sunday at 3:01 PM

And... maybe ask them to give you a DVD copy of your entire sleep study. If they tell you there's no point in doing that 'cause you won't be able to read it without the software that was used by them during your study, ask them kindly to please copy it to a DVD anyway, and send it to you. You like shiny souvenirs.

How did I mix that up? Well, souveniers are, in my mind, things that have no real value, other than to remind someone of something they did. A video of me sleeping would not have any real value, but would be cool, as I have always wanted to watch myself sleep. Also, you specified a DVD, and why would I need a DVD as opposed to a data CD for static raw data?

Not your fault, the mix up. I take full responsibility for my own confusion. And we will just see where it goes from here.

And damn! I almost posted a copy of the e-mail for review/ feedback, etc. before sending it but decided not to.

Deborah

[rested gal]

My fault, Deborah. I should have said "CD."

I've been enjoying NetFlix too much!

[BrianinTN]

Well listen, chump.. For my never having seen the machine, and you not helping to get her machine into BiPAP mode, at least she is on track in BiPAP mode, now.
Problem being that she had MAX Pressure set at 0. If you had explained to her that MAX Pressure 0 would never get her into BiPAP mode, than we may have been ahead of the game many days ago.

What sort of gibberish is this? Her problem was and never has been that she had MAX Pressure set to 0. How it is that you keep coming up with impossible settings and conditions boggles the mind. The problem was that her Max EPAP was set to 12, rather than 8, and that was constraining her PSmin. Who pointed that out? ozij, and later NotMuffy. Not you. If you'd post less factually incorrect drivel, then yes, we could indeed have been ahead of the game many days ago.

For what it's worth, PN and I had worked together and had her pre-S1 ASV working just fine in bilevel mode. By contrast, so far all you've added to this thread has been factually incomplete or incorrect information. Plus the occasional ad hominem as above.

[NotMuffy]

Oh, my!! Yes, that section in quotes up there, that is an exact quote from the e-mail I sent the RT at the lab. I wonder what she will do with that request. So, maybe I leave it alone and a few days after getting the snips of data I requested, I will say I need more than those epoch pieces and could I have all the raw data please.

Well, from my perspective, I don't think that data is essential any more:

Toward that end, when I call the sleep lab, what do I tell them I want? Raw data? Pulse Rate Graphic? *.edf?

NM. The waveform data pretty much answered everything:

• Is there an entity that would be appropriate to use ASV for (chain centrals)?
  
  There isn't.
• Could a reduced circulatory time contribute to Feedback Gain disruption?
  
  Doubt it.
• Did the NPSGs underestimate spontaneous arousals and sleep fragmentation?
  
  Probably.
• Is there anything in the waveform data that can be successfully attacked with an xPAP device?
  
  Probably not. You got 2 OAs there, and they look more like closed-airway centrals to me.
• So what up with them centrals?
  
  They all look like a normal response to something that is abnormal (like an arousal); or should be considered normal (like sleep-onset centrals); or are artifact.
  
  Your sleep continuity could be adversely affected by overly aggressive pressure attack, causing the aforementioned "spontaneous arousals".
  
  Or, your underlying architecture is poor based on the aforementioned drug cocktail, FBM, pain, etc.

Further, I wouldn't push the issue. If you haven't noticed yet, people get real defensive when you question their (anything), so don't set all the bridges on fire unless you got a boat.

[NotMuffy]

As a "baked goods" with the attention span of an otter on crystal blue meth, I find it no surprise that as I read over these posts I find myself saying "Hah?" a lot.

However, assuming that you want to continue a "fruiful" realationship with your physician, I would respectfully bring a couple of points to the forefront:

• You've got 30 days before your physician visit. If you do not have at least 14 to 30 days of consistent therapy to present, once a pattern of arbitrary dial wingin' is seen, regardless of of what you say after that point, all your physician is going to hear is "blah, blah, blah".
• If you don't have a better answer to "what are you trying to fix" than this:
  
  What?
  
  your answer will pretty much look like your answer.
• How long is your visit? If it's a "follow-up", and like 15 or 30 minutes, you better have a rough plan (definitely not a "fixed plan" - "IMHO", I do not think the conversation is going to go anything like you think it will, so get ready to think on the fly), anticipating that you may only have like 4 - 6 minutes of time to ask questions (and if you talk like you write, that's not a lot of time). Pick out 3 important things you want done. You go in with a laundry list and you'll come out with a box of detergent and nothing else.
• "Important" means "important". Don't waste 8 minutes talking about MIP, MEP, FEP, SCHLEP, etc. It's
  
  Q: "How's my pulmonary status?"
  
  A: "It's fine, we'll monitor every x whatever months."
  
  Don't turn it into an Obama interview.

[rested gal]

Toward that end, when I call the sleep lab, what do I tell them I want? Raw data? Pulse Rate Graphic? *.edf?

NM. The waveform data pretty much answered everything:

Ah...I missed the "never mind."

Further, I wouldn't push the issue. If you haven't noticed yet, people get real defensive when you question their (anything), so don't set all the bridges on fire unless you got a boat.

Good point.

[Paper_Nanny]

You've got 30 days before your physician visit. If you do not have at least 14 to 30 days of consistent therapy to present, once a pattern of arbitrary dial wingin' is seen, regardless of of what you say after that point, all your physician is going to hear is "blah, blah, blah".

I will leave my machine set at 8/12, as per MSD's order.

"what are you trying to fix"

1. Using BiPAP set at 8/12, I am still having a high AHI and do not feel as well rested as I did immediately after starting therapy. What do we do next to fix that?

2. I need orders for a MIP and MEP to check pulmonary muscle functioning. How often should I repeat PFT to monitor my status?

How long is your visit? If it's a "follow-up", and like 15 or 30 minutes, you better have a rough plan (definitely not a "fixed plan" - "IMHO", I do not think the conversation is going to go anything like you think it will, so get ready to think on the fly), anticipating that you may only have like 4 - 6 minutes of time to ask questions (and if you talk like you write, that's not a lot of time). Pick out 3 important things you want done. You go in with a laundry list and you'll come out with a box of detergent and nothing else.

I almost always go into my medical appointments with my questions already thought out and prioritized, with a rough plan, and prepared to think on the fly. I do not know how long my appointment is scheduled for. Based on previous appointments with MSD, I anticipate that it will be as long as I need it to be.

"IMHO", I do not think the conversation is going to go anything like you think it will

"IYHO", how do I think the conversation will go?

if you talk like you write, that's not a lot of time

I do not talk like I write. I talk with a slight Milwaukee/ Pittsburgh accent which does not come across when I write.

I will work on writing more concisly when posting here.

Deborah

[Paper_Nanny]

Link to 07-18-2011 WaveForm Data:

https://docs.google.com/viewer?a=v&pid= ... l&hl=en_US

[Paper_Nanny]

I have a couple questions about my wave form data from 07-18-2011.

https://docs.google.com/viewer?a=v&pid= ... l&hl=en_US

1. There are several places where the line for my breathing is uneven looking.
1:20-1:21
1:34- 1:36
2:19- 2:26
Can anyone explain what the graph shows during those times?

2. Between 5:34 and 6:06 and again from 6:10- 6:15, it looks like my respiration rate increased quite a bit. Why might that have happened?

3. At 7:30, there is a bit of periodic breathing. Can someone explain why this is periodic breathing? It doesn't look like other wave form images of PB I have seen.

4. At 4:05, I have a large leak. At 4:10, I woke up, probably because of the leak. Just prior to waking up, my breathing looks a bit erratic. Is this probably because of the state change?

5. At 3:09, is that an assymetrical breath? Did I inhale more than exhale? Or am I not understanding the wave correctly?

Thank you for helping me understand.

Deborah

edit #1 to fix bad link
edit #2 to fix punctuation and improve conciseness of wording.

[dsm]

PN
All I get is a 'Bad Request' when I click the link.

Cheers

DSM

[Paper_Nanny]

All I get is a 'Bad Request' when I click the link.

Link is good now.